Group Insurance Solutions

Group Insurance Solutions

Products

Voluntary Student Accident Insurance Claims

(a) Print the required Claim Form

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French

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or

Telephone the Student Accident Claims Department at:
Old Republic Insurance Company of Canada
(905) 523-5587 or 1-800-463-5437 (Toll free from all locations in Canada)

(b) Parent to complete parent portion only.

(c) The attending Physician or dentist is to complete the appropriate portion of the Claim Form and attach an itemized account.

(d) Submit the completed Claim Form to:

Old Republic Insurance Company of Canada
Student Insurance Claims Department
P.O. Box 557
Hamilton, Ontario L8N 3K9

*IMPORTANT: Old Republic Insurance Company of Canada must be notified within 30 days of any accident. Claim forms, along with the initial dental report or physician’s statement, must be submitted within 90 days of the date of the accident or date of death. It is the entire responsibility of the parent or guardian to forward claim forms as indicated.

Western Financial Group (Network) Inc.