Parks, Recreation & Culture Brochure
Benefit Claim Inquiry Request
Form Purpose – To be completed if you disagree with the claim payment you received from Sun Life Insurance regarding a health or dental benefit claim.
When complete – Please forward to Natasha Cowan, Pension & Benefit Administrator, Payroll Dept. | |
|Name |
|Department |Union |
|Phone number |
|Date of Claim: |Type of Claim: |
| |( Extended Health ( Dental |
|Have you contacted Sun Life regarding this matter? ( No ( Yes |
|If yes, please provide details of the call, including name of the Adjudicator spoke to. |
|Reason For Denial |
|PLEASE ATTACH COPY OF THE EXPLANATION OF BENEFITS YOU RECEIVED FROM SUN LIFE |
|Resolution (for administrative purposes only) |
| |
| |
| |
| |
|( Adjudication Error ( Incomplete Information Provided ( |
|Coordination of Benefits Issue ( Dependent Status not updated ( Other |
|___________________________ |
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