Improvements to the Public Service Management Insurance Plan Long-Term Disability claims process

Date: February 2022

This notice is to inform members of the Public Service Management Insurance Plan (PSMIP) of the:

New PSMIP LTD claim forms

Effective immediately, there are four forms to complete and submit to the plan administrator, Industrial Alliance, to begin processing a disability benefits claim. A claimant should send their claim two months before the end of the elimination period (13 weeks or the exhaustion of sick leave, whichever is later).

Industrial Alliance will adjudicate the claim within approximately 10 business days of receiving the four completed forms.

Change to disability claims process:

The Employer’s Statement is divided into two forms:

  1. Employer’s Statement (F54-1012A-57 Immediate Supervisor or Manager) is to be completed by the employee’s immediate supervisor or manager
  2. Employer’s Statement (F54-1013A-57 Compensation/Human Resource advisor) is to be completed by the employee’s departmental compensation advisor or Human Resource advisor

The Employee’s Statement and Attending Physician’s Questionnaire are now two separate forms and include clear steps and instructions for completion. In addition, there are now three Attending Physician’s Questionnaires forms to help the claimant describe their medical condition.

  1. Employee’s Statement (F54-1011A-57) is to be completed by the employee
  2. Attending Physician’s Questionnaire, (F54-1014A-57 Mental health condition), or (F54-1015A-57 Musculoskeletal condition), or (F54-1016A-57 for all other medical conditions) is to be completed by the attending physician. Complete just one questionnaire that best describes the medical condition and send it to Industrial Alliance

A checklist with additional information and detailed steps on the new disability claims process is also available to ensure all the required information is provided to Industrial Alliance.

Administrative improvements to the LTD claims process

  • All LTD benefit claim forms can now be digitally signed and submitted electronically to Industrial Alliance at
    Forms can still be submitted by mail or fax to:
    Group Disability Claims
    Industrial Alliance Insurance and Financial Services Inc.
    522 University Avenue, Suite 400
    Toronto, Ontario M5G 1Y7
    Fax: 1-877-781-1583
  • Senior managers can now complete, sign and submit the Employer’s Statement form on behalf of the employee’s direct supervisor or manager, should the direct supervisor or manager be unavailable. The senior manager must indicate that they are doing so due to the unavailability of the employee’s direct supervisor or manager and indicate the direct supervisor or manager’s name on the form, on a separate sheet of paper, or in the submission email.

New Industrial Alliance Webpage

Industrial Alliance has launched a new webpage,, for plan members to facilitate the new LTD claims process, assist claimants with the completion of the claims package and house the new claim forms. The webpage houses:

  • PSMIP LTD claim forms
  • Applying for disability benefits under the PSMIP Checklist to ensure all required information and documents are included and submitted
  • Additional resources


Should you, an employee or an attending physician have any questions or concerns, please contact Industrial Alliance at 1-800-830-1255 or the Customer Service page.

Chiefs of Compensation at the corporate level may contact the Employee Relations and Total Compensation Sector.

Marie-Chantal Girard
Senior Assistant Deputy Minister
Employee Relations and Total Compensation Sector
Office of the Chief Human Resources Officer
Treasury Board of Canada Secretariat                                                                                                        

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