Loan Information - Disability Insurance Form (Page 2 of 2) in pdf

Loan Information - Disability Insurance Form Page 2

IMPORTANT NOTICE

The Loan Information form is required if you ﬁle a claim for disability beneﬁts related to the monthly reimbursement of a loan

or a mortgage.

• As your claim is related to a work stoppage, you must complete the claim forms for Disability beneﬁts. You will ﬁnd these forms

in the Claimant’s Guide – Disability Insurance .

• Complete all sections of the forms, attach required documentation, and submit your claim within 90 days of the onset of disability.

• Include the following documents to this form:

- Claimant’s Statement

- Authorization (6)

- Copy of mortgage loan statement or, if you have a mortgage line of credit, loan contract

- Copy of the last mortgage renewal

- Employer’s Statement or Self-Employed Worker’s Statement

- Attending Physician’s Statement and medical ﬁle

• Do not attach:

- Request for Payment by Direct Deposit. It is not required as payments are made directly to your creditor.

- Proof of income as requested in the Claimant’s Guide. It is not required as your claim is not related to a salary replacement.

• Send your claim to the appropriate address listed below based on your province of residence.

If you have any questions, contact us before sending your ﬁle in order to avoid unnecessary delays. Please note that calls to our claims

department are recorded for training, quality control and veriﬁcation purposes.

Blue Cross Canassurance

Claims, Life and Disability Insurance

Telephone: 1 800-300-5002

Fax: 1 877-590-7504

Ontario Residents

P.O. Box 4433, Station A

Toronto, Ontario M5W 3Y7

Email: claimslife.disability@ont.bluecross.ca

Québec Residents

550 Sherbrooke St. West, Suite B9

Montréal, Québec H3A 3S3

Email: claimslife.disability@qc.bluecross.ca

Loan Information - Disability Insurance Form Page 2