Disability insurance

Given the current situation and the possibility of delays in postal services, we encourage you to use our online services.

If you have to send us a paper form, please send it, along with any accompanying information or receipts, via our secure forms submission page rather than by mail.

Instructions

  1. Fill out and sign the form
  2. Gather the required supporting documents
  3. Send everything to the address indicated on the form

Important

  • Keep copies of all correspondence for at least 12 months.
  • Originals will not be returned.

Forms


Disability or Waiver of Premium Claim – Employee Statement – Plan member – 06329E (PDF, 1.1 MB) Opens in a new tab.

This form is used to submit a disability insurance claim or to apply for a waiver of premiums if the plan member is already receiving long-term disability benefits from another source.

Important:

The Employer Statement 08317E (PDF, 1.6 MB) Opens in a new tab. and the Initial Attending Physician’s Statement – Plan member – 02025A (PDF, 1.2 MB) Opens in a new tab. must be submitted with this form. You must provide complete answers to all questions.

Disability or Waiver of Premium Claim – Employee Statement – Plan member – 06329E01 (PDF, 1.1 MB) Opens in a new tab.

This form is used to submit a disability insurance claim or to apply for a waiver of premiums if the plan member is already receiving long-term disability benefits from another source.

Important:

The Employer Statement 08317E01 (PDF, 1.6 MB) Opens in a new tab. and the Initial attending physician's statement –0202501A (PDF, 1.5 MB) Opens in a new tab. must be submitted with this form. You must provide complete answers to all questions.


Disability or Waiver of Premium Claim – Employer Statement – Plan administrator - 08317E (PDF, 1.6 MB) Opens in a new tab.

This form is filled out by the employer when a plan member submits a short- or long-term disability insurance claim or applies for a waiver of premiums.

Important:

The Employee Statement 06329E (PDF, 1.1 MB) Opens in a new tab. and the Initial Attending Physician’s Statement – Plan member – 02025A (PDF, 1.2 MB) Opens in a new tab. must be submitted with this form. You must provide complete answers to all questions.

Disability or Waiver of Premium Claim – Employer Statement – Plan administrator - 08317E01 (PDF, 1.6 MB) Opens in a new tab.

This form is filled out by the employer when a plan member submits a short- or long-term disability insurance claim or applies for a waiver of premiums.

Important:

The Employee Statement 06329E01 (PDF, 1.1 MB) Opens in a new tab. and the Initial attending physician's statement – 0202501A (PDF, 1.5 MB) Opens in a new tab. must be submitted with this form. You must provide complete answers to all questions.


Initial Attending Physician’s Statement – Plan member – 02025A (PDF, 1.2 MB) Opens in a new tab.

This form is filled out by the attending physician at the first appointment regarding a short- or long-term disability benefit claim.

Important:

This form has 2 sections. Make sure your physician only fills out the section that applies to your situation. For any follow-up assessments, the attending physician must fill out form 02026A (PDF, 1.2 MB) Opens in a new tab.. The plan member is responsible for any fees charged for filling out the form.

Initial attending physician's statement – 0202501A (PDF, 1.5 MB) Opens in a new tab.

This form is filled out by the attending physician at the first appointment regarding a short- or long-term disability benefit claim.

Important:

This form has 2 sections. Make sure your physician only fills out the section that applies to your situation. For any follow-up assessments, the attending physician must fill out form 0202601A (PDF, 1.2 MB) Opens in a new tab.. The plan member is responsible for any fees charged for filling out the form.


Additional report of attending physician – Plan member – 02026A (PDF, 1.2 MB) Opens in a new tab.

This form is filled out by the attending physician at subsequent medical appointments to monitor a short- or long-term disability.

Important:

The plan member is responsible for any fees charged for filling out the form.

Additional report of attending physician – Plan member – 0202601A (PDF, 1.2 MB) Opens in a new tab.

This form is filled out by the attending physician at subsequent medical appointments to monitor a short- or long-term disability.

Important:

The plan member is responsible for any fees charged for filling out the form.


Notice of Return to Work – Plan administrator– 00159E (PDF, 1.3 MB) Opens in a new tab.

This form is filled out by the employer when an employee returns to work after receiving disability benefits.

Important:

This form must be completed and returned to us as soon as the return-to-work date has been confirmed or, at the latest, on the day the plan member returns to work.

Notice of Return to Work – Plan administrator– 00159E01 (PDF, 1.3 MB) Opens in a new tab.

This form is filled out by the employer when an employee returns to work after receiving disability benefits.

Important:

This form must be completed and returned to us as soon as the return-to-work date has been confirmed or, at the latest, on the day the plan member returns to work.