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Long Term Disability Claim - Statement of Employer |
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Use
The employer completes the Statement of Employer Regarding Employee Group Long Term Disability Claim
to provide information to the insurer regarding the Member's Long Term Disability claim.
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Information Needed to Complete the Form
To complete the form the employer must include:
- Information regarding the disabled employee
- Other benefits that the employee may be eligible for
- Any information that may aid in the consideration of the claim.
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Notes
Questions on completing the form should be directed to the Plan
Administrator.
Completed forms should be forwarded to the Plan
Administrator.
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Plan Administrator
Millworkers Health & Welfare Plan (Unifor) Administrator
c/o D.A. Townley
160 – 4400 Dominion Street
Burnaby, BC V5G 4G3
Phone: 604-299-7482 or 1-800-663-1356
Fax: 604-299-8136
Email: Health
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