The Application for Wage Indemnity Plan Benefits, including the Claimant’s Statement, Employer’s Statement and Physician’s Statement, should be completed as soon as you know you will off work formore than 14 days. Your 14-day elimination period commences from the date of your first flight missed or reserve day, if on reserve. Your completed application must be received within 30 days of the end of your elimination period.
EMPLOYER’S STATEMENT
If not already completed when received, the Employer’s Statement should be completed as soon as possible.
CLAIMANT’S STATEMENT
- Mail the completed claimant’s statement directly toMANION
Do not use crew boxes or leave at the Airport Office.
- In case of an accident, be sure to explain the circumstances on a separate sheet. (WCB, Motor Vehicle,Home)
- Ensure you sign and date the Authorization at the bottom of the page.
PHYSICIAN’S STATEMENT
- You must see a physician (MD) within the 14-day elimination periodinordertoqualifyforbenefitscommencingonthe15thday of your
- Have your treating physician complete the Physician’s Statement. Most claim delays are due to incomplete medical evidence. Please make sure that the physician’s name is legible and that the address and telephone number are complete.
- Have your physician clearly indicate the diagnosis, complications (if any), treatment, medication and all dates of visits.
- If your physician does not know when you can return to work, an approximate date should be given. Indicating “indefinite” will delay your claim.
- If you are receiving treatment from any other medical practitioner who is not a licensed physician (MD), you must ALSO be under the regular and ongoing care of a licensed physician (MD).
- Please sign the Authorization Request. If you do not sign this authorization statement your claim will be returned to you, resulting in a
DO NOT ALTER OR ADD ANY INFORMATION TO THE PHYSICIAN’S STATEMENT!
TO ENSURE CONFIDENTIALITY SEND PHYSICIAN’S STATEMENT DIRECTLY TO MANION.
THE EMPLOYER DOES NOT REQUIRE THE PHYSICIAN’S STATEMENT!
If your disability arose out of, or in the course of your employment, you MUST apply for Workers’ Compensation (C.S.S.T. in Quebec). However, you must also apply for Weekly Indemnity benefits in the interim. All WI claims must be submitted within 30 days of the end of your elimination period, regardless of whether you have also filed a Worker’sCompensation claim. Failure to file a WI claim will jeopardize your entitlement to these benefits in the event that your Workers’ Compensation claim is refused or terminated. Weekly Indemnity benefits will be payable only for a maximum of 120 days from the date of disability while a decision is pending from Workers’ Compensation. Please contact your Regional Office for more information if you are applying for Workers’ Compensationbenefits.
When you have returned to work, notify MANION immediately, so that your WI claim can be finalized.
Your benefits will be deposited directly into your bank account, therefore please submit the Direct Deposit application along witha void cheque when you submit your application.
While you are receiving WI benefits, supplementary reports will be forwarded to you periodically. Upon receipt, have this report completed and returned to MANION, as soon as possible so that payments will not be delayed. It is your responsibility to provide proof of disability. You must submit proof of disability WITHIN 45 DAYS of the commencement of disability. If you submit proof after 45 days, it will not be processed unless you can show sufficient reasons in writing for not applying earlier.
The claimant is responsible for having all forms completed and any charges incurred for completion of same. Although you may faxyour documents in as notification of a claim, originals are required before your claim will be processed.
Please note: You must advise MANION before you travel at any time during your WI claim. Out-of-country travel requires written medical clearance from your physician.
IF YOU HAVE ANY QUESTIONS OR PROBLEMS REGARDING YOUR CLAIM, OR CLAIM SUBMISSION, PLEASE DO NOT HESITATE TO CONTACT MANION.
ADMINISTRATOR: MANION
21 Four Seasons Place, Suite 500
Etobicoke, ON M9B 0A5
1-416-234-3513 – Local
1-800-663-7849 – Long Distance FAX: 1-416-234-2071
RETURN-TO-WORK
When you return to work, you must notify MANION immediately.