Union Taxable Plan Short Term Disability Claim Form
- Before mailing this form, check that:
- All information has been provided. Failure to provide all information may delay this claim.
- Form has been dated and signed by the member, union and physician Accurate assessment of this claim depends on each question being answered in full. The patient is responsible for any charges made for the completion of this form.
Disability & Life Claims Department PO Box 7000 Vancouver BC V6B 4E1 Telephone 604 419-8040 Toll-free 1 888-275 4672 Fax 604 419-8055
Attending Physician’s Statement