Claim Forms

Claim Forms

Claim forms are available from the Administrative Agent or downloaded online. The downloadable claim forms are for eligible active members and eligible dependents of the Local 183 Members Benefit Fund as listed below.

Please be sure to complete them fully, attach necessary original paid in full invoices along with any other original documentation where applicable and keep a copy for your records to substantiate your claims, and submit to the following mailing address:

LiUNAcare Local 183
1263 Wilson Avenue – Suite 205
Toronto, ON M3M 3G2

Accidental Death (Basic) Claim Form

Accidental Death (Occupational) Claim Form

Accidental Dismemberment (Basic) Claim Form

Accidental Dismemberment (Occupational) Claim Form

Bereavement or Parental Leave Claim Form

Dental Care Claim Form

Emergency Out of Province Medical Coverage Claim Form

Extended Healthcare Claim Form

Hospital Cash Claim Form

Jury Duty Claim Form

Life Insurance Claim Form (fillable)

Life Insurance Claim Form

Long Term Care Claim Form

Long Term Disability Application Package (Construction Members)

Nursing Care Claim Form (fillable)

Nursing Care Claim Form

Permanent & Total Disability Accident Claim Form

Provincial Medical Replacement Coverage Claim Form

Registered Education Savings Plan (RESP) Claim Form

Short Term Disability Application Package (Construction Members)

Short Term Disability Application Package (Industrial Members)

Special Needs Life Insurance Claim Form

Vision Care Claim Form

WSIB Information and Intake Package

Critical Illness Claim Forms

Critical Illness Claim Form – Alzheimer’s Disease

Critical Illness Claim Form – Aortic Surgery

Critical Illness Claim Form – Aplastic Anemia

Critical Illness Claim Form – Benign Brain Tumor

Critical Illness Claim Form – Coronary Artery Bypass Graft

Critical Illness Claim Form – Heart Attack (Myocardial Infarction)

Critical Illness Claim Form – Heart Valve Replacement

Critical Illness Claim Form – Kidney Failure

Critical Illness Claim Form – Cancer

Critical Illness Claim Form – Loss of Hearing/Sight/Speech, Burns, Coma & Organ Transplant

Critical Illness Claim Form – Loss of Independent Existence

Critical Illness Claim Form – Motor Neuron Disease

Critical Illness Claim Form – Multiple Sclerosis

Critical Illness Claim Form – Occupational HIV Infection

Critical Illness Claim Form – Paralysis

Critical Illness Claim Form – Parkinson’s Disease

Critical Illness Claim Form – Stroke, CVA