EmailMeForm
Benefits Concern Form
Please fill out this form completely to assist us in helping you resolve your claim.
Name
*
First
Last
Phone
*
###
-
###
-
####
Employee #
*
Email Address
*
Active/Retired
*
Please select
Active
Retired
Retired and Over 65yrs
Former Municipality
*
Please select
East York
Etobicoke
North York
Scarborough
Toronto
York
Has your claim been submitted and denied?
*
Yes
No
Has your pre-estimate been denied. Either electronically or over the phone?
*
Yes
No
Briefly describe your issue. Please note that this information will be sent to the City Benefits staff to administer.
*
Please upload any supporting documentation that you believe will be useful.
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