How to Make a Claim

Notice of Claim

Written notice of claim must be received by the insurance company, no later than 90 days from the date of the Injury or Sickness. Notice given by You or any authorized agent of the insurance company acting on Your behalf will be deemed notice to the insurance company.

Claim Forms

The insurance company or Doctors Manitoba, upon receipt of a written notice of claim, will furnish forms to You or the claimant who will file on Your behalf for filing proof of loss.

Proof of Loss

Proof of loss includes, but is not limited to, the initial claim forms and all medical, psychiatric, psychological, educational, vocational, financial and other information the insurance company considers necessary to assess the claim.

On forms provided by the insurance company, written evidence, satisfactory to the insurance company, of Your right to benefits must be received within 90 days after the expiration of the Elimination Period. Failure to provide proof of loss, however, will not invalidate the claim nor reduce the amount of the benefits payable, provided it was not reasonably possible to give such proof within the stipulated time and provided proof is furnished as soon as reasonably possible, but in no event later than 12 months following the completion of the Elimination Period unless You are legally incapacitated.

If You are unable to give notice of claim or proof of loss due to the nature of Your disability, then someone acting on Your behalf may do so.

The insurance company does not pay for the completion of claim forms. It does pay reasonable charges for any additional items which it specifically requests in connection with a claim, such as medical examinations and medical histories.

Proof that You Remain Disabled

The insurance company may, at any time whether before or after a claim is approved, request from You further medical, psychiatric, psychological, educational, vocational, financial or other information the insurance company considers necessary for the assessment or re-assessment of the claim. Such information may be obtained from an examiner or person approved by the insurance company.

When making a decision, the insurance company will take into account all relevant information which has been provided, in conjunction with any consultants, as deemed appropriate by the insurance company.

If a disability results from a psychiatric or psychological disorder, proof may be required from a Physician who is certified in psychiatry by the Royal College of Physicians of Canada, or by the American Board of Psychiatry.

The insurance company reserves the right to obtain such evidence as may be reasonable concerning Your income and expenses prior to and after Your disability. The evidence the insurance company may require includes, but is not limited to, true copies of income tax returns, audited income and expense statements and financial statements.

The insurance company may request an independent medical examination by a Physician, appointed by the insurance company, no more than once a year, except that if conflicting medical information is received, additional independent medical examinations may be required. All independent medical examinations will be arranged and paid by the insurance company.

If, while You are outside Canada, United States of America, Australia, New Zealand or a country belonging to the European Economic Community, the insurance company is unable to obtain satisfactory proof of disability, the insurance company may request that You return to Canada, United States of America, Australia, New Zealand or a country belonging to the European Economic Community.