Short-term and long-term disability income benefits
Are you a plan administrator?
Use these forms to support a plan member's claim for short-term or long-term disability income benefits. You'll find instructions on how to return the completed form on the form itself, or you can submit your form onlineOpens a new website in a new window - Opens in a new window.
Download a form
Download the form and print it, or fill it out in Adobe Reader XI or higherOpens a new website in a new window - Opens in a new window (not your browser) and save.
Use this form to support a plan member's claim for long-term disability income benefits.
Use this form to notify the business of an employee's return to work following an accident or illness.
Use this form to support an employee's Waiver of Premium claim. The employee will need to complete a questionnaire as part of this form.
Use this guide for reference or help when completing Workplace Disability and life Waiver of Premium claim forms.