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Get and Sign G6v 8c6 2020 Form
Injury? Yes If yes: C No • a motor vehicle accident? Yes No • Please note that the claim must first be submitted under your provincial workers’ compensation plan or automobile insurance plan (if applicable in your province) before being submitted to your group plan. Date of YY • Name of injured person accident MM DD COORDINATION OF BENEFITS - This section MUST BE COMPLETED if claiming for a spouse or child. The coordination of benefits may entitle you to a reimbursement of up to 100% of...Show details
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