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Part of Insurance

Insurance – Forms

Insurance forms for consumers, insurers and health care practitioners.

Fillable PDF forms do not open properly on some mobile devices and web browsers.

If you are having problems opening the form, contact PDF form technical support.

To submit your forms

Follow the directions on the form for submission instructions. If you have any questions, contact the Alberta Superintendent of Insurance.

AB claims and minor injuries

Clarification regarding fees and disbursements for completion of Accident Benefit Claims forms

Current prescribed fees and disbursements for completion of Accident Benefit Claims forms under the DTPR

How to submit forms

Complete the form and follow the directions on the form for submission instructions.

Notice from the Superintendent of Insurance regarding recreating these forms for compatibility with health care practitioner software

  • Users may recreate these approved forms in order to ensure compatibility with their own software system.
  • Section 803 of the Insurance Act (the Act) provides the Superintendent of Insurance (Superintendent) the power to establish relevant forms. The position of the Superintendent is that the format of the Accident Benefit (AB) and Minor Injury (MI) forms (that is, size and colour of answer boxes, etc.) may be altered for compatibility with practitioners’ software, but any changes to the content of the forms (that is, word order, phrasing, question order, etc.) or the addition of corporate logos, is not allowed.
  • Moreover, making content changes constitutes a breach of sections 507 and 551 of the Act and is an offence under section 780.
  • Users are responsible for updating their systems to remain current with any approved changes to forms in the future.
  • If you wish to be notified of future changes, subscribe to receive email updates. For technical support, email [email protected]. For all other inquiries, email [email protected].

Accident Benefit Claim – prescribed forms

The following prescribed Accident Benefit Claim forms were updated in April 2017. For a description of the changes, see Superintendent of Insurance Bulletin 01-2017.

Minor injury – annual increase in amount for non-pecuniary damages

Minor injury – prescribed forms

Minor injury – Certified Examiner Register

Diagnostic and Treatment Protocols Regulation – Injury Management Consultant Registers

Forms and more

Automobile insurance policies, certificates, application forms

See the automobile insurance page for the following documents:

  • current and previous standard automobile insurance policies, certificate and application forms
  • automobile insurance endorsements

Motor Vehicle Inspection Report form

This report is for insurance underwriting purposes only, and required only if the vehicle is 12 years or older. A Certified Automotive Technician must complete the report.

This form replaced the former form effective September 1, 2018. See related Notice 05-2018: Updated Automobile Insurance Motor Vehicle Inspection Report – 2018

Forms for Insurers, Reciprocal Insurance Exchanges and Exempt Entities

See Information for insurers for forms, filing requirements and the Insurance Regulatory Information System (IRIS).

Insurance Dispute Resolution Process form

The following form is used for insurance claim disputes only, under Section 519 of the Insurance Act. For complete information on the Dispute Resolution Process, see insurance consumer complaints.

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If you have trouble opening fillable PDF forms, see the Forms page for instructions.

Connect with the Office of the Alberta Superintendent of Insurance:

Hours: 8:15 am to 4:30 pm (open Monday to Friday, closed statutory holidays)
Phone: 780-643-2237
Toll free: 310-0000 before the phone number (in Alberta)
Fax: 780-420-0752
Email: [email protected]

Alberta Superintendent of Insurance
Alberta Treasury Board and Finance
Financial Sector Regulation and Policy
402 Terrace Building
9515 107 Street
Edmonton, Alberta  T5K 2C3