How Canada Life processes workplace critical illness claims

Key takeaways

If you have workplace critical illness coverage, you can make a claim.
You must submit a form to make your claim.
There is an appeal process if your claim isn’t approved.

Where can I find a claim form?

Choose the correct critical illness claim form.

What are the submission timelines?

To allow for prompt assessment, you must submit a notice of a critical illness claim no later than 3 months after the date the critical illness is diagnosed or after the policy termination date.

My form is complete. Now what?

We’ll collect information about your coverage from your employer and plan sponsor representative.

We’ll contact you to validate that your claim was received and to advise you if there is any outstanding information.

We’ll provide you a response either electronically or by mail, depending on your communication preferences.

Once all information for your claim is received, a Canada Life case manager will review the available medical information as well as your group critical illness plan’s contractual provisions.

How long does it take to process my claim?

7 calendar days from the date we receive all necessary information.

Please note: This timeline is intended for standard plans only. Actual timelines might vary based on plan design and claim complexity. Missing information or incomplete applications for benefits may impact processing timelines. We may need to extend the timeline if additional review is needed.

How will I find out if my claim has been accepted?

A case manager will communicate the claim decision (including benefit details and next steps) with you. We’ll provide a response either electronically or by mail, depending on your communication preferences.

Appeal details for critical illness claims

If benefits are denied, the plan member/claimant will receive a detailed letter with an explanation for the decision. The letter will also include:

Options for appeal
What information should be included if an appeal is pursued
Where to send the appeal

Appeal level 1

Canada Life will review the appeal and communicate a decision either electronically or by mail, depending on your communication preferences.
If the decision is maintained, you’ll receive information regarding options for the next level appeal.

Appeal level 2

A Canada Life team manager will review the appeal and communicate a decision either electronically or by mail, depending on your communication preferences.
If the decision is maintained, you will receive information regarding options for the next level appeal.

Appeal level 3

A Canada Life senior case manager and team manager will review the appeal information and communicate a decision either electronically or by mail, depending on your communication preferences.
The appeal process is deemed final once the third appeal decision is made.

What’s next?

Get the critical illness claims forms you need.

This information is general in nature and is intended for informational purposes only. For specific situations you should consult the appropriate legal, accounting or tax advisor.