Alberta Blue Cross uses its own copy of the industry-standard Initial Disability Insurance Medical Statement (June 2025 version) for disability insurance claims. The patient's doctor supplies the medical side of the claim, alongside the employee and employer statements. The statement is kept in the insurer's benefits file and may be accessible to the patient or others authorized by law.
The patient completes Section 1, including current medications, height, weight, dominant hand and a signed consent. The family physician, consulting specialist or other medical provider completes Section 2, the Medical Statement, and signs with their licence or registration number.
Download the current version from the source each time; forms change without notice.
Initial Disability Insurance Medical Statement
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.
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.
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Not always. If the patient has returned to work, or the disability is expected to last less than 4 weeks, the form says to stop after the hospitalization and surgery questions and sign. For disabilities expected to last more than 4 weeks, complete all pages.
It asks for current cognitive and physical restrictions and limitations based on your findings, whether any licence has been restricted or revoked, whether the patient can manage their own affairs, other factors affecting recovery, the prognosis, and the return-to-work goals you have discussed.
Section 2 can be completed by the family physician, a consulting specialist or another applicable medical provider, who checks the matching box. The signature block asks for the provider's specialty and licence or registration number along with contact details.