GL5450E Group Benefits Plan Member Statement. Group Disability Claim Form.. GL5450E 2026

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  1. Click ‘Get Form’ to open the GL5450E in the editor.
  2. Begin by selecting the benefit type you are applying for in Section 1. Options include short-term disability, long-term disability, and more.
  3. In Section 2, fill out your plan member information. Ensure you have your plan contract number and certificate number from your benefits card.
  4. If applicable, complete Section 3 for direct deposit authorization. Provide your banking details and attach a void cheque if necessary.
  5. Proceed to Section 4 to describe your injury or illness. Be specific about how it occurred and whether it is work-related.
  6. In Section 6, detail your illness information including treatment dates and symptoms that prevent you from working.
  7. Complete Sections 7 and 8 by listing health care professionals consulted and any other income sources related to your claim.
  8. 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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The group disability income plan is designed to provide you with a source of income if you are unable to work due to a Total Disability. The plan consists of two parts: Short Term Disability (STD) and Long Term Disability (LTD). An employee may be enrolled in one or both parts.
Group disability plans typically provide a totally disabled covered employee with a benefit of up to 60% of their pre-disability income, to a specified maximum, such as $10,000 a month. It can help to cover personal expenses as well as provide business overhead protection.
Disadvantage Policy Provisions: As compared to individual coverage, group plans may have less favorable standards for receiving disability benefits. A group plans definition of what constitutes a disability may be more vague or restrictive than that in an individual policy.
GLTD disability benefits are usually limited to 50% to 60% of base salary and often have a maximum monthly benefit, regardless of how much you earn. Some employers do offer the ability to buy additional coverage up to 70% of earnings or salary.
Disability groups operate nationwide to share information and resources on specific disabilities. Quite often, these national-level organizations also have chapters in every stateand those state chapters may have multiple local chapters.

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