Extended Health Care claims (including vision, paramedical services, prescription drugs, etc.) are submitted using The Co-operators' Extended Health Care Claim Form.

Authorization from a physician is required for certain paramedical practitioners - please call The Co-operators Customer Service Centre for additional details.

If, for any reason, the employee's pay-direct drug card was not used at the point of sale, simply have the employee complete The Co-operators' Extended Health Care Claim Form and attach the original receipt(s).

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The Co-operators dental claim forms are supplied through this website. However, the Co-operators will accept the standard claim form provided by most dentists, as long as Part 2 of The Co-operators claim form is filled out. Attach the two forms together and send to The Co-operators.

1. Have the dentist complete section 1 of the Dental Claim Form. The employee should complete all other sections

For any extensive course of treatment involving crowns, bridgework, etc., which may exceed $300, we recommend the employee ask his/her dentist to complete a cost estimate before the work is completed. Send the estimate to The Co-operators' claim department to determine how the expenses will be reimbursed.

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1. Long and short term disability claims are submitted using forms:

(a) Application for Group Weekly Indemnity Insurance

• Application for Group Weekly Indemnity Insurance - Claimant's Statement
• Application for Group Weekly Indemnity Insurance - Plan Sponsor Statement
• Application for Group Weekly Indemnity Insurance - Attending Physician's Statement

(b) Application for Long Term Disability Benefits

• Application for Long Term Disability Benefits - Claimant's Statement
• Application for Long Term Disability Benefits - Plan Sponsor Statement
• Application for Long Term Disability Benefits - Attending Physician's Statement

2. Once all sections of the forms are completed by the appropriate individuals, they should be forwarded to the insurer along with a copy of the employee's last pay stub, and a copy of the employee's original enrollment form

3. Claims must be submitted six to eight weeks before the end of the elimination period (for long term disability) and as soon as possible after the date of disability for short term disability claims (refer to your benefit summary for the applicable elimination periods for both long and short term disability benefits)

When a disabled employee returns to work (whether the claim was for short or long term disability), please complete the Group Benefits Return To Work Form and forward the original to the insurer.

Note: If the employee is eligible for Worker's Compensation (WSIB) Benefits, he/she will receive a Worker's Compensation claim form from his/her physician.

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1. The employer must completed the Notice of Death Plan Sponsor Statement Form and the claimant must complete the Notice of Death Claimant Statement Form.

2. The attending physician completes a Proof of Death - Physician’s Statement

3. Once all sections of the form are completed by the appropriate individuals, it should be forwarded to the insurer

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Authorization from a physician is required for certain paramedical practitioners - please call The Co-operators Customer Service Centre for additional details.

For accidental death claims the employer must complete the Notice of Death Plan Sponsor Statement Form and claimant must complete the Notice of Death Claimant Statement Form and submit the following supplemental documents if applicable:

• Proof of Death - Physician's Statement, Death Certificate.
• Newspaper clipping, if available
• If newborn or over age 65, send birth certificate
• Police Report
• Toxicology & Autopsy Report

Once the appropriate individuals complete all sections of the above form, it should be forwarded to the insurer along with all supporting documents.

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1. For accidental dismemberment claims, the following form must be filled out:

• Claim for Accidental Dismemberment Benefit

2. Once the appropriate individuals complete all sections of the form, forward it to the insurer

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If you have any further questions, please contact us; we'll be glad to help you.

Last updated on:  June 21, 2012  Page: 

This information is not intended for use without professional advice. While we have attempted to make this site as accurate as possible, it is only a summary. For more information, see our disclaimer.

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All Rights Reserved.