Family of condition-specific physician statements for group critical illness claims, including dependent children's covered illnesses.
- Completed by
- Treating physician
- Issued by
- The Co-operators
- Format
- Language
- English
Co-operators GL2332: Life Waiver of Premium APS
When a disabled plan member claims a waiver of group life insurance premiums, Co-operators asks the treating physician for medical evidence on this three-page statement. It covers diagnosis, symptoms, investigations, treatment, physical and psychiatric or cognitive restrictions, and prognosis with timelines. Separate plan member and plan sponsor waiver of premium statements are listed with it on Co-operators' group benefits forms page.
Who completes it
The physician providing treatment completes Section 2, Medical Information, and signs Section 3. The plan member completes Section 1, including height and weight, and signs an authorization releasing medical information to the plan administrator, plan adjudicator and insurer.
Submitting and payment
- How to submit it
- The completed form must be emailed or faxed to Co-operators directly from the physician's office, or the original can be mailed to the Group Life Claims Department at the address on the form.
- Who pays
- The plan member is responsible for the cost of completing this form.
Good to know
- The diagnosis section includes DSM-IV axes and current and previous GAF scores where applicable, plus symptoms with severity, frequency and duration, and the date symptoms appeared or the accident occurred.
- You are asked whether you know the duties of the patient's occupation, whether the patient can manage their own affairs, and whether their driver's licence has been restricted or revoked.
- The prognosis section asks for recovery timelines, the return-to-work goals discussed with the patient, and when they could return on modified duties or a gradual return.
- Other questions cover visit frequency, hospitalizations, surgery, physiotherapy, whether the patient follows the recommended treatment, and social or non-medical factors that may affect recovery.
Get the official form
Download the current version from the source each time; forms change without notice.
Life Waiver of Premium – Attending Physician Statement
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.
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.
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
Frequently asked questions
What is a Co-operators life waiver of premium physician statement?
It is the medical part of a claim asking Co-operators to waive group life insurance premiums for a plan member who cannot work. On GL2332 the treating physician documents the diagnosis, treatment, restrictions and limitations, and prognosis, while separate statements collect the plan member's and the plan sponsor's information.
Who pays for the Co-operators GL2332 form?
The plan member. The instructions state that the plan member is responsible for the cost of completing the form, and the authorization the member signs in Section 1 confirms they are responsible for obtaining it and for any amount the physician charges.
Does GL2332 ask about return to work?
Yes. The prognosis section asks what return-to-work goals you have discussed with the patient and, if they cannot return to their regular occupation, when and under what circumstances they could return, for example with modified duties or a gradual return to work.