Sun Life uses this attending physician statement to collect medical information when a plan member is referred to its Accommodation Services, which support workplace accommodation and staying at work. The referral involves three forms: the plan sponsor's referral, the plan member's statement and this physician statement. Sun Life lists it among its group benefits forms for businesses with more than 50 employees.
The attending physician completes the statement. The employer, as plan sponsor, completes the Accommodation Services Plan Sponsor Referral Form (490SC-ER-AS-S-E), and the employee completes the Plan Member Statement (5134-E).
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Accommodation Services - Attending Physician Statement
Services d’aménagement des conditions de travail – Déclaration du médecin traitant
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Yes. The French version is titled Services d'aménagement des conditions de travail, Déclaration du médecin traitant, and its file is numbered 490SC-AS-HH-P-F. The English version, 490SC-AS-HH-P-E, is listed with Sun Life's group benefits forms for businesses with more than 50 employees.
Accommodation Services focus on workplace accommodation and stay-at-work support, starting with a plan sponsor referral. A new short-term disability, long-term disability or salary continuance claim uses a different physician form, Sun Life's Initial Disability Insurance Medical Statement (5548-SL-IDIMS-E), with plan member and plan sponsor statements.
The referral itself is made on the Accommodation Services Plan Sponsor Referral Form (490SC-ER-AS-S-E), a plan sponsor form. The plan member completes their own statement (5134-E), and the attending physician provides the medical information on this statement.