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

The Employer Section should be completed first.  You must complete and sign the Member Section.   Your Physician must complete the "Attending Physician's Statement" portion of the form, after the date last worked.  Claim forms completed in anticipation of medical treatment are not acceptable.  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. All sections of the form must be completed 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, who must be a medical 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 Physician for the full 52 week period, plus the waiting period, and your treatment must be appropriate to the diagnosis indicated.  Alternative or experimental treatments are not recognized by this plan.

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

If it appears that you will continue to be disabled after 52 weeks of receiving wage replacement benefits, at approximately 44 weeks, the administrator 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.