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Long Term Disability Claim |
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Use
Use the Statement of Claimant for Long Term Disability Benefits
if you've been disabled (through sickness or injury) and are now wishing to
apply for LTD benefits.
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Information Needed to Complete the Form
Your personal Member information is needed to complete the form.
The Plan number 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.
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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
International Association of Heat and Frost Insulators & Allied Workers, No. 118 Health and Wellness Trust Fund
Administrator
c/o D.A. Townley & Associates Ltd.
101 – 4190 Lougheed Highway
Burnaby, BC V5C 6A8
Phone: 604-299-7482 or 1-800-663-1356
Fax: 604-299-8136
Email: Health
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