Terms and Conditions for Online Disability Claims Submission
Protecting Your Personal information
At The Canada Life Assurance Company (Canada Life), we recognize and respect the importance of privacy. Personal information about you is kept in a confidential file at the offices of Canada Life or the offices of an organization authorized by Canada Life. This information about you may include medical and psychiatric information. Canada Life may use service providers located within or outside Canada. We limit access to personal information in your file to Canada Life staff or persons authorized by Canada Life who require it to perform their duties, to persons to whom you have granted access, and to persons authorized by law. Your personal information may be subject to disclosure to those authorized under applicable law within or outside Canada. We use the personal information to investigate and assess your claim(s), to administer coverage that you may have with Canada Life and to administer the group benefits plan. For a copy of our Privacy Guidelines, or if you have questions about our personal information policies and practises (including with respect to service providers), write to Canada Life’s Chief Compliance Officer or refer to www.canadalife.com.
I have read and understand and agree with the contents of the section entitled "Protecting Your Personal Information" on this form.
I authorize:
- Canada Life, any healthcare or rehabilitation provider, my plan administrator, any insurance or reinsurance company, administrators of government benefits or other benefits programs, any person having knowledge of me or my health, other organizations, or service providers working with Canada Life or the above to exchange my personal information, when relevant and necessary for the purposes of investigating and assessing my claim(s), administering coverage that I may have with Canada Life and administering the group benefits plan. This may include performing independent assessments;
- Canada Life to exchange my personal information with my employer, plan sponsor, or plan administrator when relevant for the purposes of discussing rehabilitation and return-to-work planning;
- Canada Life to disclose personal information about my claim(s) to an auditor authorized by my employer, plan sponsor, or their agent, or by Canada Life for the purpose of auditing the assessment of claims.
- Canada Life to use my Social Insurance Number for income tax reporting purposes and as an identification number where required in the administration of benefits;
I acknowledge that the personal information is needed to investigate and assess my claim(s), to administer coverage(s) that I may have with Canada Life and to administer the group benefits plan. I acknowledge that my consent enables Canada Life to process my claim(s) and that refusing to consent may result in delay or denial of my claim(s).
These terms and conditions may be revoked by me at any time by sending a written instruction.
Except for audit purposes, the authorizations shall remain valid for the duration of my claim for benefits or until otherwise revoked by me.
I declare that the statements provided in the form and any statements provided in any personal or telephone interview concerning my claim(s) for disability benefits are true and complete. I agree that all such statements form the basis for any benefit approved.
Plan Sponsor’s Terms and Conditions for Disability Claims Administration
If your plan sponsor or employer has additional requirements than those listed above, we will let you know.