ARCHIVED CD 2010-007: Sample Letter B

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SAMPLE LETTER FOR LONG-TERM DISABILITY INSURANCE

Employment Income When Employee is Struck off Strength (SOS) and is Claiming Long-Term Disability Insurance

Group Policy No.: Group Plan G68-1400 Industrial Alliance

PROTECTED

Paylist :

Date

Industrial Insurance and Financial Services Inc.
Group Life and Disability Claims Department (PSMIP)
522 University Avenue
Toronto ON M5G 1Y7

Dear insert appropriate name :

SUBJECT: Employment Income when the Employee Is Struck off Strength and Is Claiming Long-Term Disability Insurance (Group Plan G68-1400) Industrial Alliance

The purpose of this letter is to report the amounts paid to the employee when the employee is struck off strength (SOS) and is claiming Long-term Disability Insurance.

EMPLOYEE IDENTIFICATION:
Employee's name Employee's Certificate Number SOS Date
(yyyy/mm/dd)
     

AMOUNTS PAID WHEN THE EMPLOYEE IS SOS

The employee is entitled to a return of contribution (ROC).

OR

The employee is not entitled to a return of contribution (ROC).

If yes, indicate the amount of the ROC :

The employee applied for a medical retirement.

OR

The employee did not apply for a medical retirement.

If yes, indicate if the employee was approved:

Should you require additional information, do not hesitate to contact me at
###-###-#### or by email INSERT E-MAIL ADDRESS.

Sincerely,

Compensation and Benefits Advisor

c.c. Employee file