0-0, Disability Income Benefits
eee Employee Statement Guide

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Please follow the steps in this guide to apply for disability benefits.

Your group plan requires you to notify Canada Life of your disability within a certain time after you become disabled. This means you should notify
Canada Life of your disability as soon as possible. To notify Canada Life of your disability, you can fax or mail your employee statement, consent
form, and any other information you want to provide about your claim to the Canada Life Disability Services Office. Fax numbers and addresses of
all Canada Life Disability Services Offices are on our website or you can contact your plan administrator for this information.

Complete the employee statement and consent form if you are applying for Short or Long Term Disability benefits, Life Waiver of Premium benefits,
or Early Referral Services.

The completed employee statement provides us with general information about you and your medical details and provides Canada Life with notice
of your disability claim.

A consent form is included with your employee statement. Your signature on the consent form is necessary as it gives us permission to obtain
additional information from your employer, other insurers, your doctor, hospitals, or other care providers to help us review your claim.

We may share personal information, like your functional abilities, restrictions or limitations with your employer when discussing your return to work.
We may share medical information, like your diagnosis, test results, or medical reports with your employer's Occupational Health Services if they are
involved with your disability claim(s).

Your doctor will need to provide us with medical information about how your condition(s) prevents you from working. Print the medical questionnaire
form applicable to your condition and have your doctor complete it. Your doctor can fax or mail the completed form to Canada Life directly.

You can choose the other conditions form if your condition is not a specific diagnosis listed or you can choose the “print all condition forms” if you are
unsure which form to bring to your doctor.

Your employer will send an employer statement to Canada Life on your behalf. This statement confirms your coverage, job information, monthly
earnings and other information necessary to assess and administer your disability claim.

If your plan administrator has not provided the employer statement when we receive your employee statement, we will contact your employer directly
for this information.

We will begin our review of your disability claim when we receive your employee statement in the Disability Management Services Office. At that time, a
Canada Life representative will contact you to let you know what you can expect throughout the claim process and to obtain any further information
that may be required.

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