Get the free Critical Illness Claimant's Statement - Great-West Life

Critical Illness Claimant s Statement Please print in ink. Incomplete forms will be returned. Claimant name Plan number Division number Plan member I.D. number Address (number, street, city, province,

How to fill out critical illness claimant39s statement

How to fill out critical illness claimant39's statement:

1. Gather all necessary information: Before starting to fill out the critical illness claimant's statement, make sure you have all the required information at hand. This may include personal details such as your name, address, contact information, policy number, and the date of diagnosis.
2. Review the instructions: Carefully read through the instructions provided with the critical illness claimant's statement. Understand the purpose of each section and what information needs to be provided.
3. Provide personal details: Start by filling out your personal details accurately. Include your full name, address, phone number, and any other relevant contact information. Double-check for any errors before moving forward.
4. Medical diagnosis: This section requires you to provide detailed information about your medical diagnosis. Clearly state the illness or condition for which you are making the claim and include the date of diagnosis.
5. Treatment history: Provide a thorough account of the treatment you have received for the critical illness. This may include surgeries, medications, therapies, and any other forms of treatment. Include dates, names of healthcare professionals, and any hospitalizations during the treatment period.
6. Financial details: In this section, you may be required to provide information about your financial situation related to the illness. This could include medical bills, lost wages, and other expenses directly resulting from the illness. Be honest and provide accurate details that can support your claim.
7. Supporting documents: Attach any relevant supporting documents that can substantiate your claim. This may include medical reports, test results, invoices, and statements from healthcare providers. Make sure all documents are organized and clearly labeled.
8. Review and sign: Before submitting the claimant's statement, thoroughly review all the information you have provided. Make sure there are no errors or missing details. Sign and date the document as required.

Who needs critical illness claimant's statement:

1. Policyholders: If you have a critical illness insurance policy and you have been diagnosed with a covered illness, you will need to fill out a critical illness claimant's statement to initiate the claims process.
2. Insurance company: The insurance company providing critical illness coverage will require the claimant's statement to assess the validity of the claim. This statement helps them review the details of the diagnosis, treatment, and other relevant information to make an informed decision.
3. Medical professionals: In some cases, medical professionals may need to provide information or complete sections of the critical illness claimant's statement to support the claim. This can include doctors, specialists, or any other healthcare providers involved in diagnosing and treating the illness.

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What is critical illness claimant39s statement?

Critical illness claimant's statement is a document provided by the policyholder when submitting a claim for a critical illness under their insurance policy.

Who is required to file critical illness claimant39s statement?

The policyholder or the insured individual is required to file the critical illness claimant's statement.

How to fill out critical illness claimant39s statement?

The critical illness claimant's statement should be filled out accurately and completely by providing all the relevant information about the critical illness claim being made.

What is the purpose of critical illness claimant39s statement?

The purpose of the critical illness claimant's statement is to provide the insurance company with necessary information to process and evaluate the claim for critical illness benefits.

What information must be reported on critical illness claimant39s statement?

The critical illness claimant's statement must include details about the diagnosed critical illness, medical treatment received, attending physician's information, relevant medical records, and any other information requested by the insurance company.

What is the penalty for late filing of critical illness claimant39s statement?

The penalty for late filing of critical illness claimant's statement may vary depending on the insurance company, but it could result in delays in processing the claim or potential denial of benefits.