Obtaining a claim form:
To manually submit your disability, hospital or other types of claim, please choose one of the convenient options below.
Call us toll-free at
1 800 268-2835
For local calls
Click on the link here to email a Customer Service Representative
We will respond with a form attached for easy printing
Send a fax to us at
La Capitale Financial Security
7150 Derrycrest Drive
Contact your agent or local branch office
Important tips for submitting a claim:
- Have your policy number handy when you call, and include all policy numbers on any correspondence you send to us.
- Ensure that we have been notified of any address change.
- To avoid delay, ensure your report is signed and fully completed.
- Note that the Company does not reimburse the cost for completion of forms.
- Call the Claims Department via the toll free number (above) if you have not heard from us within 10 days of receiving your claim. Forms are sent out within 24 hours of receiving your call.
- Do not delay in notifying the Company once your loss begins, even if it is continuing.
- The original form with your signature is required before payment can be made.
- The policy requires that the Company receives prompt notice of a claim, and that forms are not delayed. Should it be necessary that you leave the form with your doctor's office, follow up to ensure that it has been forwarded to us.
In your request please include full name, all policy numbers, address and phone number, and a description of your loss.