丁香园AV

Medical Absence

Illness

• Attending Physician's Statement 
• Supplementary Physician's Statement 
• CUPE Initial Threshold Met Letter  DOC
• CUPE 6 Month Threshold End Letter  DOC
• Appeal to Joint Review Committee 
• 丁香园AVFA - Sick Leave Reporting Form 
• 丁香园AVFA - Sick Leave Information 
• 丁香园AVFA - Sick Leave Reporting Flow Chart 

Weekly Indemnity (Poly Party)

• Short Term Disability Claim Form - EMPLOYEE
• Short Term Disability Claim Form - EMPLOYER
• Short Term Disability Attending Physician Statement
  
• Short Term Disability Plan Member Confirmation of Illness (Note: This form replaces the Attending Physician Statement if illness is due to COVID-19) 
• Short Term Disability Information Sheet

Long Term Disability

• Long Term Disability Benefits Guide 
• Authorization for Release of Medical Information 
• Authorization to Communicate by Email 
• Member Statement (Employee) 
• Plan Sponsor/Employer Statement (for completion by Supervisor Sections 6-8 only) 
• Initial Attending Physician's Statement 
• ManuLife Financial Group Benefits Attending Physician's Update 

Return to Work

• Return to Work Information Sheet for Employees  
• Return to Work Information Sheet for Supervisors 
• Return to Work Schedule DOC   PDF