Plan Member's Disability Statement: Short-Term Disability And Accommodation Services.pdf

## Summary of Sun Life Assurance Company of Canada (Sun Life) Disability Statement (490-STD-AS-M-20574-E-11-20)

This form outlines the process for claiming short-term disability benefits through Sun Life, a member of the Sun Life group of companies. It's designed for plan members experiencing a disability due to illness or injury.

Key Components:

1. Plan Member Information: Includes personal details like name, date of birth, address, occupation, and contact information. Also requires the Plan Sponsor (University of Ontario Institute of Technology) and Attending Physician's statements.

2. Disability Details:
Describes the illness or injury, its onset, and how it impacts work capabilities.
Specifies last day of full-time work/modified work (if applicable).
Provides expected return to work date.
Clarifies if disability is pregnancy-related.

3. Accident-Related Information: Asks if the disability resulted from an accident and provides sections for details if applicable, including location, time, and circumstances.

4. Authorization and Privacy:
Member certifies statements are true and authorizes Sun Life to access relevant information (medical records, employment history) from themselves, their Plan Sponsor, and other sources for claim processing and potential audit.
Acknowledges privacy implications of sharing personal information.

5. Submission Options: Offers multiple ways to submit completed forms: through the Sun Life mobile app, email ([email protected]), or fax/mail to a designated Sun Life office.