2022 Insurance Forms

 

Equity Insurance Plan

Crawford Logo

Equity's insurance and benefits plan is administered by Crawford & Company. 

Crawford & Company is the world's largest independent providers of claims management to the risk management and insurance industry as well as self-insured entities, with clients in more than 70 countries. 

Questions about Equity's insurance plan or an individual member's coverage should be directed to: 

Crawford & Company

100 Milverton Blvd - Suite 300
Mississauga, ON L5R 4H1
Phone: 1-888-688-4344
Email: equity@crawco.ca

 

The detailed insurance plan is available here.

Policy maximum sheet: Click here for a chart detailing benefit, eligibility, and reimbursement maximums.

An FAQ on the insurance plan is available here.

Submit your Crawford claim directly online by clicking here.

Medical / Paramedical Claim Forms

Accidental Dental
Use this form to claim reimbursement for dental expenses incurred when treatment is required as a result of an accident. If the accident occurs while on contract, the reimbursement is no more than 80% per cent to a maximum of $2,500. If you are eligible for off-contract coverage, the reimbursement rate is 50% per cent. Note that this form must accompany a standard dental claim form completed by your dentist.
 
Medical / Paramedical Claimant Statement
Use this claim form for expenses related to physical therapies, medical expenses and alternative medicine. Note that maximums for physical therapies are different for all members: either $600 or $1,200 per treatment depending on your contract. Also, medical expenses have a collective maximum of $5,000 and alternative medicines have a collective maximum of $750. Supporting documentation may be required.
 
Practitioner Statement
This form may be required depending on your claim situation and should accompany your Medical/Paramedical Claim Form.
 

Income Replacement Benefit Claim Forms

Attending Physician Statement
This form needs to accompany your Income Replacement Benefits Claim Form. It must be completed by your physician.

 

Claimant Statement
Use this form to apply for income replacement if you need to drop out of a current or upcoming contract due to illness or injury. If you are working, you are insured for 60% per cent of your contractual weekly fee to a maximum of $1,500 per week for up to 52 weeks. Additional supporting documentation is required.

 

Customary Fees

Reasonable and Customary Fee Guide
Reasonable and Customary Charges for Paramedical Services correspond to the maximum acceptable amounts as established by the insurance plan provider, for certain services, according to their average cost in any given region.
 

Chubb AD&D

Chubb Life Insurance Company of Canada

2500 - 199 Bay Street
P.O. Box 139, Commerce Court Postal Station
Toronto, ON M5L 1E2
General emailCAEA.Claims@Chubb.com

Accidental Death and Dismemberment
Chubb Life Insurance Company of Canada continues to be the provider for Equity members' Accidental Death and Dismemberment (AD&D) Plan. Access the AD&D form here.