Disability insurance

Important: before you begin

  1. Please call us prior to sending one of the following forms. Other documents may be required.

    Vision insurance: 1-866-608-4746 This link will launch your default phone software. or 1-800-294-5399 This link will launch your default phone software. (outside Canada) or 514-875-9170 This link will launch your default phone software. (call collect)

    Other insurance: 1-888-558-5525 This link will launch your default phone software. or 514-285-3000 This link will launch your default phone software., 1-800-361-7285 This link will launch your default phone software. (U.S.)

  2. Print, fill out and sign the form.

  3. Gather original supporting documents.

  4. Send everything to the address indicated on the form.

General forms


Important : These four forms need to be transmitted at the same time.

Disability claim – Disabled person’s statement – 17001E (PDF, 399 KB) Opens in a new window.
To be completed when submitting a claim for disability benefits.

Disability claim – Employer or self-employed individual’s statement – 17002E (PDF, 440 KB) Opens in a new window.
Must be completed by the employer or the self-employed individual.

Attending physician’s statement – Original request – 020255A (PDF, 315 KB) Opens in a new window.
Must be filled in by the claimant’s personal physician to describe the claimant’s current health status.
Important : The insured is responsible for any fees related to this form.

Authorization to collect and communicate personal information (disability) – 98185E (PDF, 285 KB) Opens in a new window.
Must be completed when submitting a disability claim.
Important : Original document required.


Attending physician’s statement – Additional report – 020265A (PDF, 186 KB) Opens in a new window.

Must be filled in by the claimant’s personal physician to describe the claimant’s current health status.

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


Information about eligible loans for SOLO Loan Insurance benefits – 17013E (PDF, 308 KB) Opens in a new window.

To submit a claim for SOLO Loan Insurance disability benefits (description of all eligible loans).


Specific forms

Specific form

Loss of employment coverage


Claim for loss of employment benefits – 17004E (PDF, 361 KB) Opens in a new window.

To submit a claim for disability benefits in the event of job loss.

Important : Must be completed by the claimant and the employer.


Residual or Partial Disability coverage


Additional statement regarding a disability – Employer or self-employed individual’s statement – 17011E (PDF, 245 KB) Opens in a new window.

To be completed when submitting a claim for partial disability benefits.

Important : Contract must include partial disability.



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1. This feedback was obtained when clients called us for service or a claim and may be a translation.