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 treatment are not acceptable.
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 your responsibility to apply for E.I. Sick Benefits.
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 medical 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.
Near the end of the 26-week* Employment Insurance period, you should contact Benefit Plan Administrators Limited Claims Office to ask for a new Attending Physician’s Statement, in order to apply for the balance of the 52-week benefit period available under this plan.
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.
Remember! You must be under the continuous personal care of a medical physician to qualify for Wage Replacement benefits. This includes the 26-week* Employment Insurance period.
*Effective December 18, 2022.
Proof of Loss
Written proof stating the occurrence, character and extent of loss must be submitted to the Claims Office within 6 months after the start of disability for the Weekly Disability Benefit.
The Insurance Company shall have the right and opportunity to 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.