|
|
|
|
|
|
Application for Disability Credits |
|
|
|
|
|
Use
If you’ve become disabled (through injury or sickness) and are no longer able
to work, use the Claim for Disability Credits form to make your claim for
disability credits for your Hour Bank.
Use this form only if you are receiving Worker’s Compensation, EI Sick Benefits
or you have been disabled for more than the maximum Weekly Indemnity claim of
26 weeks.
If you are receiving Weekly Indemnity, disability credits will be automatically
credited to your Hour Bank and you do not need to use this form.
|
|
|
|
|
|
Information Needed to Complete the Form
In order to complete the form, the following information is necessary:
- Member personal information,
- Information related to the Member's accident or sickness, and
- Attending physician's statement regarding the Member's condition.
Please follow the instructions on the form.
|
|
|
|
|
|
Notes
Your doctor must complete his/her section before the claim will be considered. If
there is any charge from your doctor to complete the form, this amount must be paid
by the member.
Questions on completing the form should be directed to the Plan
Administrator.
Completed forms should be forwarded to the Plan
Administrator.
|
|
|
|
|
|
Plan Administrator
Ironworkers Local 97 Plan 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
|
|
|
|
|
|
|
