Completion of these forms by you or your employee may be necessary to proceed with your claims. Should you have any questions about the process or which forms apply to your situation, please feel free to contact us.
Claims Management Forms
Completion of an employee injury report is necessary for occupational injury claims.
| Form Name | Format |
|---|
| Accident Investigation Report | PDF |
| Functional Abilities Form | PDF |
| Employee Injury Report | PDF |
Early Intervention Forms
English:
| Form Name | Format |
|---|
| Early Intervention Contact (for GroupHEALTH members) | PDF |
| Early Intervention Contact (for GroupHEALTH members) | Online Form |
| Upload Information Form (for GroupHEALTH members) | Online Form |
French:
| Form Name | Format |
|---|
| Formulaire d’avis d’intervention précoce | PDF |
| Intervention immédiate – Coordonnées (absent pendant 5 jours consécutifs) | PDF |
GroupSource Forms
| Form Name | Format |
|---|
| Early Intervention Program Form | PDF |
