Try for free

Wawanesa Life Critical Illness Physician Statements

Wawanesa Life requires a physician statement for every group critical illness claim and posts a separate two-page version for each of 33 covered conditions, from aortic surgery and cancer to stroke, cerebral palsy and cystic fibrosis. Each version asks clinical questions specific to that condition. The statement goes to Wawanesa Life's claims team with the plan member's statement, the claim checklist and the patient's chart notes.

Who completes it

The attending physician completes the Clinical Information section and signs with their name, specialty and phone number after confirming they are not related to the plan member. The patient signs the Patient Authorization at the top, and the plan member separately completes the Critical Illness Plan Member's Statement and the checklist with direct deposit authorization.

Submitting and payment

How to submit it
Each statement says to return the completed form and supporting documents to Wawanesa Life's claims team, and the group claims page accepts claim documents by email, fax or mail.
Who pays
In the Patient Authorization, the patient acknowledges responsibility for any fees related to completing the form.

Good to know

  • Each statement carries the plan's rule that a covered condition must be diagnosed by a physician who is not related to the plan member, with a yes or no question for the physician.
  • The cancer version asks for a copy of the pathology report showing tumour type, site, histology and staging, plus any previous cancer or predisposing disorder and any HIV testing.
  • The heart attack version asks for ECG changes or copies of the tracing, cardiac enzyme levels including MB band at the time of the event, and cardiovascular risk factors with dates.
  • If the illness is not among the 33 statements, Wawanesa Life's critical illness forms page tells plan members to consult their contract or contact the insurer.

Get the official form

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

Critical Illness Physician Statements (condition-specific)

Official pagePDF

Fill it with Vero

If your copy of the form is a fillable PDF, upload it 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.

See how Vero Documents works

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

Can a relative complete a Wawanesa Life critical illness statement?

No. Each statement says the plan requires a covered condition to be diagnosed by a physician who is not related to the plan member, and it asks the physician to answer whether they are related. The physician then prints their name and specialty, adds a phone number, and signs and dates the form.

What else is needed with the Wawanesa Life critical illness physician statement?

Wawanesa Life's claim checklist lists the Plan Member Statement, the attending physician statement for the covered condition, medical chart notes, an Authorizations and Declarations form and a direct deposit authorization. The physician statement itself asks for relevant clinical chart notes, test results, consultation reports and hospital summaries.

Does Wawanesa Life accept electronic signatures on claim forms?

Yes. Wawanesa Life's group insurance claims page states that all claim forms must be signed by the person completing them and that electronic signatures are acceptable. The patient authorization on each statement also says a photocopy or electronic copy of the authorization is as valid as the original.