4841e 2025

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127 votes

The document is a Claim for Disability Insurance form that must be completed by an employee's immediate supervisor or manager. It outlines the necessary information regarding the employee's disability, job duties, and employment status to assess the claim for benefits from Sun Life Assurance Company of Canada. The form emphasizes the importance of accurate and complete information, submission deadlines, and the potential for vocational rehabilitation.

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Click ‘Get Form’ to open the 4841e document in the editor.
Begin by filling in the employee information section. Enter the first name, last name, date of birth, address, and contact details accurately.
In the disability and rehabilitation section, provide observations regarding the employee's ability to perform their job and any changes made due to their condition.
Complete the employment information section by selecting the employment status and providing details about the last day worked and any modifications to duties.
Fill out the leave information section, indicating any sick leave taken and attaching relevant records as required.
In the work environment section, specify conditions related to the employee’s job that may affect their health.
Finally, review all sections for accuracy before signing off as the immediate supervisor. Ensure all necessary attachments are included.

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Versions	Form popularity	Fillable & printable
2019	4.8 Satisfied (127 Votes)

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