Accident insurance

Instructions

  1. Fill out and sign the form
  2. Gather original supporting documents
  3. Send everything to the address indicated on the form

Forms


Accirance Claim form – 15161E01 (PDF, 146 KB) Opens in a new window.

Used to submit a claim for:

  • Fracture
  • Hospitalization
  • Disability (students aged 17-24 only)
  • Other

Important:

The insured is responsible for any fees related to this form.


Claim for benefits following an accident – 17003E (PDF, 534 KB) Opens in a new window.

For all claims regarding a fracture or rupture, a disability (students only), the loss of a limb, the loss of sight, death or other.

Important : The insured is responsible for any fees related to this form.


Death, dismemberment or loss of use

Please contact us at 1-877-886-5042 This link will launch your default phone software..