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Claim for accidental dismemberment benefit and loss of use: Employer’s statement Please PRINT clearly. 1 Sun Life Assurance Company of Canada, a member of the Sun Life Financial group of companies,

How to fill out claim for accidental dismemberment

How to fill out a claim for accidental dismemberment:

1. Obtain the claim form from your insurance company. This form can typically be downloaded from their website or requested directly from their customer service department.
2. Fill in your personal information accurately. This includes your full name, address, contact details, and policy number. Make sure to double-check this information before submitting the claim.
3. Specify the date and details of the accident. Provide a clear and concise description of how the accidental dismemberment occurred, including the date, time, and location. Include any relevant supporting documentation, such as police or medical reports.
4. Provide information about your medical treatment. Indicate whether you sought medical attention immediately after the accident or if there was a delay. Include details of the medical facility or healthcare professional you visited, along with their contact information.
5. Outline the extent of the dismemberment. Explain the nature and severity of the dismemberment, such as the body part(s) affected and the resulting impact on your daily activities or ability to work.
6. Include any additional supporting documentation. Attach any relevant medical records, diagnostic test results, or statements from healthcare professionals that substantiate your claim.
7. Review and sign the claim form. Carefully read through the completed form to ensure all details are accurate and complete. Sign and date the form before submitting it to your insurance company.

Who needs a claim for accidental dismemberment?

1. Individuals who have experienced accidental dismemberment and have an insurance policy covering such events.
2. Policyholders who wish to seek reimbursement for medical expenses, loss of income, disability benefits, or other compensation related to their accidental dismemberment.
3. Any insured person who wants to ensure they receive the appropriate support and benefits from their insurance company after suffering from accidental dismemberment.

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