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.

forms_doc

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

hospital

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

feet

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

  For further assistance, please submit an inquiry.