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GL5450E Group Benefits Plan Member Statement. Group Disability Claim Form.. GL5450E 2026
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- Click ‘Get Form’ to open the GL5450E in the editor.
- Begin by selecting the benefit type you are applying for in Section 1. Options include short-term disability, long-term disability, and more.
- In Section 2, fill out your plan member information. Ensure you have your plan contract number and certificate number from your benefits card.
- If applicable, complete Section 3 for direct deposit authorization. Provide your banking details and attach a void cheque if necessary.
- Proceed to Section 4 to describe your injury or illness. Be specific about how it occurred and whether it is work-related.
- In Section 6, detail your illness information including treatment dates and symptoms that prevent you from working.
- Complete Sections 7 and 8 by listing health care professionals consulted and any other income sources related to your claim.
- Finally, review Sections 9 and 10 for agreement and authorization. Sign where indicated before submitting the form via fax or email.
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