Co-operators Life Insurance Company fax number

Fax destination details

Department

Disability Claims Department

Purpose

Group Benefits Long Term Disability Attending Physician Statement submission

Form

GL2235 (06/14) — Group Benefits Long Term Disability Attending Physician Statement

Address

Disability Claims Department, 1920 College Avenue, Regina, SK S4P 1C4

Website

Visit organization website

Before you send

• Confirm that this exact department handles your document or request.
• Check the organization website or call its main line for the current fax number.
• Include a cover sheet and any case, member, claim, or form reference required.
• Keep the delivery confirmation with your submission records.

Physician completes the Medical Information section and returns the form to Co-operators Life Insurance Company Disability Claims Department. There are two forms (one for mental health conditions and one for all other conditions); submitting the wrong form could delay processing. Mailing address: 1920 College Avenue, Regina, SK S4P 1C4; Fax: 1-866-889-9926. The plan member is responsible for the cost of completing this form, and Medical Information is to be completed by the physician providing treatment.

Official form instructions are published as a downloadable file on the organization's website.