Borrowers with CIBC creditor disability insurance on a personal loan, line of credit, mortgage or credit card (Payment Protector) claim with this 11-page package. Canada Life underwrites the coverage and, once a claim is approved, pays the benefits to CIBC on the borrower's behalf. The clinician's part is the embedded Initial Disability Insurance Medical Statement, the industry-standard form, on pages 8 to 11.
The patient completes the Claimant Statement and Section 1 of the medical statement, and the employer at the date of disability completes the Employer Statement. The family physician, consulting specialist or other medical provider completes Section 2, the Medical Statement, on pages 9 to 11.
Download the current version from the source each time; forms change without notice.
Disability Insurance Claim
Upload the fillable PDF once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms change without notice, so download the current version from the official page before you fill it in.
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To the patient. The medical statement says to return the form to your patient, who submits it with the Claimant and Employer Statements to CIBC Creditor Customer Service, by mail or by secured email arranged through the Creditor Insurance Helpline. Credit card claims can also use Canada Life's digital option.
Disability insurance under Creditor Insurance for CIBC Personal Loans, Personal Lines of Credit and Mortgages, and CIBC Payment Protector Insurance for CIBC Credit Cards. The Canada Life Assurance Company underwrites these plans, and CIBC and Canada Life administer them under the Certificates of Insurance.
Diagnosis, whether the condition stems from occupational illness or injury or an accident, treatment and response, hospitalization and surgery, investigations, symptoms, restrictions and limitations, prognosis and return-to-work goals. If the disability will last under 4 weeks or the patient is back at work, you can stop after the surgery questions.