Canadian Life and Health Insurance Association Inc.

Standard Claim Forms

Streamlining the Claims documentation process for Physicians and Insurers

The Canadian Life and Health Insurance industry has created simplified and standardized forms to address short and long term disability claims. These forms can be accessed below or alternatively, by physicians on the Canadian Medical Association's (CMA) Insurance Forms page.

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Standard Disability Claim Forms

Attending Physician’s Statement: Short-Term Disability Claim
This form can be used in support of a patient's initial short-term disability claim. You can download this form and submit it to any CLHIA member company.
Standard STD Claim Form

NEW > Attending Physician's Statement: Long-Term Disability Claim
This form can be used in support of a patient's initial long term disability claim. You can download this form and submit it to any CLHIA member company.
Standard Long-Term Disability Claim Form

Attending Physician’s Statement: Confirmation of Ongoing Long-Term Disability Claim
This form can be used in support of the confirmation of a patient's ongoing long-term disability. It will provide the basic medical information that an insurer will require to continue a claim. You can download this form and submit it to any CLHIA member company.
Standard Confirmation of Ongoing LTD Form
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Hospital Claim Forms

The standard hospital form is available below.
Claim Form for Hospital Expenses

In addition, the Hospital Claim Payment Standards adopted by the CLHIA are available to assist hospital administrators in the completion of these forms.
Hospital Claim Payment Standards
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Understanding Claims for Footwear and Orthotics

This reference document has been developed by member companies of the Canadian Life and Health Insurance Association Inc. This reference document is intended for general information only and will assist plan members and plan sponsors by providing some guidance on:
  • the terminology commonly used in describing footwear and orthotics, and
  • the information which may typically be required by insurance companies and benefit plan administrators in order to adjudicate footwear and orthotic claims.
Understanding Claims for Footwear and Orthotics
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Service Provider Receipt Best Practices for Group Insurance Reimbursement

The following is a list of suggested receipt detail best practices for service providers. The best practices have been developed by member companies of the Canadian Life and Health Insurance Association (CLHIA) and provide a reference for providers. Following these best practices is an important tool in helping to reduce claims fraud and the reprocessing of submitted receipts due to incomplete information provided.
Service Provider Receipt Best Practices for Group Insurance Reimbursement
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