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iA F54-381A: Disability Initial Request (Group)

iA Financial Group's initial group disability claim brings the policyholder's, member's and attending physician's statements together in one 11-page form for short-term disability, long-term disability or waiver of premium. The employer or plan administrator first reports the absence and iA calls the member for a telephone interview; iA's claims page says to complete this form only if required.

Who completes it

The employer or plan administrator completes the Policyholder's Statement, including work schedule, earnings and physical and mental job demands, and the member completes the Member's Statement. The attending physician completes the physical and/or psychological declaration that applies.

Submitting and payment

How to submit it
The member mails the entire form, without detaching pages, to iA's Disability Claims address for Quebec or for all other provinces.
Who pays
The form states that the member is responsible for any fees charged to complete it.

Good to know

  • For long-term disability or waiver of premium without short-term coverage, iA must receive the form, signed by all parties, six to eight weeks before the waiting period ends.
  • Both physician statements separate limitations (what the patient cannot do) from restrictions (what they should not do) and ask about the patient's ability to endorse cheques.
  • The psychological statement asks for Axis I to III diagnoses, current GAF and highest GAF in the past year, and a current mental status examination.
  • Each statement ends with a recommended week-by-week return-to-work plan, days per week, and an explanation if a gradual return is needed.

Get the official form

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

Disability – Initial request

Invalidité – Demande initiale

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

What does the physical illness statement on iA's F54-381A ask?

Diagnoses and complications, previous episodes, whether the disability relates to the specific risks of the patient's job, an accident, occupational illness or motor vehicle accident, pregnancy or preventive leave, functional limitations at onset and now, cardiac class, treatment, surgery, hospitalization and expected duration.

Is iA's initial disability request available in French?

Yes. The French version, F54-381, is titled Invalidité, Demande initiale. The English F54-381A is revision 25-02 and is published as a fillable PDF that must be printed and signed by hand.

What else does iA need with the initial request?

The member encloses benefit statements and correspondence from any government plan paying benefits, such as the Régie des rentes du Québec, CPP, workers' compensation or auto insurance. iA also lists a personal information collection form (F54-900A) and a direct deposit request (F54-072A).