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Foresters Death Claim with Physician's Statement

Foresters Financial uses this claim package when an insured dies in policy years three to five and the policy has not been reinstated in the last two years. Along with the claimant's statement and authorization, it contains a Proof of Death Physician's Statement recording the causes of death, attendance dates, any inquest or autopsy, tobacco or nicotine use and five years of treatment history.

Who completes it

The attending physician completes the Proof of Death Physician's Statement and signs it. Each claimant completes a separate Claimant's Statement and signs the Authorization to Release Information.

Submitting and payment

How to submit it
Foresters asks that the completed package be mailed to its claims address; its claims representatives can also mail a package after a death is reported by phone.
Who pays
The physician's statement states that the claimant is responsible for any fee for this information.

Good to know

  • Record causes using the International List of Causes of Death: one cause each on lines A, B and C, the underlying cause last, plus other significant conditions.
  • For deaths from accident, suicide or homicide, Foresters asks the claimant for police, coroner or toxicology reports, and the physician states whether an inquest or autopsy was held.
  • The claim needs a certified provincial death certificate or the funeral director's statement of death; one per decedent is enough even with several claimants.
  • You are asked whether you treated or advised the deceased in the 5 years before the last illness, and whether other physicians or hospitals did, with dates and details.

Get the official form

Download the current version from the source each time; forms change without notice.

Statement of Claim for Death Benefits (Non Contestable, policy years 3–5, with Attending Physician’s Statement)

Official pagePDF

Fill it with Vero

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.

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How this list is checked

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.

Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.

Frequently asked questions

When does Foresters use the death claim form with an attending physician's statement?

Foresters' claims page says to use the non-contestable claimant statement with attending physician's statement when the death occurred in policy year three to year five, provided the policy was not reinstated in the last two years. Otherwise, claims representatives determine the form needed and mail a claims package.

Who pays for the Foresters Proof of Death Physician's Statement?

The claimant. The statement says at the top that the claimant is responsible for any fee for this information. It also asks the physician to conform to the International List of Causes of Death in the interest of accurate vital statistics.

What else does Foresters need with the physician's statement?

A completed Claimant's Statement from each claimant, a certified provincial death certificate or original funeral director's statement of death, and appointment documents for an executor, administrator or guardian. Deaths outside Canada or the United States need the foreign certificate with a notarized translation, a questionnaire and a passport copy.