Easy as 1...2...3
1. Print out a claim form.
(Adobe Acrobat Reader is required to open file. Click here to download.)
2. Complete page 1 of the claim form. Insured children of minority age must have a parent or guardian of majority age complete and sign the form.
For non-dental claims: please have the Physician complete the Attending Physician’s Statement on the second page of this form.
For dental claims: please have the Dentist complete the Dental Claim form on the third page of this form.
The company must be notified within 60 days of the date of the accident and proof of claim, including a report from the attending Doctor or Dentist, must be submitted within 90 days of the date of the accident.
3. Submit claim form to the following address:
Old Republic Insurance Company of Canada
Student Accident Insurance Claims Department
100 King St W. Suite 1100
Hamilton, ON L8P 1A2
