Desjardins Insurance uses this two-sided follow-up report for ongoing group disability claims: one side for physical illnesses, the reverse for psychological illnesses. It updates the insurer on diagnosis, treatment, functional limitations, prognosis and the expected return to work. The form, dated 2018-09, carries the logos of the Fédération des médecins omnipraticiens du Québec and the Regroupement des assureurs de personnes à charte du Québec.
The employee completes Section 1 with their policy, group or contract and certificate numbers. The attending physician completes the side that matches the condition, in block letters, and gives the form to the employee.
Download the current version from the source each time; forms change without notice.
Additional Report of Attending Physician
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During an ongoing Desjardins group disability claim, after the initial attending physician's statement (02025A). It records the last consultation, tests to come, follow-up frequency, specialist referrals, how functional limitations have changed since the start of the disability, and how long before the patient can return to work.
Partly. The PDF is fillable, but the diagnosis section is not fillable online because Desjardins says diagnosis information should come from the attending physician. Complete that part in block letters and give the form to the employee, who sends it online, by mail or by fax.
The employee. Both the physical and psychological sides state in capitals that the employee must pay the fees requested to complete the form. The physician completes the diagnosis and follow-up sections in block letters and gives the form to the employee, who sends it to Desjardins.