Canada Life uses this statement for the physician's part of a workplace critical illness claim for an employee, spouse or child. It asks for the diagnosis and date, how long the person has been your patient, referral history, first symptoms and consultation, prior episodes, family and smoking history, and other physicians or hospitals involved, with copies of all supporting medical evidence attached.
The attending physician completes sections 2 to 5 and signs section 5. The insured completes the patient information and signs the privacy consent on page 3, and the employee also completes the Critical illness insurance claim employee statement (M6537).
Download the current version from the source each time; forms change without notice.
Physician’s initial statement – Group 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. The form gives examples: for cancer, the initial consultation, pathology and oncology reports; for a heart attack, all ECG reports, laboratory results, angiography or cath lab reports and chart notes.
The patient. The form states that the patient is responsible for any fees related to completing it and for any other medical information provided. The completed statement goes to Canada Life's Critical Illness Claims Unit by mail, email or fax.
Yes. Canada Life's workplace critical illness forms are used to apply for benefits for an employee, their spouse or their child under coverage provided by an employer or plan sponsor. The physician's initial statement is one of 3 forms submitted as instructed on the Claimant Statement.