If the incapacity coverage is provided use the Claim Notification and Medical Certificate forms to report the occupational incapacity of an affiliate.
As soon as the required waiting period is over or you know that it is about to be exceeded, ask the affiliate:
to complete the Claim Notification form and sign it,
- to have their physician complete and sign the Medical Certificate form,
- to have their sickness fund complete and sign the certificate for the first year of occupational incapacity.
The certificate must only be completed when the benefits paid under the occupational benefit coverage take into account the contribution by the sickness fund and the affiliates benefit from a contribution by the sickness fund of 55%. Without the certificate, payment will be based on a 60% contribution by the sickness fund.
Please also send a photocopy of the extension certificates and of any return-to-work certificate to your manager.
After one year of occupational incapacity:
At the end of the first year of incapacity, or as soon as you know that they will be disabled for more than a year and if the benefits paid under the disability annuity coverage take into account the contribution by the sickness fund, request that the affiliate on occupational incapacity leave:
- have their sickness fund complete and sign the occupational incapacity certificate after a year
- send the certificate to AG Insurance - AG Employee Benefits to the attention of the claim manager of your plan at Boulevard Emile Jacqumain 53, 1000 Brussels.
The certificate will enable us to calculate the amount of the benefits starting in the second year given the change in the contribution by the sickness fund starting in the second year of occupation incapacity.