Canada Life uses this statement for the physician's part of an individual critical illness claim on a policy sold through an advisor. It asks for the diagnosis and date, how long the person has been your patient, first symptoms and consultation, prior episodes, family and smoking history and other physicians or hospitals, with copies of all investigation, diagnosis and treatment records attached.
The physician completes sections 2 to 5 and signs section 5. The insured completes the critical illness initial claim form (K883 or 186), which Canada Life also offers online through DocuSign.
Download the current version from the source each time; forms change without notice.
Physician’s initial statement – Critical illness 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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Copies of all medical evidence about the investigation, diagnosis and treatment, including test results, laboratory results, surgical reports and consultation reports. For cancer, Canada Life lists the initial consultation, pathology and oncology reports; for a heart attack, all ECG reports, laboratory results, angiography or cath lab reports and clinical chart notes.
The claimant statement can be completed online through DocuSign, but Canada Life says the doctor must still complete the physician's statement and return it to Canada Life. Paper claims and physician statements are mailed, emailed or faxed using the contact details on the claim form.
The patient. The form states that the patient is responsible for any fees related to its completion and for any other medical information provided, such as copies of reports attached as evidence of the critical illness diagnosis.