How to claim benefits
How do I make a claim?
What proof of death is required?
What is the deadline for submitting a claim and proof of death or injury?

 


How do I make a claim?

Here's what you (or a family member) need to do:

In the event of a potential claim, verbal notice MUST BE immediately given to Industrial-Alliance Pacific Life, with the following preliminary information:

   
• policyholder's name (which is QPAT);
   
• policy number (which is 100004461);
   
• insured's name;
   
• name and address of beneficiary;
   
• date of accident and/or death;
   
• type of accident; and
   
• amount of insurance.

Important: Claims should be reported within 30 days of the date of an accident/death. Obtaining a claim form off the Web site will not be considered notice of a claim and may result in non-payment due to failure to report. Please ensure that a potential claim is reported as soon as possible.

The claim form provided on the Web site is for death claims ONLY, for all other losses, you will be sent the appropriate forms upon notice of claim to Industrial-Alliance Pacific Life.

What proof of death is required?

As this is an accident-only policy, the following will be required:

  1. Completion of the Claimant's Statement by the beneficiary

  2. Completion of Physician's Statement (may be obtained through Industrial-Alliance Pacific Life when a claim is reported) or the Medical Examiner's report

  3. Proof of eligibility including:
       
    • copy of enrollment form (application for insurance)
       
    • verification of most recent premium paid
       
    • copy of the most recent beneficiary designation
  4. A certified copy of the official Death Certificate that may be obtained from the vital statistics office

  5. Police reports (if applicable)

  6. Toxicology reports (if applicable)

Return the completed forms and any supporting documents DIRECTLY to Industrial-Alliance Pacific Life.

What is the deadline for submitting a claim and proof of death or injury?

The claim form and any related documents must be submitted to Industrial-Alliance Pacific Life before the following deadlines:

Document
Deadline
Verbal notice

Within 30 days immediately following the insured person's death or injury
Claim form and Proof of death or injury

Within 90 days immediately following the insured person's death or injury but in no event more than 12 months

Note: Failure to give notice of claim or furnish proof of claim within the time prescribed does not invalidate the claim if the notice or proof is given or furnished as soon as reasonably possible, and in no event later than 12 months from the date of the accident, if it is shown that it was not reasonably possible to give notice or furnish proof within the time so prescribed.