Application for Benefits and Forms


Since April 1, 2016, crime victims and rescuers have been required to provide a diagnosis from a physician as objective proof of injury. The diagnosis is used in analyzing applications for benefits and assessing eligibility.

This new procedure paves the way for rapid medical case management and greater efficiency throughout the file handling process at the Direction de l'IVAC.

The medical report required is the CNESST Rapport médical or Attestation médicale. Since the Régie de l'assurance maladie du Québec (RAMQ) automatically reimburses physicians, there will be no charge for this report.

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Application for Benefits

Fill out this form and send it to the Direction de l’IVAC.

Authorization to forward copy of file

This form must be completed for the Direction de l’IVAC to obtain the medical or psychosocial reports required.

Information on Employee Remuneration

Have your employer fill out this form.

Expense claim

To obtain a reimbursement for expenses (travel, medication, meals, accommodation) previously authorized by the compensation officer in charge of the file.

Originals of receipts are required.

Agreement to act ex-officio as proxy of the beneficiary

This form must be signed by the person responsible for managing sums paid to a victim who is a minor or disabled. The Direction de l’IVAC transmits the information to the Curateur public.

Direct deposit

Fill out this form for direct deposit of money paid to you by the Direction de l’IVAC into your bank account.

Extension of Pension

Declaration and certificate of attendance at educational institution to be completed a the beginning of every academic term and sent to the Direction de l'IVAC.