Please read the following carefully to avoid delays in processing your file, then click on the link at the bottom to load the form

 

Dear,

 

Your disability insurance benefit request includes four (4) forms:

 

1 - Claimant's statement

 

-Please complete this ENTIRE form, date and sign.

NB It is very important to enter your GROUP number, your CERTIFICATE number and to answer all the questions in Part D.

 

2 - Declaration by the lessee

 

-Please complete this form yourself, but PART B ONLY.

 

3 - Declaration by the attending physician

 

- Please choose the form (s) appropriate to your state of health, ie physical and / or psychological illness and have it (s) completed by your attending physician. This form must also be dated and signed by him.

 

4- Proof of insurance from the SSQ

 

-indicating that you had “long-term disability” insurance coverage.

 

Direct deposit service

 

If you wish, our company can pay your disability insurance benefits by direct deposit. To do this, please attach to your request a sample check from your financial institution marked "Canceled".

 

 

You have three options for returning the documents to us:

 

By email: services@humania.ca

 

By mail: By fax: 450 778-2519

 

Humania Assurance inc.

 

Complaints department

 

1555, rue Girouard Ouest - PO Box 10000

 

Saint-Hyacinthe (Quebec) J2S 7C8

 

For more information, please contact us at one of the following numbers:

 

Saint-Hyacinthe region: 450 773-7236

Montreal region: 514 485-7236

Other regions - Toll free: 1 800 818-7236

 

We thank you for your cooperation and please accept, Madam, Sir, the expression of our best feelings.

 

The Claims Service team

 

1555, rue Girouard Ouest,

CP 10000,

Saint-Hyacinthe (Quebec)

J2S 7C8

 

Group insurance: Tel. : 450 773-7236 | Toll free: 1 800 818-7236 Fax: 450 778-2519 | benefits@humania.ca | www.humania.ca

Association des Routiers Professionnels du 

Quebec (ARPQ)

 

CALL US: 1-877-956-2777
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