Get Application For Group Short Term Disability Benefits - Employer's ...

Filling out the Application For Group Short Term Disability Benefits - Employer's Statement accurately is essential to ensure timely processing of disability claims. This guide will provide you with clear, step-by-step instructions on completing the form online.

Follow the steps to effectively complete the application.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin with Section A for employer identification. Fill in the name of the employer, address (including street number, P.O. Box if applicable), telephone number, group policy number, division number (if applicable), class (if applicable), city, province, postal code, and fax number.
3. Move on to Section B for employee identification. Provide the employee's name (first, initial, last), address (including street number, P.O. Box if applicable), GWL employee ID number, social insurance number, date of birth, city, province, and postal code.
4. Proceed to Section C for employment information. Indicate the effective date of hire and the last day the employee was at work. Choose the reason for absence from the provided options, and detail the employment class and status of the employee.
5. In Section D, input the insurance information, including the original effective date of the employee’s Short Term Disability coverage and whether the employee was a late applicant.
6. Complete Section E by answering questions related to earnings and benefits. Provide the employee’s basic pre-disability weekly earnings and any average monthly commissions earned in the 24 months prior to the last day worked.
7. Fill out Section F with job information. State the employee’s job title as of their last day worked and the duration in that position. Include detailed duties and the percentage of time spent on each.
8. Once all sections are completed, review the information for accuracy. Ensure that all required signatures are obtained in the declaration section and date accordingly.
9. Finally, save any changes made to the document. Download, print, or share the completed form as necessary to submit it to Great-West Life.

Start the application process online today to ensure your claim is submitted promptly.