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iA F54-382A: Disability Extension Request (Group)

iA Financial Group uses this eight-page form to update an ongoing group short-term disability, long-term disability or waiver of premium claim. The member reports their current situation and other income, and the attending physician completes the statement for physical illness, psychological illness or both. iA's claims page says members complete it only when iA requests it.

Who completes it

The member completes the Member's Statement and signs the member authorization at the top of each physician declaration. The attending physician completes the physical and/or psychological declaration and gives it to the patient.

Submitting and payment

How to submit it
The member mails the entire document, without detaching pages, to iA's Disability Claims address for Quebec or for all other provinces.
Who pays
As printed at the end of each physician statement, the member is responsible for any fees charged to complete the form.

Good to know

  • The psychological statement rates 16 abilities, such as relationships, following instructions, handling supervision and stress, on a scale from 0 (no limitation) to 4 (total impairment).
  • Psychological questions include a DSM-5 diagnosis, GAF scores (highest in the past year and current), and medication strategies: increased, maximized or combined, with dates.
  • The physical statement asks for hours of sitting, standing and walking in an 8-hour day, lifting capacity and limb functions such as keyboarding and fine manipulation.
  • Both statements ask whether the absence will exceed the usual period for the diagnosis and, if so, the factors behind that prognosis.

Get the official form

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

Disability – Extension request

Invalidité – Demande de prolongation

Official pagePDFVersion française

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.

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Frequently asked questions

Is the iA disability extension request available in French?

Yes. The French version is Invalidité, Demande de prolongation, with physician sections titled Déclaration du médecin traitant, maladie à caractère physique or psychologique. The English version is F54-382A, revision 25-02. Both are on iA's group disability claims pages.

What should be attached to the iA extension request?

The physician attaches documents relevant to the request, such as recent examination results (scan, MRI or ECG) and specialist reports, plus the latest obstetrical report for pregnancy complications. The member encloses government benefit statements and correspondence, such as CPP, RRQ or workers' compensation decisions.

When does iA ask for an extension request?

During an ongoing disability, when iA needs updated information. iA's claims page says to complete these forms only upon request, and the form tells members to read the comments on their benefit cheque stubs, where iA reports decisions and asks for more information in case of an extended disability.