LISC CLAIM FORM

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Policy Information











Claim Details


Attended Trial Details

















Check all that apply and upload in the section below.

Attended Arbitration Details















Check all that apply and upload in section below.

Discontinued and Abandoned Details





**Note** If you have submitted an order to be removed from the record, please advise the date that you served the Plaintiff with the order. Please also submit a Case History Report that is dated after the number of days allowed for in the order plus the number of days allowed for service. If you do not have the Case History Report please still submit the claim now.

Premium Waiver Details


Settlement Details



Lost Motion Details









Other


Document Submission










Ongoing Actions


Privacy & Confidentiality

“Personal Information” as defined in the Personal Information Protection and Electronic Documents Act, S.C. 2000, C.5 (“PIPEDA”), is collected, used, and retained by LISC pursuant to PIPEDA, to evaluate and consider your eligibility for legal expense insurance and for the purposes of sharing with LISC’s affiliated partners, which are listed at legalinsurecanada.ca/partners/, where you or your clients have products with LISC’s affiliated partners. The Personal Information is strictly private and confidential and will not be disclosed without your express written consent or where required by law to do so.

 

LISC is committed to protecting Personal Information and using or disclosing it only for the purposes for which it is collected.

 

All personal information provided to and/or maintained by LISC and its successors and assigns in respect of your claim may be (a) collected and used to handle your claim, which includes determining the extent of coverage (if any) and investigating, evaluating, negotiating, litigation, and/or resolving your claim; and (b) disclosed to third parties involved in the claim (including counsel, adjusters, experts, mediators and adjudicators, and other insurers including the Law Society’s Compensation Fund), to the extent disclosure of the personal information is necessary for handling of the claim.

 

For more information about how LISC uses and protects your personal information, please refer to LISC’s privacy statement at www.legalinsurecanada.ca. You may request to review and make corrections to the personal information in LISC’s file by writing to Legal Insure Services Canada Inc. 202-488 Wellington Street West, Toronto, ON, M5V 1E3 or call 1-833-283-7399 ext 226.