BRANT COMMUNITY HEALTHCARE SYSTEM MANUAL. Policy/Procedure
|
|
|
- Willis Harper
- 9 years ago
- Views:
Transcription
1 BRANT COMMUNITY HEALTHCARE SYSTEM MANUAL Policy/Procedure CATEGORY: Organizational Health NUMBER: X ISSUED BY: Board of Directors PAGE: 1 of 6 Date: March 1983 SIGNATURE: Review Date: July 2006 PRESIDENT DISTRIBUTION: All Staff Via Electronic Access Revision Date: July 2006 SUBJECT TITLE: Sick Leave ( Policy ( Procedure POLICY: Illness is defined as a state of incapacity resulting from bodily injury or disease, physical or mental, preventing the employee from performing regular duties in which the employee was engaged immediately prior to the commencement of disability, and for which compensation is not payable under The Workers Compensation Act. Sick leave is the period of time an employee is permitted an absence due to illness. The Hospitals of Ontario Disability Income Plan (HOODIP) sick leave benefits are available solely to protect the employee against loss of income. Qualifying criteria must be met in order to be eligible for sick leave benefits (In accordance with V= 235 HOODIP- Qualifications for Short & Long term Disability Pay Hospitals of Ontario Disability Income Plan). The employee must provide proof of illness by a HOODIP Sick Pay Medical certificate from a duly authorized medical doctor, stating the nature and length of the illness or disability when the employee has been absent for three (3) or more days. The Hospital has the option, however, to request such proof of illness or disability for absences of shorter duration. In the case of illness or surgical procedure covered by OHIP where disability is expected to last more than ten (10) working days, the employee must complete a Leave of Absence Form A187, and have an Attending Physician s Statement completed by a duly authorized medical doctor. The employee must provide proof and notify their manager and Organizational Health of a planned OHIP covered surgical procedure at least one month prior to the start of total disability.
2 Title of policy: Sick Leave Page 2 of 6 Further proof of total disability may be required at any time by the Hospital to maintain entitlement to Sick Pay Benefit. In order to qualify for sick leave, the employee must notify the immediate Supervisor or designate as soon as possible before the start of the employee s regular shift. Sick leave will not be paid in any of the following circumstances: When the absence is caused by an injury compensable under the Workers Compensation Act, During scheduled vacation, unless illness requires hospitalization or bed rest for more than 3 days and is of a serious nature as confirmed by the Occupational Health Nurse - Ref. V-680 Vacation Non Union - Entitlements. For absence resulting from over exposure to the sun, which does not restrict the employee from performing any work in the department nor does it require the care of a physician. The Manager in granting sick leave and authorizing payment of sick leave, must prevent its misuse and must therefore be certain that the absences are due to bona fide illness or injury. Ref.: V-235 HOODIP - Qualifications for Short & Long Term Disability Pay Hospitals of Ontario Disability Income Plan Reporting Employees who are unable to report for work due to illness (incapacity as a result of bodily injury or disease) must notify their immediate Manager or designate as far in advance as possible. Absences will be recorded on the yellow Absence Notification and Follow up form by the manager or designate when the absence is called in. If the illness is prolonged, employees must keep their Manager informed on a regular basis. Employees who fail to comply with this procedure will be considered absent without pay. Employees who have so notified their Manager and are unable to confirm attendance on their next regularly scheduled shift shall be required to notify the Manager when they are able to return to work, at which time they will be advised of their next scheduled shift.
3 Title of policy: Sick Leave Page 3 of 6 Employees who become ill while on duty will report to their immediate Supervisor who will arrange for them to see the Occupational Health Nurse, if necessary. If the Occupational Health Nurse is unavailable, the Administrative Manager must be contacted to determine if the employee should be sent to the Emergency Department for treatment. In either case, if the employee is subsequently absent for three or more working days, the Manager, or designate, must complete Form A-92 and submit the form to the Health Office. If the absence will extend to 5 or more working days the Manager or designate is to complete and submit the Absence Notification and Follow up form to Organizational Health, and the employee is instructed to contact Organizational Health. For absences of 5 days or greater, an Attending Physician s Statement must be completed by a duly authorized medical doctor and returned to Organizational Health by the 10th day of absence. Exceptions will be considered under extraordinary circumstances. If the supporting medical is not received, or does not qualify for sick pay benefits, sick pay may be ceased, and the matter will be forwarded to Human Resources. When employees return to work after an absence of three or more days, they must report to the Health Office and submit the required medical clearance certificate. The Occupational Health Nurse will then complete Form A-92 and the employees will return to their Department with the completed form. An employee who reports for work following an illness without prior notice, as above, may be sent home without pay for that shift.
4 Title of policy: Sick Leave Page 4 of 6 Absence Notification and Follow Up Employee Name Department Date of Notification Time of Notification Scheduled Shift Expected Return to Work Date Date Unknown If date unknown, employee instructed to notify department as soon as possible to confirm a return to work date Expected return to work date (to be filled out if date was initially unknown) If absence is expected to be 3-4 days, employee instructed that HOODIP Sick Pay Medical Certificate will be required for return to work Reason for Absence Personal Request Referred to Manager/Supervisor for approval Non work-related Illness or Injury If non work-related absence employee instructed to: i) Contact extension 2248, Organizational Health Services if absence expected to be 5 days or greater. Employee instructed that Attending Physician Statement will need to be completed ii) Contact extension 2248 for instructions if absence due to possible communicable disease resulting in vomiting, fever diarrhea, rash, sore throat or flu-like symptoms Work-related Illness or Injury If work related absence employee instructed to: i) Complete an Employee Incident Report ii) Contact extension 2248, Organizational Health Services, Health & Safety Coordinator Recorder s Name Signature Manager/Supervisor Signature Date Copy to Organizational Health if absence expected to be greater than 5 days
5 Title of policy: Sick Leave Page 5 of 6 HOODIP Sick Pay Medical Certificate Employee s name Position Employee s Signature Date I understand the reason for this form is to enable me to provide proof of illness causing total disability by a medical certificate from a duly authorized medical doctor. The purpose of this information is to allow the Organizational Health department to adjudicate the HOODIP Sick Pay benefits under policy X130 and PolicyV-235 or equivalent [Sun Life]. The information provided on this form will be used for the stated purpose and kept confidential within the employee s health file. 1. *Nature of illness/ injury: 2. Current treatment: 3. Return to regular work: yes no Date: Please return this confidential form to Organizational Health fax [519] Physician s signature Date *Illness is defined as a state of incapacity resulting from bodily injury or disease, physical or mental preventing the employee from performing regular duties in which the employee was engaged in immediately prior to the commencement of disability, and for which compensation is not payable under the Workers Compensation Act.
6 Title of policy: Sick Leave Page 6 of 6 Three Day Absent Report Form: A-92 To: Organizational Health Notice of absence due to illness or other disability has been received from: Name: Department: First day off: Reason given: Date: Signature: To: Department Manager This will certify is fit to return to work on: Doctor s medical certificate received Date: Signature: APPROVAL BY: Occupation H&S APPROVAL BY: Operations Team Date: June 2006 Date: July 2006 APPROVAL BY: APPROVAL BY: Senior Leadership Team Date: Date: July 2006 If applicable: If applicable: TWH Date Originated: BGH Date Originated: Original Policy No: Review Contact Position: VP Resources/Development
7 BCHS ABSENCE REPORTING PROCEDURES Policy X-130 attachment EMPLOYEE must call manager/designate or if after hours, they must call their unit area Non-work related Work related Less than 5 days Off Work 5 days or greater Call Organizational Health, Health & Safety Coordinator Complete Employee Incident Report Provide medical documentation (Treatment memorandum) Call manager If absence 3-4 days, HOODIP sick pay medical certificate required, however such proof of illness or disability may be requested for absences of shorter duration Manager notifies Organizational Health (absence notification and follow up form delivered) Employee to contact Organizational Health APS/LOA Form to be completed Assess for RTW Modified Work not appropriate Assess for RTW RTW Regular duty Modified work appropriate Modified work not appropriate RTW Regular Duty Modified work appropriate Off work Medical supporting Total Disability required RTW modified duty Remain off work Maintain regular contact with Organizational Health, Manager Ongoing medical documentation required C:\inttemp\OLK103\X130 attachment - Sick policy.doc RTW Modified duty Maintain regular contact with Organizational Health: Health & Safety Coordinator Ongoing Medical documentation required
Workers Compensation. Your Guide to Handling Worker s Compensation Reporting and Filing
Workers Compensation Your Guide to Handling Worker s Compensation Reporting and Filing Filing Worker s Compensation Claims Compensation Claims When the department is notified of an employee s work-related
Policy: Worker s Compensation/ On the Job Injury
Worker s Compensation Policy Policy: Worker s Compensation/ On the Job Injury Policy Statement CITATION REFERENCE Official Title: Worker s Compensation / On the Job Injury Policy Abbreviated Title: Worker
A Social Welfare medical certificate is required from all staff except those on Class D PRSI where an ordinary medical certificate is sufficient.
Code: QA105 Title: Sick Leave Date: 27/1/2015 Approval: UMT 1.0 Purpose Sick Leave entitlements, approval, recording and reporting. 2.0 Description Sick Leave forms an integral part of each staff member
MEMBERS BENEFIT FUND Hourly Construction Division. APPLICATION for SHORT TERM DISABILITY BENEFITS
MEMBERS BENEFIT FUND Hourly Construction Division APPLICATION for SHORT TERM DISABILITY BENEFITS L. I. U. N. A. L o c a l 1 8 3 IMPORTANT INFORMATION If you become disabled, while covered, because of either
Table of Contents SHORT TERM DISABILITY BENEFITS
Table of Contents SHORT TERM DISABILITY BENEFITS 5.2 Eligibility... 2 5.3 Enrollment... 2 5.4 Plan Cost... 2 5.5 How the Plan Works... 3 Schedule of Benefits... 3 5.6 Recurring Disability... 4 5.7 Duration
Personal Accident Insurance Accident Claim Form
Claimant & Accident Details Name of Birth Address Telephone Number Email Occupation Self-Employed Description of Working Duties If yes, will your business cease to operate during this incapacity of Accident
Rehabilitation of employees back to work after illness or injury Policy and Procedure
Rehabilitation of employees back to work after illness or injury Policy and Procedure Document reference number HSAG 2011/3 Document developed by Revision number 4.13 Document approved by Approval date
LONG TERM DISABILITY INSURANCE CERTIFICATE BOOKLET
LONG TERM DISABILITY INSURANCE CERTIFICATE BOOKLET GROUP INSURANCE FOR MONROE CO COMMUNITY COLLEGE SCHOOL NUMBER 704 TEACHERS The benefits for which you are insured are set forth in the pages of this booklet.
racingindustryaccidentbenefit scheme (riabs) April 2015 March 2016
racingindustryaccidentbenefit scheme (riabs) April 2015 March 2016 Group Scheme for Temporary Total Disablement and Group Capital Benefits Insurance Scheme, For Paid Stable Workers Claim Form All claim
FLORIDA ATLANTIC UNIVERSITY WORKERS COMPENSATION RETURN TO WORK PROGRAM
FLORIDA ATLANTIC UNIVERSITY WORKERS COMPENSATION RETURN TO WORK PROGRAM APPLICABILITY/ACCOUNTABILITY: In compliance with statutory requirement, this program provides general guidelines for employees who
HUMAN RESOURCES POLICY Fauquier County, Virginia
HUMAN RESOURCES POLICY Fauquier County, Virginia Policy Title: Workers Compensation Effective Date: 05/17/04 36 Supersedes Policy: 09/04/90 I. PURPOSE It is the objective of the Board of Supervisors that
Employee Injury/Illness Reporting and Managed Return to Work. April 15, 2011 HR 23. Human Resources Responsible Key Business
Managed Return to Work Date Effective April 15, 2011 City Manager Revision Date Effective Code Number HR 23 Human Resources Responsible Key Business Objective: The City of Charlotte seeks to ensure the
1. The initial claim must be filed within 20 days of employees last work day.
DISABILITY LEAVE SOURCE: OHIO REVISED CODE 124.385, OHIO ADMINISTRATIVE CODE 123:1-33-07, & OCSEA/AFSCME BARGAINING UNIT AGREEMENT ARTICLE 35 CONTACT: OFFICE OF EMPLOYEE SERVICES Disability Leave Policy:
OPSEU Guide to the Hospitals of Ontario Disability Income Plan (HOODIP)
OPSEU Guide to the Hospitals of Ontario Disability Income Plan (HOODIP) OPSEU Membership Benefits Department April 2010 Page 2 of 28 Table of Contents 1. INTRODUCTION... 5 2. HOODIP AND YOUR COLLECTIVE
Business Loan Insurance Plan Disability Insurance Claim Group Policy 51000*
Business Loan Insurance Plan Before submitting a disability claim: Complete and sign the Claimant s Statement for Disability. Sign and complete the Patient Authorization on the Attending Physician s Statement.
(*~ CERTIFIED SICK LEAVE AND EMERGENCY LEAVE
Cour Perrate Internationale International Criminal Court (*~ UNCLASSIFIED on 22 November 2012 under ICC/INF/2012/020 ----------\ ;)---------- ~~ Administrative Instruction Ref: leaaii20111 005 Date: 25July
HUMAN RESOURCES MANAGEMENT POLICY WORKERS COMPENSATION. Policy 27
HUMAN RESOURCES MANAGEMENT POLICY WORKERS COMPENSATION Policy 27 NOTE: THE LANGUAGE USED IN THIS DOCUMENT DOES NOT CREATE AN EMPLOYMENT CONTRACT BETWEEN THE EMPLOYEE AND THE MEDICAL UNIVERSITY OF SOUTH
Great-West G R O U P. Short Term Disability Income Benefits Employee s Statement
Great-West G R O U P Short Term Disability Income Benefits Employee s Statement Employee s Statement Short Term Disability Income Benefits This guide contains the forms you need to apply for disability
SICK LEAVE AND SHORT TERM DISABILITY THE PEOPLE CENTER
SICK LEAVE AND SHORT TERM DISABILITY THE PEOPLE CENTER SECTION I PURPOSE OF THE POLICY The purpose of this procedure is to establish guidelines and procedures for using Sick Leave and applying for Short
4.4 Attendance Management Policy
Policy Statement The is committed to providing excellence in service to the general public. It is important for all employees of the Government of Nova Scotia to work as a team in the attainment of this
Short-Term Disability Income Benefit. Employee s Statement
Short-Term Disability Income Benefit Employee s Statement Employee s Statement Short Term Disability Income Benefits This guide contains the forms you need to apply for disability benefits and some important
For Employees: Employees: What What to to do do when when an an accident occurs 08/19/14/dmv
For Employees: What to do when an accident occurs 08/19/14/dmv When there is a work-related accident or illness, procedures must be taken to ensure the employees needs are met with respect to treatment
Long Term Disability Insurance
Long Term Disability Insurance Group Insurance for School Employees FERRIS STATE UNIVERSITY INSTRUCTOR,FACULTY,LIBRARIAN Underwritten by Connecticut General Life Insurance Company 1475 Kendale Boulevard
1. Employee Benefits: Workers' Compensation provides both medical and indemnity benefit payments for and to eligible employees.
Policies of the University of North Texas Health Science Center 05.803 Worker s Compensation Insurance Chapter 05 Human Resources Policy Statement. The University of North Texas Health Science Center at
Modified Duty/Return to Work (RTW) Program
Modified Duty/Return to Work (RTW) Program Client Name: Effective Date: PROGRAM OUTLINE 1. Accident Reporting and Return to Work Process 2. Modified Duty/Return to Work (RTW) Program 3. Employee Responsibility
Who Administers the Workers Compensation Program and Related Responsibilities?
What is Workers Compensation? Who Administers the Workers Compensation Program and Related Responsibilities? Who is Eligible for Workers Compensation? What Coverage is Provided? What is a Compensable Injury?
Dallas County Human Resources/Civil Service Department. Workers Compensation: Frequently Asked Questions for Managers
Dallas County Human Resources/Civil Service Department Workers Compensation: Frequently Asked Questions for Managers Below you will find a categorical list of the most Frequently Asked Questions (FAQ s)
SELF-INSURANCE OF WORKERS COMPENSATION
SELF-INSURANCE OF WORKERS COMPENSATION Information for: STAFF Page 2 SUPERVISORS & MANAGERS Page 5 TREATING DOCTORS Page 7 REPORTING PROCEDURE Page 8 Self-Insurance of Workers Compensation Revised February
TEXAS DEPARTMENT OF CRIMINAL JUSTICE Supervisor s Report Packet for Workers Compensation CONTENTS
Supervisor s Report Packet for Workers Compensation CONTENTS PERS 299-1, Supervisor s Guidelines for Workers Compensation PERS 299-2, Witness Statement PERS 299-3, Supplemental Worksheet PERS 299 (09/15)
Creditor Disability Claim Application Kit
Life and Health Claims Dept. Creditor Disability Claim Application Kit The Application Kit contains: an instruction sheet plus forms that need to be completed in order to apply for disability benefits;
DISTRICT OF COLUMBIA MUNICIPAL REGULATIONS for ACUPUNCTURE
DISTRICT OF COLUMBIA MUNICIPAL REGULATIONS for ACUPUNCTURE 6/24/04 1 CHAPTER 47 ACUPUNCTURE Secs. 4700 General Provisions 4701 Term of License 4702 Educational and Training Requirements 4703 Applicants
Welplan Building Engineering Services Employee Benefits Scheme Scheme Rules
Welplan Building Engineering Services Employee Benefits Scheme Scheme Rules Crown House Technologies Ltd SUMMARY The Scheme operates in the following way: a b The Employer notifies Welplan of all Operatives
Short Term Disability Income Plan. Benefit Booklet
LifeMap Assurance Company 100 SW Market Street P.O. Box 1271, MS E-3A Portland, OR 97207-1271 (503) 721-7161 (800) 794-5390 Short Term Disability Income Plan Benefit Booklet OREGON PUBLIC EMPLOYEES UNION
Short Term Disability Plan
Short Term Disability Plan The Short Term Disability Plan provides eligible Full-Time Employees with short term income protection for absences due to nonworking related disability. Coverage is automatic
d d mm y y If the injury was as a result of criminal assault or a Road Traffic Accident, was the accident reported to the police?
Personal Accident Claim Form This form has been designed to help you provide all the information we need to process your claim quickly. Failure to complete this form correctly may delay your claim. We
TEXARKANA, TEXAS POLICE DEPARTMENT GENERAL ORDERS MANUAL. TPCA Best Practices Recognition Program Reference
Effective Date February 1, 2008 Amended Date Reference Distribution All Personnel City Manager City Attorney TPCA Best Practices Recognition Program Reference No Reference Review Date January 1, 2017 Pages
PERS Disability Benefits
PERS Disability Benefits (for Tiers I, III, and III) Division of Retirement and Benefits PO Box 110203 Juneau, AK 99811-0203 (907) 465-4460 (800) 821-2251 Welcome to the Division of Retirement and Benefits
Claim for Long Term Disability Benefit
Public Service Management Insurance Plan Claim for Long Term Disability Benefit The National Life Assurance Company of Canada Group Policy No. G68-1400 A CLAIM CONSISTS OF FORM 5945 (PARTS 1 AND 2) AND
University of British Columbia (the University) CUPE Local 2278 English Language Instructors
University of British Columbia (the University) CUPE Local 2278 English Language Instructors Contract Number 23218 Part G Effective January 1, 2008 Table of Contents Table of Contents General Information...1
North Carolina State Government
North Carolina State Government W O R K E R S C O M P E N S A T I O N E M P L O Y E E H A N D B O O K PURPOSE The contents in this handbook are designed to provide employees of the State of North Carolina
Industrial Injury Allowance Policy
Industrial Injury Allowance Policy 1. Aim The aim of this policy is to provide information to managers on the reporting of industrial injury related absence, and the mechanisms available to support employees
Short Term Disability Income Benefit. Employee s Guide
Short Term Disability Income Benefit Employee s Guide Short Term Disability Income Benefits This guide contains the forms you need to apply for disability benefits and some important information about
LONG TERM DISABILITY INSURANCE CERTIFICATE BOOKLET
LONG TERM DISABILITY INSURANCE CERTIFICATE BOOKLET GROUP INSURANCE FOR SOUTH LYON COMMUNITY SCHOOL NUMBER 143 TEACHERS The benefits for which you are insured are set forth in the pages of this booklet.
Administrative Procedures Memorandum A4007
Page 1 of 9 Date of Issue May 2015 Original Date of Issue March 2011 Subject WORKPLACE SAFETY AND INSURANCE BOARD (WSIB) CLAIMS References Links Contact Workplace Safety & Insurance Act (Ontario) Human
LONG TERM DISABILITY INSURANCE CERTIFICATE BOOKLET
LONG TERM DISABILITY INSURANCE CERTIFICATE BOOKLET GROUP INSURANCE FOR WAYNE WESTLAND COMMUNITY SCHOOLS SCHOOL NUMBER 944 TEACHERS The benefits for which you are insured are set forth in the pages of this
AVON MAITLAND DISTRICT SCHOOL BOARD ADMINISTRATIVE PROCEDURE NO. 402
AVON MAITLAND DISTRICT SCHOOL BOARD ADMINISTRATIVE PROCEDURE NO. 402 SUBJECT: Legal References: ATTENDANCE REPORTING: STAFF Education Act: Section 283 Chief Executive Officer: Maintain an Effective Organization;
Purpose of the Policy Who Needs to Know This Policy The University s Obligations Supervisor/Human Resources Officers Obligations
New York University University Policy Title: Workers Compensation Policy and Procedure Effective Date: 01/01/2011 Last Revised: 03/07/2013 Issuing Authority: Office of the Executive Vice President Responsible
Constituent Union HSPBA Enhanced Disability Management Program: Overview
Constituent Union HSPBA Enhanced Disability Management Program: Overview The EDMP is a collaborative holistic program between the employer, employee and union. All regular employees must be referred to
Public Employees Benefits Agency. Public Employees Disability Income Plan
Public Employees Benefits Agency Public Employees Disability Income Plan Table of Contents INTRODUCTION...4 Overview Administration Employee Booklet ELIGIBILITY...5 Employer Responsibility Enrolment BENEFITS...7
BUSINESS SERVICES FAMILY AND MEDICAL LEAVE CHAPTER 2 Board of Trustees Approval: 8/8/12 POLICY 4.13 Page 1 of 1
CHAPTER 2 Board of Trustees Approval: 8/8/12 POLICY 4.13 Page 1 of 1 I. POLICY Salt Lake Community College will provide employee leave in accordance with the Family and Medical Leave Act of 1993. Provisions
Accident Cover Claim Form
Accident Cover Claim Form In order for us to consider your claim, we require the following: Section A: Must be fully completed by you Section B: Must be fully completed by your current medical attendant
Mortgage Disability Insurance Claim Creditor Insurance Policy no. 51007
Mortgage Disability Insurance Claim Creditor Insurance Policy no. 51007 BMO Bank of Montreal Representative: First name Last name Branch Domicile Stamp Signature Fax number What information is required
Temporary Injury Allowance Process and Procedures
Temporary Injury Allowance Process and Procedures Isle of Man Government Temporary Injury Allowance Process and Procedures Introduction Staff who are injured or become ill due to their employment may be
Disability Income Protection
Disability Income Protection Table of contents Introduction... 1 Highlights...2 Sick Leave plan... 4 Joining the plan...4 Cost...4...4 Exclusions... 5 In the event... 5 How to submit claims... 5 Group
Policy and Procedure. Managing Attendance. Policy and Procedure
Managing Attendance Policy and Procedure Agreed at CNG on 25 th April 2007 Managing Attendance Policy and Procedure Table of contents: TABLE OF CONTENTS Section 1 The Policy 3 Aim of the Process 3 Key
WORKPLACE REHABILITATION & RETURN TO WORK QUEENSLAND
WORKPLACE REHABILITATION & RETURN TO WORK QUEENSLAND POLICY STATEMENT Kelly Services is committed to the prevention of work-related injuries and illnesses by providing a safe working environment through
How To Manage A Return To Work
Policy Number: CS-1302-2013 Policy Title: Return to Work Occupational & Non-Occupational Absences due to Medical Reasons Policy Policy Owner: Chief Human Resources Officer Effective Date: March 27, 2013
MASSACHUSETTS DEPARTMENT OF CORRECTION SICK LEAVE 103 DOC 209 TABLE OF CONTENTS 209.01 DEFINITIONS...2 209.02 ACCRUAL OF SICK LEAVE CREDITS...
MASSACHUSETTS DEPARTMENT OF CORRECTION SICK LEAVE 103 DOC 209 TABLE OF CONTENTS 209.01 DEFINITIONS...2 209.02 ACCRUAL OF SICK LEAVE CREDITS...3 209.03 CONDITIONS UNDER WHICH SICK LEAVE IS GRANTED...3 209.04
CIBC Mortgage Disability Insurance and CIBC Mortgage Disability Insurance Plus
Page 1 of 5 CIBC Mortgage Disability Insurance and CIBC Mortgage Disability Insurance Plus Your Certificate Of Insurance CIBC Mortgage Disability Insurance ( Mortgage Disability Insurance ) and CIBC Mortgage
& Care & Choices at the End of Life. Advance Directive. Planning for Important Healthcare Decisions
compassion & choices Care & Choices at the End of Life. Advance Directive Planning for Important Healthcare Decisions District of Columbia Power of Attorney for Healthcare INFORMATION ABOUT THIS DOCUMENT
Personal Accident Or Illness Claim Form
Once completed, please return your claim form to: Intana Sussex House Perrymount Road Haywards Heath West Sussex RH16 1DN Thank you for notifying us of your claim. Please complete this claim form and return
WORKERS' COM PEN SATION (CSST) REPORTIN G, RETURN TO WORK AND TEM PORARY WORK ASSI GN M EN T
Effective Date: October 20, 2004 Supersedes /Amends: VRS-43/October 1, 1997 Originating Office: Office of the Vice-President, Services Policy Number: VPS-43 SCOPE This Policy applies to all full and part-time
According to WCB Policy Number: POL 04-66, Learners (students) who are injured while performing on the job training may receive compensation benefits.
University of Prince Edward Island Policy Policy No. admhrdemb0002 Revision No. 1 Policy Title (WCB) & Incident Reporting & Investigation Policy Page 1 of 5 Creation Date 01 April 2002 Version Date 20
ABSENCE FROM WORK ABSENCE FROM WORK
ABSENCE FROM WORK Revised 12/17/2015 Employee Handbook: Absence From Work 1 of 11 VACATION To define time-off from regular work hours. It is company policy to grant time off from work under specific rules
WORKERS COMPENSATION EMPLOYER S REPORT
WORKERS COMPENSATION EMPLOYER S REPORT You must lodge this form with Allianz within three working days of being notified of an injured person s claim. 1 Employer Details Legal Entity / If Claimant has
Workers Compensation Return-to-Work-Program
1. Purpose Workers Compensation Return-to-Work-Program 1.1 Under workplace/occupational health and safety and workers compensation legislation, Education Centre of Australia Pty Ltd ( ECA ) is required
Facts & Tips about Long-term Disability (LTD)
Facts & Tips about Long-term Disability (LTD) Revised June 2008 Please keep this document handy for reference It offers general information about LTD benefits under an insurance policy or contract. It
PayCover Income Protection Claim Form
PayCover Income Protection Claim Form Frequently Asked Questions How long will it take to complete my section of the form? We ve tested it -- it takes about 20 minutes. We want to settle your claim for
El Paso County. Self-Funded Short Term Disability Plan
El Paso County Self-Funded Short Term Disability Plan Effective January 1, 2003 Restated January 1, 2011 Index INTRODUCTION... 2 ELIGIBILITY... 2 Eligible Classes... 2 Eligibility Date... 2 POLICY EFFECTIVE
Reference Number Policy Number Sex M F Age
Reference Number Policy Number Sex M F Age The insured is responsible for completion of this form without expense to the company Patient s name and address What is disabling patient? Please give a complete
Protect Injury and Sickness
INSURANCE SOLUTIONS CLAIM FORM Protect Injury and Sickness EXTF058 For dental claims, please use the Protect Accidental Dental Injury claim form. Call ATC for assistance on 1800 994 694 1. You complete
Policy: Accident & Injury Reporting Category: Operations. Authorized by: Joan Arruda, CEO
Category: Operations Authorized by: Pages: 11 Date effective: Dec. 15, 2010 To be revised: Dec. 15, 2013 Revised: May 9, 2011 Joan Arruda, CEO POLICY This Policy and Procedure is intended to bring consistency
Policy Summary: Policy Statement:
FITNESS FOR DUTY POLICY - EXAMPLE #1 Reason for The COMPANY is committed to promoting a safe and healthy environment for its Policy: employees, students, patients and visitors. Such an environment is possible
PERSONAL ACCIDENT CLAIM FORM
PERSONAL ACCIDENT CLAIM FORM (Form to be completed in full or claims will be delayed) Insured s name Identity number (Please attach a certified copy of your ID) Postal address.. Code... Tel number Fax
Administrative Procedures Memorandum A4002
Page 1 of 8 Date of Issue May 2015 Original Date of Issue September 1985 Subject References Links Contact REPORTING OF WORKPLACE INJURY/ILLNESS Workplace Safety & Insurance Act Occupational Health & Safety
WORKERS COMPENSATION EMPLOYEE S NOTICE OF INJURY (COMPLETE ALL ITEMS)
WORKERS COMPENSATION EMPLOYEE S NOTICE OF INJURY (COMPLETE ALL ITEMS) EMPLOYEE S NAME: (last) (first) EMPLOYEE S ADDRESS: (no.) (street) (city) (state) (zip) TELEPHONE: Home: Work: SOCIAL SECURITY NO.
Copayment Is Due At Time Of Visit. Self-pay (payment due at time of service)
REGISTRATION FORM Please present your insurance card and photo ID at time of check-in. Settlement of patient financial responsibility is expected at time of service. Copayment Is Due At Time Of Visit.
Community Underwriting Personal Accident Claim Form
Community Underwriting Personal Accident Claim Form About Community Underwriting Community Underwriting Agency Pty Ltd (Community Underwriting) acts under a binding authority as Agent for Berkley Insurance
PROCEDURES TO CLAIM SHORT TERM DISABILITY BENEFITS
PROCEDURES TO CLAIM SHORT TERM DISABILITY BENEFITS The Short Term Disability (STD) benefits help you through periods when you are off work due to disability caused by illness or accidental injury outside
Voluntary Disability Benefits
Voluntary Disability Benefits Enclosed you will find a disability packet that will provide information to assist you in filing for disability benefits through The Claremont Colleges Voluntary Disability
WORKPLACE RETURN TO WORK PROCEDURE
Date of Adoption: 25/6/2015 The process outlined by this Procedure will meet the minimum requirements to assist the Local Government Association Workers Compensation Scheme (LGAWCS) meet legislative compliance.
Canada Life Group Income Protection
A policyholder s guide to making a claim frequently asked questions We aim to make the claims process as straightforward as possible. This leaflet guides you through the process and answers some of the
Information about workers' compensation. Information for newcomers to Ontario
Information about workers' compensation Information for newcomers to Ontario What is the Workplace Safety and Insurance Board? The Workplace Safety and Insurance Board (WSIB) is Ontario's no-fault insurance
SAMPLE ONLY. TotalCare Max - Personal. Optional Benefit Appendix DISABILITY INCOME PROTECTION BENEFIT INDEMNITY
TotalCare Max - Personal Optional Benefit Appendix DISABILITY INCOME PROTECTION BENEFIT INDEMNITY This appendix only applies if cover under the policy schedule includes the disability income protection
