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RBC 83712: Critical Illness Physician's Statement

RBC Insurance uses a family of condition-specific confidential physician's statements to assess individual critical illness claims under RBC Life Insurance Company policies. The cancer version, form 83712, asks for symptom and diagnosis dates, who told the patient, a pathology report with tumour type, site, histology and staging, prior cancer, family history and tobacco use, plus copies of the complete file.

Who completes it

The attending physician completes and signs the physician's statement, giving degree and specialty and indicating primary care or consultant. The insured opens the claim with RBC Insurance first.

Submitting and payment

How to submit it
The claim is opened by phone first, and the completed statement and documents are sent to RBC Life Insurance Company's Life and Health Claims Department by email or fax.
Who pays
RBC offers a set reimbursement toward the cost of copying the complete file, but any charge for completing the form itself is the patient's responsibility.

Good to know

  • RBC's contract requires the covered illness to be diagnosed by a physician who is not related to, or in a business relationship with, the insured; the form asks you to confirm this.
  • RBC requests copies of the complete file, including specialist consultations; if its reimbursement is unreasonable for a large file, your staff can contact RBC's office.
  • The cancer statement asks whether the patient has ever been tested for HIV, with date and result, and about smoking cessation products as well as tobacco.
  • RBC's claims page lists about 15 condition-specific statements, including cancer and cardiovascular versions, so use the one that matches the diagnosis.

Get the official form

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

Critical Illness Claim – Confidential Physician’s Statement (condition-specific)

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

Who pays for RBC's critical illness physician's statement?

Two costs are treated differently. RBC offers to reimburse a set amount for preparing copies of the complete file, including specialist consultations, and asks staff to contact its office if that is unreasonable for a large file. Any charge for completing the form itself is the patient's responsibility.

Can a relative complete the RBC critical illness physician's statement?

RBC's contract requires a covered illness to be diagnosed by a physician who is not related to or in a business relationship with the insured. The statement asks you to answer yes or no to whether you are related to or in a business relationship with the patient before you sign.

Which RBC physician's statement should be used?

RBC Insurance lists about 15 condition-specific confidential physician's statements for critical illness claims on its claims page, such as the cancer version (83712) and a cardiovascular version. The claim is opened by phone first, and the statement matching the patient's condition is then completed.