Use the Statement of Claimant for Long Term Disability Benefits if you’ve been disabled (through sickness or injury) for at least 52 weeks and are now wishing to apply for LTD benefits.
Your personal Member information is needed to complete the form. The Plan number (161133) must be included on the form. In addition, information such as:
Please follow the instructions on the form.
Questions on completing the form should be directed to the PLAN ADMINISTRATOR.
Completed forms should be forwarded to the PLAN ADMINISTRATOR.