Sun Life's Group Life Claims uses this attending physician's statement of disability to decide whether a disabled plan member qualifies for a waiver of group life insurance premiums. The physician documents diagnosis, history, clinical findings, treatment, functional limitations and prognosis. Sun Life assesses the claim against the contract's definition of disability, own occupation or any occupation, which can change at a specified date.
The attending physician completes sections 1 to 6 and signs. The patient completes the first page with contract and member ID numbers, signs the authorization and gives the form to the physician; the plan member and employer also file Sun Life's claimant (4203-E) and employer (4205-E) statements.
Download the current version from the source each time; forms change without notice.
Waiver of Premium Claim – Physician
Demande de règlement – Exonération de primes – Déclaration du médecin sur l'invalidité
If your copy of the form is a fillable PDF, upload it 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.
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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The patient. Both the patient's section and the physician's section state that the patient is responsible for the costs of obtaining medical evidence and completing the form, unless prohibited by law. The patient obtains the form, completes the first page and then gives it to you.
Own occupation means being unable to perform the essential duties of the occupation held just before the disability began. Any occupation means being unable to perform the essential duties of any occupation suited to the person's education and work experience. The contract definition may change at a specified date, so ask the patient which applies.
Yes. Sun Life publishes a French version, form 4202-F, for waiver of premium claims (exonération de primes). The English edition is 4202-E-05-18, and Sun Life's group benefits forms page lists it with the claimant's (4203-E) and employer's (4205-E) waiver of premium statements.