Desjardins Insurance asks the attending physician for this additional report during an ongoing individual disability insurance claim. Like the group version, it has a physical-illness side and a psychological-illness side, but it adds a section for questions specific to the insured's contract. The English version is 020265A (2020-11); the French Déclaration du médecin traitant, Rapport supplémentaire, is numbered 020265.
The insured completes the identification section with contract, group or policy, and certificate numbers. The attending physician completes the declaration on the matching side, in block letters, and gives it to the patient.
Download the current version from the source each time; forms change without notice.
Physician's statement – Additional report
Déclaration du médecin traitant – Rapport supplémentaire
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Both are follow-up physician reports with physical and psychological sides. The 020265A is for individual disability insurance and includes a section of contract-specific questions, while the 02026A is for group disability claims, where the employee receives the completed form.
The insured. The form states that the insured must pay the fees requested to complete it, and Desjardins' individual claims page also says the insured pays any fees the doctor charges. The physician gives the completed form to the patient to submit.
Yes. Axis V asks for a functioning score on the DSM-IV scale from 0 to 100, where 100 is perfect condition, at the beginning of treatment and currently. The same side covers personality disorders, addictions, associated illness and psychosocial stressors in the last 12 months.