D.A. Townley.  -  Plan Administrators      



Long Term Disability Claim - Statement of Employer

The employer completes the Statement of Employer Regarding Employee Group Long Term Disability Claim to provide information to the insurer regarding the Member's Long Term Disability claim.

Information Needed to Complete the Form
To complete the form the employer must include:

  • Information regarding the disabled employee
  • Other benefits that the employee may be eligible for
  • Any information that may aid in the consideration of the claim.

Questions on completing the form should be directed to the Plan Administrator.

Completed forms should be forwarded to the Plan Administrator.

Plan Administrator
Millworkers Health & Welfare Plan (Unifor) Administrator
c/o D.A. Townley
160 – 4400 Dominion Street
Burnaby, BC V5G 4G3

Phone: 604-299-7482 or 1-800-663-1356
Fax: 604-299-8136

Email: Health

Form Link

Related Links
Statement of Claimant for Long Term Disability Benefits
Attending Physician's Initial LTD Benefit Statement
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