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T 450.667.7737 866.967.7737 F 450.667.7739 2, Place Laval, office 390 Laval, Quebec H7N 5N6 SHORT TERM DISABILITY CLAIM FORM info groupepremiermedical.ca www.groupepremiermedical.ca Employee Instructions

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How to fill out short term disability claim

How to Fill Out a Short Term Disability Claim:

01

Gather necessary documentation: Before starting the claim process, make sure you have all the required paperwork such as medical records, doctor's notes, and any other supporting documentation that proves your disability.

02

Understand the claim form: Read through the entire short term disability claim form carefully to ensure you understand what information is required and how it should be filled out.

03

Provide personal information: Begin by filling out your personal information accurately, including your name, contact details, and social security number.

04

Describe your disability: Clearly explain the nature of your disability, including the date it began, the symptoms you're experiencing, and any medical treatments you've undergone or are currently receiving.

05

State your work details: Provide information about your employment, including your job title, the date you last worked, and the reason for being unable to perform your job duties.

06

Include medical details: Write down the names and contact information of the doctors or medical professionals who have treated you for your disability. Attach any relevant medical records or reports to support your claim.

07

Review and submit the form: Before submitting the claim, carefully review all the information you've provided to ensure accuracy and completeness. Make copies of the form and supporting documents for your records, then submit the claim as instructed by your insurance provider.

Who Needs a Short Term Disability Claim?

01

Employees: Anyone who is employed and faces a temporary disability that prevents them from working may need to submit a short term disability claim.

02

Self-employed individuals: If you are self-employed and have short term disability insurance coverage, you may need to file a claim if your disability hinders your ability to work and earn income.

03

Individuals with non-work related injuries or illnesses: Short term disability claims can also be filed by individuals who have suffered from non-work related injuries or illnesses, as long as they have a policy that covers such situations.

04

Women on maternity leave: Many short term disability policies cover a portion of the income for women who are unable to work due to pregnancy, childbirth, or related medical conditions.

05

Individuals recovering from surgery: People who undergo surgeries or medical procedures that require a significant recovery period may be eligible for short term disability benefits during their recovery time.

In summary, filling out a short term disability claim involves gathering the necessary documentation, correctly completing the claim form, and providing accurate details about your disability, employment, and medical treatment. Short term disability claims are relevant for employees, self-employed individuals, those with non-work related injuries or illnesses, individuals on maternity leave, and those recovering from surgery or medical procedures.

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