FAQ’s (Frequently Asked Questions) for Critical Illness Claims

Describe the process for clients to submit a claim:

CHUBB Life Insurance Company of Canada (“Chubb Life”) operates an internal claims department. Claims

are handled in the CHUBB Life

office located at 199 Bay Street, Suite 2500 P.O. Box 139 Commerce

Court Postal Station Toronto, ON

Canada M5L 1E2.

with all the required claim forms to be completed, including the Administrator Statement. Due to

privacy regulations, it will be the insured person’s responsibility to forward the Administrator Statement

to the appropriate person for completion.

The required forms are:

 Claimant’s Statement, to be completed by the Claimant

 Authorization to Obtain Information, to be completed by the Claimant

 Administrator Statement, to be completed by the Administrator

Please note that additional requirements may be required based on the diagnosis.

Claims can be submitted by clients as follows:

Completed claim forms and supporting documentation may be submitted via the following channels:

Email:

claims.A_H@chubb.com

Fax-(416) 368-0641

Mail: 199 Bay Street, Suite 2500 P.O. Box 139 Commerce Court Postal Station Toronto, ON

1E2.

Once the claim forms are received, the initial assessment is completed within 10 business days. At this

time we determine if the claim requires additional information or if a claim decision can be rendered.

If additional documentation is required, it is requested from the appropriate party. Once the

outstanding documentation is received, the claim file is reviewed within 10 business days of receiving

the final piece of information to render a final decision.

Once a decision is rendered, the appropriate letter is sent to the insured person and administrator.

What can delay a claim decision or payment? A claim decision may be delayed due to incomplete

forms, forms that are not fully completed, errors in completing the forms.

We may also require additional information from third parties such as doctors or hospitals which we

The request for medical information is completed via fax.

There are instances where we engage a third party vendor to assist with obtaining medical records

either from a physician, health care provider, hospital, and/or health facility.

There are circumstances where third parties do not accept the completed claimant Chubb Life

authorization resulting in a specific authorization for the health facility. This results in the requirement

for completion of an additional authorization which may result in a delay with the documentation being

released.

There are also instances where pre-payment is requested from the physician’s office, health care

provider, hospital, and/or health facility; this is not communicated until the initial Chubb/Chubb Life

request has been received by the third party. This may also result in a delay of receiving the required

How many attempts are made?

Three to four attempts will be made.

Are there any escalation protocols established if this continues to further delay the employee’s claim?

We have various protocols in place.

The protocols are as follows: contact the MD office via telephone, there are instances where we ask the

claimant for assistance in contacting the MD to expedite the request, we will also engage a third party

vendor to assist with the pick-up of medical records.

In extreme circumstances, we also contact the provincial Medical Association for assistance.

How and who is provided status updates on the claim, and at what frequency?

What is the claim turnaround time once all information is received?

A status and/or decision is rendered within 10 business days of receiving the final piece of

documentation which allows us to adjudicate the claim.

What is the service standard expectation for claims (e.g. claim assessment will be completed within X

days)?

Our standard process is to have the initial claim assessment completed within 10 business days of

receiving the initial claim documentation.