Step 1

Your consent

We need your permission to obtain information necessary to help us assess your claim. By signing this authorization request, you give Great-West Life permission to obtain information from your doctor, employer, other insurers and hospitals where you received treatment.

You can send these forms by fax or mail to the Great-West Life Disability Management Services Office nearest to where you live.

Step 2

Attending physician’s statement

Print the statement that applies to you. Have your doctor complete and sign the form, and then fax or mail it to the Great-West Life Disability Management Services Office nearest to where you live.

Note: Any fees charged by your physician relating to the completion of claim reports including this Attending Physician’s Statement are your responsibility.

Step 3

Employee statement

If you aren’t able to complete the entire form now, you can save it and finish it later. When the form is complete, save the final version and return here to submit it.

Submit online

If you have any questions about submitting your document online, contact us at 1-855-755-6729

Prefer to send us a printed copy?

Print the completed Employee’s Statement and then fax or mail it to the appropriate Disability Management Services Office.