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The form explains how fees are handled for required examinations and includes signature and date requirements, plus a physician notice defining disability for benefit payment.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/medical-report-for-disability-benefits-under-a-public-sector-pension-plan-consent-and-physicians-notice/308199/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/medical-report-for-disability-benefits-under-a-public-sector-pension-plan-consent-and-physicians-notice/308199.png","ImageObject",300,407,{"name":42,"@type":43},"Aurelia","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-22","2026-09-19",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",10,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"Who is eligible to receive disability benefits under this public-sector pension plan?","Question",{"text":63,"@type":64},"A person who is permanently and totally disabled and entitled to a deferred pension under a public-sector pension plan may receive disability benefits.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What consent does the applicant provide on the form?",{"text":68,"@type":64},"The applicant authorizes physicians, health professionals, and social services facilities to release pertinent medical and psychosocial information to Retraite Québec. This consent also applies to employers and other organizations that the applicant applied to for benefits.",{"name":70,"@type":61,"acceptedAnswer":71},"What information is included for evaluating training and work ability?",{"text":72,"@type":64},"The form requests details about completed schooling, most recent diploma, refresher courses, driver’s license information, job start and stop dates, work hours, reasons for stopping work, job description, and last employer.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},308199,1790095775,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,115,120,123,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":108,"slug":109},7,40,"healthcare",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":112,"show_sort_weight":113,"slug":114},8,"Research & Report",30,"research-report",{"id":116,"doc_module":4,"doc_module_name":25,"category_name":117,"show_sort_weight":118,"slug":119},9,"Religion & Spirituality",20,"religion-spirituality",{"id":118,"doc_module":4,"doc_module_name":25,"category_name":121,"show_sort_weight":118,"slug":122},"World Cup","world-cup",{"id":55,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":55,"slug":125},"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":97,"slug":129},19,"General","general",{"code":4,"msg":82,"data":131},{"doc_id":79,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":139,"language":140,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":12,"update_tm":144,"read_time":145},1099514068365,"https://ap-avatar.wpscdn.com/avatar/10000253d8d9f28188e?_k=1776742907772140068","Medical Report for Disability Benefits Under a Public-Sector Pension Plan  \nBefore completing the form, please read the following information carefully:  \n• As a permanently and totally disabled person entitled to a deferred pension under a public-sector pension plan, you can receive disability benefits.  \n• Your consent is mandatory so that we can access information related to your state of health. A medical report must be completed by your physician and the fees that apply are at your expense. However, if a medical examination is necessary, the fees that apply will be at our expense.  \n• The requested information concerning your studies and your work will allow Retraite Québec’s medical advisors to assess your ability to do your usual work or any other work in which you have acceptable qualifications.  \nPlease print.  \n1. Information on the person who is filing the application for the disability benefit  \n\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |\n| \u003Cbr>\u003Cbr>Write your Social Insurance Number or your identification number, which can be found on your Statement of Participation. |  |  |  |  |  |  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| Social Insurance Number |  |  |  | Identification number\u003Cbr> 1  7         |  |  |  |  |  |  |  |  |  |\n| Sex  F\u003Cbr> M |  | Family name |  |  | Given name |  |  |  |  |  |  |  |  |\n|  |  | Given name at birth, if different |  |  |  |  |  |  | Date of birth\u003Cbr>year month day\u003Cbr>|  |  |  |  |\n| Address (number, street, apartment or Post Office Box) |  |  |  |  |  |  |  |  |  |  |  |  |  |\n| City |  |  | Province |  |  | Country |  |  |  |  | Postal Code |  |  |\n| Telephone\u003Cbr>area code\u003Cbr>Home  area code\u003Cbr>area code\u003Cbr>Other \u003Cbr>Work  Extension  |  |  |  |  |  |  | Language of correspondence\u003Cbr>French\u003Cbr>English |  |  |  |  |  |  |\n| Please indicate the pension plan to which you contributed before your disability. |  |  |  |  |  |  |  |  |  |  |  |  |  |\n\n\n| 2. Information on your training and your work |\n| --- |\n| 2.1 Studies and training\u003Cbr>2.1.1 How many years of schooling have you completed?  \u003Cbr>2.1.2 What is your most recent diploma?  \u003Cbr>2.1.3 Please list other refresher training or courses you have done (including workplace training, special interest courses, etc.) .\u003Cbr> |\n\n1 of 3 Retraite Québec RSP-502A (2023-11)  \n2. Information on your training and your work (continued)  \n2.1.4 Do you have a valid driver’s license?  Yes  No  \nIf so, which class(es) do you have?   Are there any conditions indicated on your driver’s license?  Yes  No  \nIf so, which ones?    \n2.2 Work situation year month day  \n2.2.1 Provide the date on which you began your current job or the last job you had:            \n2.2.2 Have you stopped working completely?  Yes  No  \nyear month day  \nIf so, provide the date of your last day of work:           \nIf not, how many hours do you work per week?    \n2.2.3 For what reason have you completely or partially stopped working?  \n\n|  |\n| --- |\n|  |\n|  |\n|  |\n|  |\n|  |\n|  |\n|  |\n|  |\n|  |\n|  |\n|  |\n|  |\n\n2.2.4 What is or what was your job?    \n2.2.5 Please provide a brief description of your work.  \n\n|  |\n| --- |\n|  |\n|  |\n|  |\n|  |\n|  |\n|  |\n|  |\n|  |\n|  |\n|  |\n|  |\n|  |\n\n2.2.6 Provide the name of your last employer:   area code  \nTelephone            Extension          \n2 of 3 Retraite Québec RSP-502A (2023-11)  \n3. Consent and signature  \n\n| By completing this form, I hereby authorize the physicians, health professionals and social services facilities to release to Retraite Québec any pertinent medical or psychosocial information that they may have concerning me. This consent is also valid for my employers and, if applicable, other organizations with which I have applied for benefits due to my state of health.\u003Cbr>Unless revoked by me in writing, this consent will remain in effect, even in the event of my death, until a final decision is rendered by Retraite Québec","cbCaiiLrjkojTu05","https://ap.wps.com/l/cbCaiiLrjkojTu05","pdf",233948,11,"English","# Instructions and eligibility consent\n## Applicant personal information\n## Training and work history\n## Consent and signature\n# Physician’s part and notice","[{\"question\":\"Who is eligible to receive disability benefits under this public-sector pension plan?\",\"answer\":\"A person who is permanently and totally disabled and entitled to a deferred pension under a public-sector pension plan may receive disability benefits.\"},{\"question\":\"What consent does the applicant provide on the form?\",\"answer\":\"The applicant authorizes physicians, health professionals, and social services facilities to release pertinent medical and psychosocial information to Retraite Québec. This consent also applies to employers and other organizations that the applicant applied to for benefits.\"},{\"question\":\"What information is included for evaluating training and work ability?\",\"answer\":\"The form requests details about completed schooling, most recent diploma, refresher courses, driver’s license information, job start and stop dates, work hours, reasons for stopping work, job description, and last employer.\"}]","Medical Report for Disability Benefits Under a Public-Sector Pension Plan - Consent and Physician’s Notice | PDF",1789862056,28]