Understanding your insurance

Understanding your insurance

 

REHABILITATION PROGRAM AND/OR MODIFIED RETURN TO WORK PROGRAM

Returning to work under a Modified Return to Work/Rehab Program? Please read the following:

The Modified Return to Work Program provision under your Disability Policy is a program provided to a Member at the sole discretion of the Insurance Company, Great-West Life.

1. Who determines if I qualify for group insurance benefits under a Modified Return to Work and/or Rehab Program?

Canadian Benefits Consulting Group, the Plan Administrator for your Short-Term Disability Plan (STD), will determine whether or not a Rehabilitation Program is appropriate and/or insurance approved in reference to Rehab benefit eligibility for any Member under your Group STD Policy. Great-West Life administers your Long-Term Disability (LTD) Plan and they will have sole discretion in determining eligibility for Rehab insurance benefits under the LTD Plan.

2. How is eligibility determined?

Eligibility for this Program will be based on the medical documentation received from your Attending Physician and/or your Specialist (Medical Doctor). It is not dependent on whether the Company Physician recommends that you return to work under a Rehabilitation Program. Rehab insurance benefits are not automatic.

If you are thinking of returning to work under a Rehabilitation Program you must keep your Disability Case Manager (DCM) informed to determine if you qualify for Rehab insurance benefit consideration.

3. When is a the Modified Return To Work and/or the Rehabilitation Program available to me?

The Modified Return To Work Program is available to eligible Members whose medical documentation on file with the Insurance Company supports a return to work under this Program and who are unable to return to their pre-disability work schedule immediately after receiving Group Insurance Disability Benefits.

4. (a) What is the purpose of a return to work under a Rehabilitation Program?

The purpose of the Modified Return to Work Program is to assist you back to full-time employment on a gradual basis when medically required and supported.

There must be a plan of treatment in place outlining a schedule for the gradual return to work with a goal date for a full-time return to work. Once your Modified Return to Work is approved for insurance benefits, if you cannot return to work at the planned date you must submit medical from your Attending Physician/Specialist that supports a further rehabilitation period. Under this Program the Insurance Company expects either regression or progression. If your condition has regressed or remains unchanged, your Attending Physician must explain:

(i) how your condition has regressed or has remained the same; (ii) how it has medically affected your inability to return to your full-time work schedule; (iii) the treatment implemented to assist you in reaching your goal of a full-time return to work and a new final date for such a return.

(b) What does 'gradual return to work' mean?

A gradual return to work means that you return to work at a stated number of hours per day increasing the hours over the next several weeks to build up your ability to maintain your full pre-disability daily work schedule.

5. My Physician advised me that I can return to regular work on a full-time basis. However, before I can return to work, I am required to see the Company Physician who suggested that I return to work on modified hours.

The Insurance Company bases benefit eligibility for a Modified Return to Work on the medical documentation received from your Attending Physician who is your treating Physician on file with the Insurance Company. Your own treating Physician has monitored your condition to establish your ability to perform your regular or modified duties when you return to work. Please see #2 and # 3 of this brochure. If the medical documentation on file with the Insurance Company does not support a Modified Return to Work Program, insurance 'top-up' benefits will be denied.

When you return to work under a Modified Return To Work Program that is not insurance approved, disability coverage is terminated and is only reinstated when you return to your full work schedule.

6. What if my Physician supports a Modified Return to Work and writes me a note? Do you require any other forms?

A note alone is not sufficient to support a Modified Return To Work Program. You must submit:

(a) From your Attending Physician:

(i) a schedule for a Modified Return to Work, including a goal date for a full-time return to work; and

(ii) If there is insufficient medical on file to support such a return to work, you must also submit medical documentation outlining the medical reasons you require a gradual return to work.

(b) Other:

(i) Your employer will provide you with a Rehabilitation Letter of Agreement. This Agreement states that there is no shift trading, no overtime and no vacation allowed during the Rehabilitation (Modified Return to Work) period. You must submit a copy of this Agreement to the Insurance Company.

(ii) Your employer also requires that a Work Evaluation Form be completed. You must submit a copy of the completed Work Evaluation Form to the Insurance Company.

(iii) You will be asked to submit medical updates on your condition from your Attending Physician at regular intervals depending upon the length of the Modified Return To Work Program approved for insurance benefit 'top up'. Your Physician will monitor your health status to see how you are recovering during your work re-integration.

When you have submitted all the required documentation listed, the Insurance Company will advise you by letter if you are approved for insurance benefit 'top up' for a Modified Return To Work Program. This letter will usually include the date to which rehab insurance benefits have been approved.

7. My Employer has approved vacation for me during the rehab period. Will I continue to be eligible for rehab benefits upon my return from vacation?

When you return to work under an insurance approved rehab program you will no longer be eligible for insurance 'top up' benefits if you take vacation. If you need to take vacation, please discuss with your insurance Disability Case Manager prior to such vacation.

8. Once I am approved for a Modified Return to Work Program by the Insurance Company, how do I get paid?

(a) Your employer will pay you wages for the hours you work. Your Group Insurance Plan will pay you for the hours you are not scheduled to work.

(b) You must ensure that your Human Resource Administrator forwards the hours you worked to the Insurance Company at the end of each pay period. Upon receipt of these hours, your benefits will be paid. You will receive a calculation sheet with your payment showing how your insurance benefit was determined.

9. What happens if I am ill during the Modified Return to Work Program and am unable to work my scheduled hours? Will you pay me Disability Insurance Benefits?

If you are unable to work your scheduled hours, because of illness, you must see your Physician and submit a note from him/her confirming your inability to work on the day missed listing the medical reasons.

10. How long can I expect to receive insurance benefits under the Modified Return to Work Program?

The duration for the Rehabilitation Program can vary from 2 - 6 weeks under the STD portion of your Plan. If your Rehabilitation program has not concluded within the normal duration, you must submit the medical reasons and documentation from your treating Physician that would prevent you from returning to full time hours within the normal duration of the Rehabilitation Program. Your GIDIP Plan does not provide benefits for permanent partial disabilities.

11. What happens if my Modified Return To Work Rehab Program has not been completed before the Long Term Disability (LTD) Plan starts?

You must apply for LTD benefits under your LTD Plan. Your LTD Plan is administered by Great-West Life (GWL). When you go from the STD Plan to the LTD Plan, you must submit an LTD Application, Upon receipt of your LTD application, GWL will review your LTD claim for ongoing insurance Rehab benefits and advise you of their decision.

If you are in receipt of LTD benefits and return to work on an insurance approved Modified Return to Work Program, please note that Modified Return to Work (Rehab) benefits will usually terminate at the end of the 'own occupation' period under the LTD Policy/Plan. Please refer to your benefit booklet in reference to the 'own occupation' definition under your LTD Policy/Plan.


This brochure is provided as a tool to assist you in understanding your disability plan and the modified return to work program under your insurance plan/policy. It is not meant to replace the Group Insurance Disability Policy.


CANADIAN BENEFITS CONSULTING GROUP LTD.
2300 YONGE STREET, SUITE 3000
TORONTO, ON M4P 1E4

Telephone : (416) 488-7755
Toll Free : 1-800-268-0285
Fax: (416) 488-7774


Canadian Benefits Consulting Group Ltd. June 1, 2002