Canada Life links the industry Initial Disability Insurance Medical Statement as its Attending Physician's Statement for workplace short-term disability, long-term disability and early referral services claims. The same PDF supports group life premium waiver claims and individual disability claims made through an advisor. For a workplace claim, it is one of three forms the claimant submits together.
The patient completes Section 1 (patient information and consent), and the attending physician or other medical provider completes Section 2, the Medical Statement. The employee also completes the disability benefits employee statement (M7413) and the privacy consent form (M7415).
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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No. Canada Life states that it cannot accept forms with a typed signature. Forms can be signed by hand, with a stylus or finger on a touchscreen, with an inserted image of a handwritten signature, or through a validation system such as Docusign.
Yes. Canada Life links the Canadian Life and Health Insurance Association's Initial Disability Insurance Medical Statement, version June 2025, as its Attending Physician's Statement. The same PDF is linked from its group life premium waiver page and from its individual disability and premium waiver claim pages.
The claimant. Canada Life tells plan members to download the forms, complete and save them, and attach all three, including this statement, in the online claims process. Mailing or faxing them to the local disability management services office is also accepted, although Canada Life warns responses may be delayed.