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

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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