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 NameFormat
Accident Investigation ReportPDF
Functional Abilities FormPDF
Employee Injury ReportPDF

Early Intervention Forms

Form NameFormat
Early Intervention Contact (for GroupHEALTH members)PDF
Early Intervention Contact (for GroupHEALTH members)Online Form
Upload Information Form (for GroupHEALTH members)Online Form
Form NameFormat
Formulaire d’avis d’intervention précocePDF
Intervention immédiate – Coordonnées (absent pendant 5 jours consécutifs)PDF

GroupSource Forms

Form NameFormat
Early Intervention Program FormPDF

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Since 2002, the Disability Management Institute (DMI) has been providing comprehensive claim management and review services to over 3,500 clients nationwide. Request a Consultation

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