The EDGE™ - Report a Claim

Report a Claim

Use this form to initiate the claims process for Disability, Business Overhead Expense, Critical Illness, Guaranteed Issue Life, Accidental Death & Dismemberment, or Fracture Accident Benefits. Upon submission of this form, a Claims Customer Care representative will contact you or will send you a claim package within 24 to 48 business hours.

For personal assistance, please call us at 1-877-902-EDGE (3343) or email us at claimscustomercare@edgebenefits.com. The Claims Customer Care Call Centre is open Monday to Friday, 8:30 - 4:30 Eastern Time.

For Health & Dental claims inquiries and specific claim forms, contact Green Shield Customer Service at 1-888-711-1119 or online at www.greenshield.ca. Health & Dental claims can also be submitted electronically by using Green Shield’s Online Services, GSC everywhere.

For Travel Medical Emergency (“Out of Province”) claims, you must contact La Capitale's travel assistance provider immediately if medical treatment is required during a trip.

Canada/USA Toll-Free: 1-844-780-9832

Worldwide Call Collect: 418-780-9832

If you have our Travel Medical Emergency Monthly Plan: when calling La Capitale to report your claim, quote ID number 010245
If you have our Travel Medical Emergency Annual Plan: when calling La Capitale to report your claim, quote ID number 010246

Client personal information

First Name:

Last Name:

Street Address:

City:

Province:

Postal Code:

Home Phone:

Other Phone:

Email Address:

Policy Number:

Date of Incident:

Type of Claim:

(Loss of Income – Injury, Loss of Income – Illness, Business Overhead Expense, Critical Illness, Guaranteed Issue Life, Accidental Death & Dismemberment, Fracture Accident Benefits)

Type of Accident/Injury:

(Work, Auto, Other)

Details regarding the loss:

Date of original submission:

I want to be contacted by phone:

Yes

Name of Advisor (if chosen):

Remarks: