Table of contents

Form instructions

Trouble opening PDF forms?

Fillable forms do not open on some mobile devices and web browsers. If the form doesn't open or you see a 'please wait' message, follow these steps to complete and save fillable forms from the Alberta Superintendent of Insurance:

  1. Right-click on the form link and select 'Save Target As' or 'Save Link As', and save the form to your computer.
  2. Launch Adobe Reader.
  3. Open the PDF from within Adobe Reader. You can now fill and save your form.

To submit your forms

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

Accident Benefit Claims and Minor Injuries

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

  • The fees for physical therapy services, chiropractic services and Accident Benefit (AB) claim forms completion prescribed in Superintendent of Insurance Bulletins only apply to claims made under the Diagnostic and Treatment Protocols Regulation (DTPR).
  • Amounts established by the Health Information Regulation pursuant to the Health Information Act for the provision of full or partial copies of health records apply to all claims made under the DTPR.
  • The prescribed AB claim forms are to be used for claims made under both the DTPR and the Automobile Accident Insurance Benefits Regulation (AAIBR).
  • Completion of the AB-2, AB-3 and AB-4 claim forms under the AAIBR is at the request of the insurer. Expenses for completion of AB claim forms and services under the AAIBR are not prescribed, and must be reasonable.
  • For more information, see Superintendent of Insurance Interpretation Bulletin 09-2018 (PDF, 274 KB).

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

How to submit forms

  • Please 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 (i.e. size and colour of answer boxes, etc.) may be altered for compatibility with practitioners’ software, but any changes to the content of the forms (i.e. 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, please email [email protected]. For all other inquiries, please 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 (PDF, 75 KB).

Minor Injury - Amount effective January 1, 2021

Minor Injury - Prescribed Forms

Minor Injury - Certified Examiner Register

Diagnostic and Treatment Protocols Regulation - Injury Management Consultant Registers

Automobile Insurance Policies, Certificates, Application Forms

Please 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 (PDF, 353 KB) (May 29, 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 PDF 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]

Address

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