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

Emergency Out of Province Medical Coverage Travel Card

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 – Additional Dependent Child Critical Illness

Critical Illness Claim Form – Bacterial Meningitis, Benign Brain Tumor, Coma, Stroke

Critical Illness Claim Form – Cancer

Critical Illness Claim Form – Heart Related Conditions

Critical Illness Claim Form – Kidney Failure, Major Organ Transplant or Failure on Waiting List Aplastic Anemia

Critical Illness Claim Form – Loss of Sight, Hearing, Speech, Limbs, Independent Existence, Paralysis, Burn

Critical Illness Claim Form – Neurologic Disorders

Critical Illness Claim Form – Occupational HIV Infection