Who is eligible for STD benefits?

Employees in the following Benefit Class are eligible to apply for Short-term disability benefits:

• Benefit Class 1: Permanent Full-time and Part-time employees
• Benefit Class 2: 1-year contract employees
• Benefit Class 4: Priests

There is no termination age for this benefit, providing that you continue to be: an insurable employee, actively at work, and meet the definition of disability.

This wage-loss benefit is available when eligible employees become disabled due to non-work-related injuries while insured and suffer a loss of earnings as a result. Disability means being unable to perform the essential duties of the employee’s occupation for your or any other employment due to illness or injury. Medical evidence must support this accordingly. The availability of work is not considered when assessing disability.

The benefit is payable at 66.67% of weekly earnings. STD payments are paid weekly in arrears by the disability office. Weekly earnings are your annual earnings divided by the number of weeks you work and are paid for. Examples: 43 weeks (if the employee is a Teacher and/or Teacher Aide), 48 weeks (if a Principal), and 52 weeks for a 12-month employee.

• STD, which extends into summer periods (July 1st to August 31st), will stop on the last day of June for workers on a 10-month work schedule and resume in September if the disability continues. Workers on a 12-month schedule will have no interruption of payments. Sample benefit calculation (employee is a 10-month employee, earning $45,000/year):
  • $45,000 (gross annual earnings) ÷ 43 (weeks worked) = $1,046.52 (gross weekly earnings)
  • $1,046.52 (gross weekly earnings) x 66.67% (STD benefit amount) = $697.72 (STD benefit amount)

How long is the STD benefit available? For an approved STD claim, benefits are payable for a 15-week period. During this time, the disability office reserves the right to request updated medical information to support your claim. In such cases, the disability claimant is expected to keep in touch with their doctor to be sure such reports are sent promptly and do not delay the payment.

This is a non-taxable benefit; therefore, a T4A will not be issued by the disability office for Income Tax purposes.

There is a 7 consecutive day waiting period from the last full day worked until the first day payable for disability. Statutory holidays are counted as part of the waiting period and are paid for by your employer. It is presumed you will use “sick days” according to your contract to remain at full pay during this waiting period. • If you apply for disability, you CANNOT use banked sick days in excess of the 7 consecutive days waiting period – even if you have them accumulated. This is a contractual stipulation with Canada Life that must be adhered to.

• If you have exhausted all of your sick days within the 7 consecutive days waiting period, then any days in excess of your sick days would result in time off without pay.

The disability office must receive proof of claim within 90 days after the disability begins. Please refer to the Forms/Claim forms/Disability portion of our website to obtain the applicable Employee and Employer Statements.

• Within the Employee Statement, there is the Physician Statement that must be completed. The doctor must specify your diagnosis/prognosis and any other applicable information to support your claim.

When you are on disability, all your benefits continue except for the Pension benefit. As an STD claimant, you are still responsible for paying your share of the benefit premiums.

Who is eligible for LTD benefits?

Employees in the following Benefit Class are eligible to apply for long-term disability benefits, providing that they continue to be an insurable employee, actively at work, and meet the definition of disability:

• Benefit Class 1: Permanent Full-time and Part-time employees
• Benefit Class 4: Priests This benefit terminates at age 65 as you are then eligible to receive Old Age Security (OAS) benefits.

Definition of Disability

LTD continues to be a wage-loss benefit available when eligible employees become disabled due to non-work-related injuries while insured and suffer a loss of earnings. Medical evidence must support that during the first 24 months of payments, an employee will be considered disabled if unable to perform the essential duties of the employee’s occupation for your or any other employment due to illness or injury. The availability of work is not considered when assessing disability. After 24 months of payments, the employee will be considered disabled due to illness or injury if unable to perform the essential duties of any occupation for you or any other employer for which the employee is qualified or could reasonably become qualified based on education, training, or experience. The availability of work is not considered when assessing disability.

How is the LTD benefit calculated?

The benefit is payable at 67% of pre-disability monthly earnings. This means that there is a lapse of time for a period of 1 month after the last weekly STD payment is issued to the first LTD monthly payment.

• Your gross annual salary is divided by 12 (months) to calculate your monthly earnings. Please note that for Teachers and Principals, although you are paid over a 10-month period, your salary represents earnings incurred for a 12-month period.
• Unlike STD, LTD payments continue throughout the summer (July 1st to August 31st), so there is no break in coverage. Sample benefit calculation (employee is a 10-month employee, earning $45,000/year):
  • $45,000 (gross annual earnings) ÷ 12 (months per year) = $3,750 (gross monthly earnings)
  • $3,750 (gross monthly earnings) x 67% (LTD benefit amount) = $2,512.50(LTD monthly benefit amount)

Non-taxable benefit

• This is also a non-taxable benefit; therefore, a T4A will not be issued by the disability office for Income Tax purposes.

Satisfying the LTD waiting period

The waiting period before the employee can receive LTD payments is 119 days. Please note that the 119 days represents the 15-week benefit period for STD. Therefore, once you have exhausted the STD benefit, you are eligible for LTD benefits. Canada Pension Plan (CPP) Prolonged disability will prompt Great-West Life to ask you to apply for Canada Pension Plan (CPP) disability benefits. Your CPP income is deducted (direct offset) from your LTD benefit if approved.

Continuation of benefits & premium responsibilities

When approved for LTD benefits, benefit premiums for the Life, Optional Life (if you’ve applied and been approved), AD&D, STD, and LTD benefits are no longer due. However, you are still responsible for paying your share of the benefit premiums for the benefits not listed above (for example, Extended Health, Dental, and Critical Illness).

• The waiver of applicable benefit premiums takes place on the first of the month following approval of your LTD claim by the disability office.

Short-term and Long-term disability insurance plays a valuable role in replacing income lost due to a disability. The best outcome, however, is the return of employees to productive employment. The goal of rehabilitation is to help make that return to employability happen as early and as smoothly as possible for both the employee and the employer.

Employees engaged in approved rehabilitative employment will have their earnings from rehabilitative employment coordinated with their disability benefits. The employer must only pay for the hours/days the employee is at work.

The disability office will be in contact with your local employer to obtain the following information for the period that the employee worked the previous week:

• Specific days that the employee worked
• Hours worked per day by the employee
• Earnings paid by the local Employer

The disability office will then calculate the appropriate disability benefit payment for you (the employee), based on your earnings through the school/parish. This process will continue until you return to work, FULL-TIME.

It’s important to understand that income from all sources can’t exceed 100% of net pre-disability earnings while on a back-to-work program. This 100% clause does not apply if you are solely on disability.

It is your obligation as an employee to ensure that there is clear communication with your local employer at all times in regards to when you are expected to return to work!

Disability, Approved Leave of Absence (LOA) & Maternity Leave

Our Group Policy Contract with the pension department clearly states the following regarding your employer-matched contributions to the Registered Pension Plan (RPP):

“…if a Member is unable to work because of disability (Short-term disability, Long-term disability or WCB), leave of absence or temporary lay-off, all contributions will cease during such periods.”

That being said, the Member may continue to make Voluntary (not matched by your employer) contributions to the Plan while on disability.

For an expectant mother who goes on disability prior to her official Maternity Leave starting, the Pension contributions must be suspended as well. Only when the Maternity Leave officially starts can the employee request to have her RPP contributions reinstated.

An employee who is on a maternity/parental leave of absence may continue to participate in the CISVA, RPP. This is the only type of leave in which an employee may opt-out of the pension plan, and then resume contributions upon their return to work.

This information is reflected on Page 14 of the CISVA Registered Pension Plan booklet.

An employee usually receives credit for service while on STD for the purposes of vacation and employment security. An employee usually does not receive credit for service while on LTD in regards to the Vacation Policy. In general, any vacation outstanding in respect of the employee at the expiry of the STD leave is paid out to the employee at the time they are accepted onto LTD.

LTD Plans or any type of disability insurance plans are considered Income Maintenance Plans/Wage Loss Replacement Plans.

Please refer to your employment contract to confirm if reference is made to your entitlement of vacation time or vacation pay.

Insured with Canada Life Assurance Company

Policy No. 335645 – Division 10

Canada Life Assurance Company

Langley Disability Management Office

2^nd Floor, 8700 – 200 Street

Langley, BC V2Y 0G4

General Office Number: 604-455-2700

Toll-Free Number: 1-877-262-0749

Fax Number:  1-844-569-3131

Email Address: Langley.dmso@canadalife.com 

Disability comes in degrees. At any given time, there may be employees on the job who are at risk for absences and disability. You could be coping with the demands of teenagers or aging parents, trying to manage a medical condition, etc. Other employees could be attempting to return to their normal or work routine after an absence. Any of these situations could escalate into a disability.

The focus of the disability office is on creating opportunities to support recovery and the ability to enable you to return to work.

Once an employee is on short-term disability, the focus shifts to recovery and return. Statistics show the longer an employee remains on disability, the less likely they may return to work. Providing the right support for the right problem early on is critical.

Employees facing a serious long-term disability need the most extensive level of support and intervention to realize their potential. By using the same Case Manager throughout, the disability office provides a seamless transition from Short to Long-term Disability and effective support for our employees.

• Health & Wellness Library – employees participating in our Extended Health or Dental benefits can access a wealth of information to help manage their health through the Canada Life website for plan members (Canada Life website).
• Medical Coordination – provides medical support and expertise from the first report of illness or injury, continuing through treatment. It includes coordinating information between the employees and physician, confirming diagnoses and treatment plans, and faster access to specialists.
• Vocational Rehabilitation, Consulting – provides return-to-work planning, education and job search assistance and helps employees adjust on a personal and vocational level.
• Exchange – a unique communication process that uses facilitated meetings to bring the employee and the employer together early, to work through issues affecting the employer’s return to work.
• STD and LTD Case Management – progressive case management services designed to ensure claims are handled according to the terms of your plan.
• At-Work Services – provides vocational or medical rehabilitation and related services while the individual is still at work, to help the employee remain on the job.

Every claim submitted to Canada Life will be unique but will follow through a management approach that offers the following key-value points:

• Timely information gathering and initial assessment
• A team approach to management, quarterbacked by a single Case Manager
• Regional claim management
• Vocational Rehabilitation consultants who focus on the non-medical elements of case management
• Medical Coordinators who can add value where medical attention or interpretation is a barrier to return to work

At the heart of the management team is the Case Manager. This person is responsible for a claim from inception until the employee returns to work, or otherwise is no longer eligible for benefits.

Gathering information quickly and making an initial assessment early is critical. For straightforward claims, the value the disability office looks to add is:

1. To get the employee their income as soon as possible
2. To minimize the investment in resolving the claim by avoiding the collection and expense of unnecessary reports and documentation

More complex claims can pull in the expertise of specialists to achieve and return to work goal. In most of these cases, early telephone contact will be established with the employee to get a good first-hand understanding of the disability, and to set the stage for the process. With these cases, the goal is to apply more resources to the management of the claim where there is a good expectation an early return to work may be achieved.

The two primary resources the Case Manager may call upon are their Vocational Rehabilitation consultants and their Medical Coordinators.

All of the Case Managers are trained to recognize situations where employees are suitable candidates for return to work programs. The Case Manager would then engage one of their Vocational Rehabilitation Consultants who will work together with the employee, employer, and the attending physician to implement and monitor the program.

Canada Life’s Medical Coordinators are qualified professionals with a medical background and several years of experience managing disabilities. The expertise they bring is important since prolonged waits to access a specialist can otherwise cause unnecessary frustration and uncertainty, as well as delay treatment and jeopardize a successful return to work.

Some of the other resources the Case Manager may use throughout the management of a claim could include the following:

• On-line access to proprietary disability management manuals and medical investigation manuals
• Local Medical Consultants, whose primary function is to assist with the interpretation of medical files
• Independent Medical Examiners may be used where the medical information may not be fully available
• Surveillance and fraud investigation tools are available on extreme and generally rare occasions.

Finally, as a part of the financial management of a claim, the disability office will correspond with the employee concerning their application for other income benefits, such as C/QPP and Workers’ Compensation.

Before a claim decision can be made, the Case Manager must review the claim to gain insight into its complexity and validity. This step in the process includes gathering information about the claim and verifying the plan parameters and assessment criteria.

The first information gathered by the Case Manager will be the claim form and the physician’s statement. If the documentation is straightforward and complete, then the claim decision can be made quickly and accurately. On the other hand, if the information is not straightforward or incomplete, it is examined more closely.

Canada Life may call employees to obtain information about their condition and treatment. Then, if additional information is needed, more specific questions can be directed to the employee’s physician. Calling the employee establishes early and personal contact and sets the stage for potential rehabilitation discussions.

The Case Manager must assess the plan-specific criteria before making a decision. This entails reviewing eligibility requirements, plan limitations, and any further plan-specific criteria within the CISVA Group Policy Contract. Once these plan parameters are verified, then the disability office can accurately assess the claim against the contractual provisions of the CISVA plan.

Once the claim has been initially reviewed, the Case Manager can then assess the claim and determines if it satisfies the plan provision. If the claim is accepted the management of the claim begins. If the claim is declined, then the employee is advised concerning the reasons for the declination. Information is also provided on additional medical facts needed for further review or on how to appeal the decision should the employee disagree with the discussion.

In making an initial assessment of a claim, the disability office reviews all of the information gathered pertaining to the claim. This initial assessment will give direction to the claim, and assist in determining the plan for further handling of the claim.

• Maximize Return on Investment

In order to maximize return on investment, the Case Manager must make sure that straightforward claims are paid accordingly, and only investigate the more complex claims further.

• Plan provisions

In order for a disability claim to be accepted, the disability must be covered in the CISVA plan provisions; therefore, the Case Manager must check the plan provisions before moving forward with the claim assessment.

• Limitations and Exclusions

Limitations are provisions that may result in a claim terminating (temporarily or permanently) if certain criteria have not been satisfied. Exclusions, on the other hand, are initial requirements that, if not met, will result in a claim being declined (i.e., a pre-existing condition).

The Case Manager uses many tools when deciding on a claim. These tools are important in making the right decision in a timely matter.

• Manuals

At Canada Life’s disability offices, they have created proprietary manuals to assist in assessing and managing disability claims.

• Normal Convalescence Periods

Industry-recognized reference materials are used to establish a normal recovery period for disabilities. These reference materials and the knowledge of Medical Coordinators and Medical Board Consultants allow the disability office to determine duration period information. This also enables the Case Manager to make appropriate plans for the employee to return to work.

The Case Manager determines when it is appropriate to use the services of a Medical Consultant. The medical consultant interprets the medical test results and other clinical information. The Case Manager then compares the medical restrictions to the employee’s job abilities to assess if the employee is medically able to do their job.

If a claim is declined or disputed, the employee has the right to an appeal; this right to appeal is outlined to the employee in the decision letter. The review process requires the employee to submit additional information. The employee may also appeal by providing detailed reasons why the claim should be reassessed. Upon receipt of the additional information, the employee will be provided with the results of our reassessment.

The management of a disability claim is the most detailed part of the disability claim process. In order to manage such detailed claims, Case Managers frequently use the following tools:

• Medical Coordination
• Rehabilitation
• Reviews

The overall objectives to the management of a claim are to:

1. Maximize non-medical management via Vocational Rehabilitation Consultants
   2. include Vocational Rehabilitation and Medical Coordination in detailed claims
   3. Have the Case Manager act as the “Gate Keeper”, responsible for the management of the claim from inception until the return to work
   4. use other supplemental disability tools to help manage the claim

Case Managers can use many different tools to manage a disability claim. These tools are in place for the Case Manager to get the employee back to work as soon as possible. The main disability management tools are as follows:

• Vocational Rehabilitation Referral

Vocational Rehabilitation Consultants are internal specialists that focus on return-to-work planning and management.

• Medical Coordination

Canada Life’s Medical Coordinators are qualified professionals with a medical background and several years of experience managing disabilities. The expertise brought is important since prolonged waits to access a specialist can otherwise cause unnecessary frustration and uncertainty, delay treatment and jeopardize a successful return to work.

Ongoing Medical Coordination supports the treatment plan by focusing on realistic return-to-work options. Throughout the disability, the disability office maintains close contact with the employee, physician(s), and employer to coordinate medical care and return-to-work planning.

• Disability Reviews

Disabilities will be reviewed at various times during the claim. The timing depends on the medical condition and the treatment plan. The disability office may contact the employee by phone to determine the appropriate timing of these reviews. This personal approach to the claim review keeps the employee and the Case Manager in constant communication throughout the claim.

• Medical Consultants

A Medical Consultant may be used at any time to assess a claim. Their expertise can assist in interpreting test results, reviewing current treatment plans, or other clinical information. Referral to a Medical Consultant may also be an appropriate approach when trying to bring a new treatment direction to the management of a claim. Medical Consultants can provide recommendations for medication and future treatment that may be more comprehensive than those available from a basic assessment.

• Independent Medical Exam

Canada Life arranges an Independent Medical Examiner (IME) when the situation is appropriate, and the cost of an examination is warranted.

• Functional Capacities Evaluation

Canada Life uses Functional Capacity Evaluations to test for abilities in different tasks. This evaluation, often conducted by occupational therapists, verifies the employees’ abilities through medical exams and physician’s tests.

• Fraud Investigation

Canada Life has policies and procedures for identifying and investigating potentially fraudulent claims. The Case Managers are in the best position to identify possible fraudulent claims and cases of abuse. Information that does not appear consistent or logical may provide an initial warning of a possible fraudulent claim.

• Activity Investigation

Activity investigations using third-party investigators are not routine in disability claim management. However, they can be important in cases where the medical information may support the employee’s entitlement to benefits, but the degree of disability is in question. Under these circumstances, an investigation is initiated to determine whether the employee’s observable daily activities correspond with the degree of disability claimed. An investigation may also be warranted in response to suggestions that the employee is engaged in other employment and thus earning income that should be offset from the disability benefit.

Experience has shown that early initiation of rehabilitation is an integral part of effective, comprehensive disability management; therefore, the possibility of rehabilitation is immediately considered in claim assessment. If appropriate, a telephone interview will be conducted to assist in developing rehabilitation plans and programs for the employees.

The disability office strives for a seamless disability approach allowing for an easier transition between Short Term and Long Term disability benefits. The assigned Case Manager is responsible for referrals to Medical Coordination and Vocational Rehabilitation and the claim assessment. Individual claim attention provides consistent and proactive management of the claim and a personal touch in what is often a difficult time for the employee.

Alternate sources of income, such as CPP, WCB, and auto insurance, act as significant sources of savings for disability benefits. The disability office ensures that any employee entitled to these alternate insurance benefits is notified of their potential entitlement.

Canada Life advises the following individuals to pursue a claim with CPP benefits:

People with degenerative, chronic, or terminal conditions.

Where there is no indication that a person is medically capable of any work (i.e., If it appears improvement is unlikely, benefits may continue until age 65),

Or where the person is over age 60 and not expected to recover from their medical condition and be able to perform any work.

In these situations, benefits could continue beyond the change in definition point, so it is appropriate to advise employees to apply for these CPP benefits.

Canada Life will request a completed CPP option form, a CPP assignment form, and a copy of the CPP/QPP confirmation of application from the employee. The disability office continually assesses claims each time new information is received to determine if the employee should be pursuing a claim with CPP.

The possibility of auto insurance benefits is considered whenever disability results from a motor vehicle accident. If alternate benefits are denied, the disability office will assume liability provided other contract requirements have been satisfied.

Once a claim has been approved, the employee is entitled to disability benefits. The following point needs to be taken into consideration to claim payments:

Canada Life currently supports two methods of payment – Direct Deposit and Cheque Payment. To process an electronic fund transfer, Canada Life requires bank identification and account number for each disability claimant. If the employee chooses cheque payment, the disability office sends the cheque directly to the employee.

Termination of the claim is the final step in the disability claims process. A claim is considered terminated once an employee has returned to work or no longer meets the CISVA plan provisions. For those employees who have received Long Term Disability benefits for more than two years, the employee will receive 30 days’ notice before the termination of benefits; for those whose Long Term Disability benefits are terminating due to a change in the definition of disability. The disability office will advise employees of their decision as early as possible. If a claimant feels their claim has been terminated prematurely, they are entitled to an appeal.