When an employee may qualify both for statutory leave and for the employer's short-term disability benefits, Sun Life gathers both in one provider statement: certification of a serious health condition, plus the disability details. Questions needed only for disability benefits are bold and marked with three asterisks. Sun Life uses it to decide the STD claim and may use it for other leave the employee qualifies for.
The patient completes Section 1; the health care provider completes Sections 2 to 7, covering diagnosis, treatment, restrictions, leave and return to work, and signs Section 9.
Download the current version from the source each time; forms change without notice.
Own Serious Health Condition and Short-Term Disability Health Care Provider Statement
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The patient. Section 1 states that the patient is responsible for any costs associated with completing the form, so any charge for the statement is the patient's responsibility rather than Sun Life's or the employer's.
Leave laws allow a narrower medical inquiry than disability insurance does. Questions marked *** are needed only for the short-term disability claim; skipping them will not affect the statutory leave request, but may delay or affect disability benefits.
Section 7 asks when the patient can return to their part-time occupation and to their full-time occupation, either as a specific date or as a range from 1-2 weeks to 2 months or more, never, or other. Section 5 records restrictions and limitations.