This guide will help you through the critical illness claim submission process and to answer any initial questions you may have with respect to filing a critical illness claim. Please review your Certificate of Insurance for details regarding your coverage prior to submitting a claim.
Critical Illness means a diagnosis by a Physician or Specialist of a covered condition of Cancer, Heart Attack, Stoke or Coronary Artery Disease as these conditions are described in your Certificate of Insurance.
Please refer to your Certificate of Insurance for a complete description of each covered Critical Illness condition.
How do I obtain the claim package?
The package can be obtained from your nearest BMO Bank of Montreal branch or downloaded and printed directly by clicking the appropriate link below:
Critical Illness claim form – Cancer
Critical Illness claim form – Coronary Artery Bypass Surgery
Critical Illness claim form – Heart Attack
Critical Illness claim form – Stroke
Back to topWhen should I submit a Critical Illness claim?
Critical Illness claims must be submitted to the Insurer within 180 days from the date the critical illness is diagnosed; otherwise your claim may be declined. If you are submitting a claim outside this period, please include a note outlining the reasons for the late filing and Sun Life Assurance Company will determine if you are entitled to benefits.
Back to topWhat information is required in order to process my claim?
A complete claim package must include:
Please read all instructions on each form and ensure that all forms are fully completed. Incomplete forms and failure to provide all necessary information could result in delays in processing your claim or denial of your claim.
The Attending Physician's Statement provides Sun Life with specific medical information about your condition and your expected recovery. This form can be completed by your family doctor or treating specialist. All available test results and specialist consultations and clinical notes should be submitted with the Physician's Statement to Sun Life.
Note: You are responsible for any cost for the completion of the claim forms.
Back to topWhat happens if my doctor does not provide the necessary information in a timely manner?
Sun Life can only process your claim once they have received all requested information. You may wish to make an appointment with the doctor to explain the importance of this request to ensure that this information is provided promptly.
Back to topWhere do I send the completed claim package?
Once all claim forms are completed, send the entire claim package to:
Sun Life Assurance Company of Canada
Creditor Team – Disability Claims
P O BOX 100 STN C
Kitchener, ON
N2G 3W9
Or, you may fax the entire claim package directly to Sun Life at 1-866-209-7215.
Alternatively, you may return the completed forms, in a sealed envelope, to your Bank of Montreal Branch and they will courier the completed forms to Sun Life.
Back to topWhat happens when Sun Life receives my claim?
In assessing your claim, the claims analyst will consider the information provided by you, your physician or specialist and information from any other source to determine if you are eligible for benefits in accordance with the terms of your Certificate of Insurance. As part of this review they may need to contact you directly to obtain additional information or contact your doctor for further medical documentation.
Note: Any payments required on your line of credit must continue to be made until such time as your claim is approved.
Back to topHow will I be notified of Sun Life's decision?
Your claim will be reviewed by Sun Life within 14 days of receiving all of the necessary information. Sun Life will advise you in writing if your claim is approved or declined. If declined, Sun Life will include an explanation for why the claim was declined. Your branch will also be notified of Sun Life's decision, but if declined, for privacy reasons, the branch will not be provided with any details.
Back to topWhat if my claim has been declined and I do not agree with the decision?
If you do not agree with Sun Life's decision on your claim, you may provide new or additional information for Sun Life to review. If your claim is declined, Sun Life will provide you with the appeal process in the denial letter. This will include the time limit for any appeal and where you should send any additional information or you may call Sun Life at the number provided in their letter.
Back to topHow and when are payments made once the claim is approved?
Critical Illness benefits will be paid by to the Bank by the Insurer and will be applied towards the outstanding balance of the Loan. You will be notified by Sun Life of their decision in writing with an explanation of the benefits paid.
For an Installment loan the benefit amount payable on the date of diagnosis is:
For a revolving LOC , the benefit amount payable on the date of diagnosis is:
The lesser of:
Please note that for a revolving LOC , premiums continue to be charged according to the outstanding balance while you are on claim.
See the Certificate of Insurance for complete details.
Back to topWhen a Critical Illness claim may not be paid
If you were not eligible for the insurance when you applied
Or
For Cancer:
No benefit will be payable for cancer if, within 90 days of the insurance application date, you have any of the following:
No benefits will be payable for a recurrence of metastasis of an original cancer, which was diagnosed prior to the insurance application date
No benefit will be payable for the following non-threatening cancer:
For Heart Attack
No benefit will be payable for:
For Coronary artery bypass surgery
No benefits will be payable for:
For a Stroke
No benefits are payable for:
Please review your Certificate of Insurance for complete details of all terms of coverage.
Back to topWho do I contact for a status update or more information on my claim?
If you have any questions or require information about the status of your claim, please call Sun Life Assurance Company directly at 1 877-271-8713.
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