Physician statement for an RBC individual disability insurance claim; RBC directs physicians to the CLHIA form.
- Completed by
- Attending physician
- Issued by
- RBC Insurance
- Format
- Language
- English
Wawanesa Life Disability Attending Physician Statement
Wawanesa Life uses one attending physician statement for group long-term disability, short-term disability and waiver of premium claims: the industry Initial Disability Insurance Medical Statement, June 2025 version, with Wawanesa's return details on every page. Wawanesa considers a claim complete only with the Plan Member Statement, the Plan Sponsor Statement and this statement.
Who completes it
The patient completes Section 1 (patient information and consent). The physician or other medical provider completes Section 2, the Medical Statement.
Submitting and payment
- How to submit it
- Return it to Wawanesa Life's Life Claims Department by email, fax or mail; Wawanesa says most claims can also be submitted online or through its app.
- Who pays
- As printed on the first page, the patient pays any fees related to completing the statement.
Good to know
- Wawanesa says any registered physician can complete the statement, and lists general practitioners, specialists, nurse practitioners and physician assistants as examples.
- All Wawanesa claim forms must carry the handwritten signature of the person responsible for completing them.
- Wawanesa says a case manager makes contact within five business days of receiving all short-term disability forms, or ten business days for long-term disability.
- Waiver of premium forms are needed only if no disability benefit claim is being submitted; the same physician statement serves both.
Get the official form
Download the current version from the source each time; forms change without notice.
Attending Physician Statement
Fill it with Vero
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.
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
Can a nurse practitioner complete Wawanesa Life's attending physician statement?
Wawanesa's disability forms page says any registered physician can complete the APS and gives general practitioners, specialists, nurse practitioners and physician assistants as examples. Section 2 of the statement includes an Other box for the applicable medical provider.
What makes a Wawanesa Life disability claim complete?
Wawanesa says a complete claim must include the Plan Member Statement, the Plan Sponsor Statement and the Attending Physician Statement, and each form needs a handwritten signature. Its checklists list the other documents, such as direct deposit details, needed for long-term or short-term disability.