Get Accirance Claim Form - Desjardins Life Insurance

This guide provides a comprehensive overview of how to complete the Accirance Claim Form for Desjardins Life Insurance online. By following these steps, users can efficiently submit their claims while ensuring all necessary information is accurately provided.

Follow the steps to successfully complete your online claim form.

1. Use the 'Get Form' button to obtain the claim form and open it in your preferred editing tool.
2. Begin with section A, which requires the name and address of the contract holder. Provide your postal code and contract number. Indicate whether the benefits are also covered by another insurance plan by selecting 'Yes' or 'No' and include the related information if applicable.
3. Move to section B, known as the claimant's statement. Fill in the name and date of birth of the injured insured. Input the date and time of the accident, as well as the location. Describe the accident's circumstances and note the nature of injuries. Include dates of hospitalization, names of consulted physicians, and the educational institution if relevant.
4. Proceed to section C, the physician's report. State the diagnosis, date of first visit, hospitalization details, and total disability period. Ensure to provide the physician's name, address, and signature along with the date.
5. Complete section D, the authorization to collect and communicate personal information. Sign and date where indicated for both the contract holder and the injured person, if they are 14 years or older.
6. Carefully review all sections for accuracy and completeness. After confirming that all required fields are filled, save your changes, and proceed to download, print, or share the completed form as necessary.

Start completing your claim form online today for a seamless claim submission experience.