What the 02025A is for
The 02025A is the initial medical statement for a disability claim under a Desjardins group insurance plan. It has two versions in one file: one for physical illnesses and one for psychological illnesses, each on its own page. It carries the logos of the Fédération des médecins omnipraticiens du Québec and the Regroupement des assureurs de personnes à charte du Québec. Desjardins’ claims page now lists its own disability claim package (06329E) as the initial form, so check which one the plan member’s package asks for.
Who completes it
The employee completes Section 1 with their name, policy or group number and certificate number. The attending physician completes Sections 2 to 6 of whichever version fits the condition.
Employees usually get the form from their employer or the plan, fill in Section 1 and bring it to the appointment. In Medulla, you can send Section 1 to the patient over a secure link, and their policy and certificate numbers appear on the PDF you complete the medical sections on. It’s a small section, but it’s the one that matches your statement to the right claim.
How to fill in the physician’s sections
Section 2: Diagnosis
On the physical version, give the principal and secondary diagnoses and complications, previous treatment for the same condition, whether the disability is from an accident, illness, occupational or automobile accident, pregnancy or preventive withdrawal, and the event date. Then describe the functional limitations that stop the patient doing their job, at the start of the disability and now. On the psychological version, give the diagnoses, current symptoms, overall severity, the problems behind the work interruption, and previous episodes.
Section 3: Treatment
List medications and dosages. On the physical version, record tests, surgery, other treatment, hospitalization and observation stays. On the psychological version, record whether the patient is consulting a psychiatrist, psychologist or social worker, and any hospitalization.
Section 4: Follow-up and prognosis
Give the date of first consultation for this disability, the next appointment, other consultation dates, follow-up frequency and any referral. Estimate the duration of disability in days or weeks, or a return date, and how long until the patient can return part time, full time or gradually.
Sections 5 and 6: Additional information and physician
Add anything else on a separate sheet if needed. Give your name, licence number and whether you’re a general practitioner or specialist, then sign and date.
Common reasons it’s delayed
- The physical version used for a psychological condition, or the reverse.
- A diagnosis with no functional limitations described.
- No estimated duration or return-to-work timing.
- Missing policy or certificate numbers in Section 1.
- The physician’s licence number or signature left out.
Submitting and who pays
The form goes to Desjardins online, by mail or by fax, at the addresses printed at the top. Desjardins asks for original forms by mail and suggests keeping copies. The employee pays the fee for completing the form, so clinics bill the patient directly.