D.A. Townley.  -  Plan Administrators      
 

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Long Term Disability Claim

Use
Use the Statement of Claimant for Long Term Disability Benefits if you've been disabled (through sickness or injury) for at least 26 weeks and are now wishing to apply for LTD benefits.


Information Needed to Complete the Form
Your personal Member information is needed to complete the form. The Plan number (G644) must be included on the form. In addition, information such as:

  • details of the sickness and/or accident,
  • the physician's contact information,
  • details of your current condition,
  • information on other benefits to which you may be entitled, and
  • the signature of a witness is also required.
Please follow the instructions on the form.


Notes
Questions on completing the form should be directed to the Plan Administrator.

Completed forms should be forwarded to the Plan Administrator.



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
 

Form Link
 

Related Links
Long Term Disability Benefit Information
Attending Physician's Initial LTD Benefit Statement
Statement of Employer Regarding Employee Group Long Term Disability Claim
 
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