In the event that you are unable to work due to accident, sickness or injury, there is coverage for eligible employees. The waiting period for benefits, the level of benefit and the maximum duration of benefits are outlined in this section of the HEALTH BENEFIT PLAN BOOKLET.
SEND CLAIM TO THE ADMINISTRATOR, DO NOT SEND CLAIM TO THE INSURANCE COMPANY.
To claim for Weekly Indemnity benefits use the Weekly Indemnity Claim Form.
The form consists of the following sections:
(a) Attending Physician’s Statement
(b) Employer’s Statement
(c) Employee’s Statement
The Physician should complete the “Attending Physician’s Statement” portion of the form. He or she must clearly indicate his or her diagnosis, date(s) of service and type(s) of service rendered.
The “Employer’s Statement” should be completed by the employer. The date the Employee last worked must be shown on this form.
Remember! The claimant must be under the continuous personal care of a medical doctor to qualify for Weekly Indemnity benefits.