To use the Add to cart function, you must change your Web browser’s parameters to accept cookies. Once the parameters have been changed, you must refresh the Web page.
This form is to be used by the physician to submit to Retraite Québec report on the state of health of a person who has applied for disability benefits.
electronic signature is accepted on this form.
Notice to disabled persons
You could receive a disability pension under the QPP, but you are already receiving disability benefits from an insurance company? With this form, you are authorizing us to remit the benefits you already received to it, in whole or in part. Complete the first part of the form. Then, ask your insurance company to complete the second part.
By signing the form, you are agreeing to file an Application for Disability Benefits with Retraite Québec. Review your contract with your insurance company, because you may not be required to complete the form.