What is expected of you when claiming Short Term Disability Benefits
SHORT-TERM DISABILITY PHASE I (STD-I)
The maximum STD-I benefit period is 18 weeks. STD benefits are paid once every 2 weeks. It is your responsibility to submit medical documentation to support a claim of Total Disability.
To qualify for ongoing benefits you must be "medically" unable to perform each and every duty pertaining to your own job due to illness or accidental injury.
You must be under the Regular Supervised Care of your Treating Physician (Social Workers, Counsellors, Psychologists, Naturopaths, Physiotherapists do not meet this criteria although they may play a part in your Doctor's Treatment Plan for you) and be receiving active medically recognized treatment for the totally disabling condition. This means that you should consult your Physician (MD) within the first 14 days of your illness/injury and on a regular basis thereafter to monitor your progress and recovery.
Your Initial Claim Form has 4 sections: 1) one provides instructions in submitting a Short-Term Disability (STD) claim; 2) one is for completion by the Employer who will list such things as your date of hire, name, employee number, job title, date you last worked, whether your condition is work related; and your basic weekly wage including longevity at the time you stopped working. Benefits are based on your basic weekly wage and longevity pay; 3) one part is for you to complete and sign giving your name, address, telephone number, work location and information about your condition; 4) the final part is for the Attending Physician to complete. If there is a fee for completion of this form, it is your responsibility.
The 'Attending Physician' is the Doctor who will be treating you on a regular basis throughout your disability period. This is usually your 'Family' Physician. It is not the Employer's Physician. When the Employer's Physician is your treating Doctor usually your medical is available to your Employer and is not a private matter between your Physician and you alone. If the Employer's Physician is your treating Physician, this can be viewed as a 'conflict of interest'.
The Claim Form also includes an Authorization Request for signature by you allowing the release of medical information to the Administrator of your Plan and the Insurance Company.
Most importantly, the Attending Physician's Statement should be completed in its entirety by your Family Physician (General Practitioner or GP) and include the following: Medical Diagnosis, Secondary Diagnosis, Symptoms, Name and Dosage of any Prescribed Medication, Name of Specialists to whom you have been Referred, Type of Treatment Recommended (i.e. physiotherapy), type of tests/x-rays ordered and results, how the condition prevents you from working, and information on any complications or unusual circumstances to consider that could be helpful in the assessment of your claim, and a goal date for a return to work.
Proof of Disability is a requirement under your GIDIP coverage (Policy 71405). Your employer will mail you the initial STD claim form. Your completed claim form must reach the Plan Administrator within 90 days of your Total Disability. You may forward the claim form by facsimile to start the claim process, but you must submit the original claim form for ongoing benefit consideration. Thereafter, Medical forms will be sent to you periodically for your GP or Specialist to complete. These forms should be completed and returned as quickly as possible to avoid any interruption in your benefits.
You may call your Plan Administrator Toll Free at 1-800-268-0285 to update your claim and changes in your treatment program.
EXTENDED SHORT TERM DISABILITY BENEFITS
(EMPLOYMENT INSURANCE SICK BENEFITS)
Your Group Insurance Plan allows benefits under the GIDIP program for up to 18 weeks, after which you are in the Employment Insurance (EI) Sick Benefit period (government program) of your claim.
If you do not return to work within the first 14 weeks of the STD-I benefit period an Application to apply for EI Sick Benefits will be mailed to you with a letter outlining how to apply for these benefits. A copy of this letter will also be mailed to your Employer's Human Resources. You will require a Record Of Employment (ROE) from the Employer when applying for EI Sick Benefits.
It is important to make application quickly if you do not expect to return to work because EI takes approximately 3-4 weeks to process your claim. EI provides a maximum of 15 weeks sick benefits, which are taxable to you.
If you are returning to work under a Rehab Program during the EI Benefit Period, please refer to the Rehab Section of the Brochure.
SHORT-TERM DISABILITY - PHASE II (STD II)
After a 35 weeks of Total Disability (2 weeks 'waiting period', 18 weeks of STD-I benefits, 15 weeks of EI sick benefits) you are eligible to apply for STD-II benefits. The maximum STD-II benefit period is 17 weeks. At this stage in your claim it would be expected that you are either under the care of a Specialist or have been assessed by a Specialist relative to your condition.
If you are still disabled and receiving EI sick benefits at week 11 of the EI sick benefit period, the Plan Administrator will forward a 'Continuing Disability Claim Form' to you for completion by you, your Attending Physician and/or MD Specialist.
You may also be requested to submit specific updated medical documentation to support ongoing Total Disability. This medical could include recent Specialist Consultation Reports, copies of recent tests/x-rays results, progress notes, copies of treating professionals' clinical notes, medication information, etc. You must submit supporting medical documentation to substantiate continuous Total Disability and treatment throughout the EI Sick Benefit Period.
STD-I and STD-II benefits are non-taxable because you pay the premiums in full.
WHAT YOU CAN EXPECT WHILE ON GIDIP
Your Disability Case Manager may contact you to conduct a Telephone Interview with specifically designed questions to assist in understanding your condition and your medical limitations.
You may also be asked to complete an Employee Questionnaire. The information you give on this form will assist in understanding how your condition limits your daily activities compared to your pre-disability abilities.
If your claim has been accepted and benefits paid, a Narrative Report may be requested directly from your GP or Specialist. This offers a more detailed medical account of your condition. Conversely, you may be requested to forward a copy of all Specialists' Consultation Reports, Physiotherapy Reports, all test results, etc.
During the course of your claim, an Independent Medical Examination (IME) may be arranged. If this occurs you will be notified. This is used for a second opinion of your condition when medically warranted and is not dictated by you or your Physician, but is at the sole discretion of the Insurance Company. The IME Report is the property of the Insurance Company; however, a copy of the IME Report and/or recommended Treatment may be sent to your Family Doctor to assist in the ongoing management of your condition.
Your Plan employs an in-house Medical Consultant for internal consultation purposes when a further review of your claim is medically required.
All Medical submitted is Private and Confidential.
MODIFIED RETURN TO WORK UNDER GIDIP
Rehabilitation GIDIP 'top up' benefits ARE NOT automatic but MUST be approved by the Insurance Company. Because your Employer offers you a return to work on reduced hours does not mean that you will qualify for GIDIP rehabilitation benefits. A return to work on reduced hours must be recommended and medically supported by the medical documentation submitted from your Primary Care Physician/Specialist.
If you have been receiving Benefits under GIDIP or under the EI Sick Benefit period and feel you are unable to return to work full time but would like to try returning on a part time or modified work schedule, you may qualify under your GIDIP.
Should you be interested in Returning to work under a Rehab Program and wish to know if you qualify for GIDIP 'top up' disability benefits, please call Toll Free 1-800-268-0285 for more information.
WORKERS' COMPENSATION CLAIMS
A GIDIP Claim Form should be completed if you have a work accident and have been away from work for longer than 14 days. Remember, you must submit a GIDIP Claim Form and the claim form must reach the Plan Administrator's office within 90 days of becoming Totally Disabled whether or not Workers' Compensation (WC) accepts your claim.
If Workers Compensation does not accept your claim, Bridge-Financing is available. This means that your claim will be paid if the Medical information supports Total Disability under your GIDIP Policy. However, you will be required to Appeal the WC decision and to sign a 'Reimbursement Agreement' promising to repay the Insurance Company who underwrites your GIDIP Plan if your WC claim is approved in future for the same period you received GIDIP benefits. The Reimbursement Agreement form must be signed prior to releasing any GIDIP benefits because Workers' Compensation is first payer of a work-related condition.
The Workers' Compensation disability period and the GIDIP disability period run side byside. Any amount of WC benefit you receive is deducted from any eligible GIDIP benefit. Any week for which your GIDIP benefit is zero is still counted towards the Maximum Benefit disability period under your Disability Policy.
STD CLAIM FILE REVIEW
You have the right to request a claim file review for your Short-Term Disability claim. Upon request and authorization from you, your Board of Trustees will review your claim file at their quarterly Board of Trustees' Meeting. Your Plan Administrator, Canadian Benefits Consulting Group, will provide you with an Authorization Form for you to sign, date, have witnessed and return in order to release your confidential claim information to your Trustees during these Meetings.
Decisions on your STD claim are based on the terms of the Group Insurance Disability Policy. However, your Trustees can review your claim and ensure you have been treated fairly and equitably and that all medical information is on file.
LONG TERM DISABILITY BENEFITS (LTD)
Six weeks prior to the end of the STD II, if there has been no Notification of Return to Work, you will be mailed a Long Term Disability (LTD) Application and instructions on how to apply. Should you have any questions, please call (416) 488-7755 OR 1-800-268-0285.
Your LTD Application Claim Form must reach the Administrator's office within 90 days of the eligibility date listed on the letter accompanying the LTD Application form sent to you. After that time period, your claim could be 'declined' as 'late submitted'.
Under your LTD Policy, the definition of 'Total Disability' changes after receiving LTD benefits for 2 years/24 months. After that time period, you must be Totally Disabled from 'any occupation' for which you may be suited by education, training or experience. This means any and every gainful occupation and does not limit your ability to work for the same employer. It also means any employer. LTD GIDIP benefits are non-taxable to you.
CANADA PENSION PLAN OR QUEBEC PENSION PLAN (CPP/QPP) - DISABILTIY BENEFITS
After you have been Totally Disabled for 4 months and it appears that you may meet the definition of Total Disability under the CPP/QPP legislation (a physical or mental impairment that is severe and prolonged) you will be requested to apply for CPP/QPP Disability Benefits.
This is a requirement of the Disability Policy. Any benefits paid by CPP/QPP will reduce your GIDIP benefit in the amount of 90% of the monthly CPP/QPP benefit award. CPP/QPP disability benefits are taxable.
You are not required to pay premiums for STD and LTD coverage during the period you are in receipt of either of these benefits.
This is an information bulletin only and does not replace the Policy. In all instances, the Policy overrides the Benefit Booklet and any Brochures provided to you to assist you in better understanding your Disability Plan.
YOUR BOARD OF TRUSTEES
Always communicate with your Plan Administrator if you have any claim-related questions.
THE PLAN ADMINISTRATOR
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
lc: en What is Expected of you when on std - June05