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Alberta AB-1A: Claim for Disability Benefits

An Alberta auto insurance claimant uses this form to apply for Section B disability income benefits, and a physician certifies the period the claimant was totally disabled and unable to work. It is part of the Alberta Accident Benefits Claims Forms Package for accidents on or after October 1, 2004, and the completed form is forwarded to the claimant's insurance company.

Who completes it

The claimant or an authorized representative completes Parts 1 and 2, covering employment in the 12 months before the accident, income lost and other disability benefits. The physician completes Part 3 (Information of Physician) and signs Part 4, giving the dates of total disability and, if the claimant is still disabled, an approximate return-to-work date.

Submitting and payment

How to submit it
The form directs that it be forwarded to the claimant's insurance company. It is a dynamic Adobe LiveCycle (XFA) PDF that opens in Adobe Reader, not in web browsers or on mobile devices.
Who pays
Alberta says expenses for completing AB claims forms under the Automobile Accident Insurance Benefits Regulation (AAIBR) are not prescribed and must be reasonable.

Good to know

  • Part 2 asks whether disability income benefits are being claimed under the Automobile Accident Insurance Benefits Regulations; if not, the form says not to complete or submit it.
  • A digital signature locks every field above it, so finish Part 3 and the Part 4 dates before the physician signs.
  • The claimant's consent to collect and share health information is given in Parts 5 and 6 of form AB-1, Notice of Loss and Proof of Claim, not on the AB-1A.
  • Alberta's Care-First auto insurance system starts January 1, 2027 and comes with a new set of forms for health care practitioners.

Get the official form

Download the current version from the source each time; forms change without notice.

Claim for Disability Benefits

Official pagePDF

Fill it with Vero

Upload the fillable PDF once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

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How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms change without notice, so download the current version from the official page before you fill it in.

Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.

Frequently asked questions

Who signs the AB-1A in Alberta?

A physician signs Part 4, the Signature of Physician for Disability Benefits Claim, after entering the examination date and practice details in Part 3. The physician states the inclusive dates when the claimant was totally disabled and unable to work. The claimant or an authorized representative signs Part 2 separately.

Why won't the AB-1A open in my browser?

The AB-1A is a dynamic XFA form built with Adobe LiveCycle, and its own message says it opens only in Adobe Reader. Alberta also warns that its fillable PDF forms may not open properly on some mobile devices and web browsers, so download the file and open it in Adobe Reader.

What does the physician certify on the AB-1A?

Part 4 records that, to the best of the physician's knowledge, the claimant is totally disabled, meaning unable to work, between two dates. If the claimant is still disabled, the physician adds an approximate date the patient should be able to return to work. The adjuster may later ask the physician for more information.