How to File a Claim for Weekly Wage Replacement Benefits

Claim forms are available from the Claim Office of Benefit Plan Administrators Limited. If you are claiming for Wage Replacement a specific form must be used. This form consists of the following sections:

• Attending Physician's Statement
• Member Statement of Claim
• Employer Section

Your Physician must complete the "Attending Physician's Statement" portion of the form. Make sure your Physician clearly indicates the diagnosis, date(s) of service and type(s) of service rendered, and an estimated return to work date. Your Physician must complete the form after you stop working. Forms completed in anticipation of medical treatments are not acceptable.

Remember! You must be under the continuous personal care of a Physician to qualify for Wage Replacement benefits.

You and your employer must also complete your sections of the form before it is returned to the Claims Office. To avoid delay in payment, please make certain that all required information has been provided. Once the claim has been approved your benefit cheque will be mailed directly to you.

It is important to note that you will be required to regularly provide medical evidence from your attending Physician. This medical evidence must be sufficient to establish and maintain your inability to perform the usual functions of your job. You must be under the continuous care of a medical Physician for the full 26 week period, plus the waiting period and any period during which you received E.I. benefits; and your treatment must be appropriate to the diagnosis indicated. Alternative or experimental treatments are not recognized by this plan.

If it appears that you will continue to be disabled after 26 weeks of receiving wage replacement benefits, at approximately 22 weeks, the Administrative Agent will send you the appropriate forms for completion (with instructions), so that you may apply for benefits under the Long Term Disability benefit portion of the Plan.

The Insurer shall have the right and opportunity to independently examine any person whose injury or illness is the basis of claim, when and as often as it may reasonably require during the pending and payment period, if any, of such claim.

How to File a Claim for Long Term Disability Benefits

After approximately 22 weeks of receiving combined Weekly Wage Replacement and Employment Insurance sickness benefits, the Claims Office will send you the appropriate forms for completion (with instructions), so that you may apply for benefits under the Long Term Disability benefit portion of the Plan.

When the forms have been fully completed by yourself, your employer and your physician, forward the forms to the Claims Office. Your claim will be validated and forwarded to the Insurance Company for assessment. Your benefit cheques will be mailed directly to you.

Remember! You must be under the continuous personal care of a Physician to qualify for Weekly Disability Income and Long Term Disability benefits.