Disability Insurance claims – Frequently asked questions
These questions and answers are designed to help you understand more about the Disability Insurance (DI) Plan application process. This guide does not replace or amend your DI Plan – Member Booklet. Please consult your DI Plan Member Booklet for specific plan details.
1. What is my Certificate Number?
The Employee's Statement asks for your Certificate Number. The Certificate Number is the number used to identify you specifically (begins with the letters CG). This number can be provided to you by your departmental Compensation Services or the Public Service Pay Centre.
2. What is the Elimination Period?
The Elimination Period is a term used to refer to the length of time between the onset of a disability and when you become eligible to receive benefits. It is sometimes referred to as a "waiting period" or "qualifying period".
If you are an employee and you are not working on a seasonal basis, the Elimination Period begins with the first full day of Total Disability and ends on the latest date you have completed the periods listed below:
- periods of Total Disability due to the same cause, which when accumulated within a period of 12 consecutive months, prevent you from being Actively At Work for 13 weeks, or
- an uninterrupted period of Total Disability of 13 weeks and
- you have used all of your accumulated sick leave credits and any other paid leave granted (other than vacation leave).
3. Why is it important for my doctor to complete all of the information on my form?
If your doctor provides only part of the information, or a brief note on a doctor's prescription pad, Sun Life may not have all of the information needed to assess your request for benefits, or extension of benefits. This could potentially delay a decision on your claim.
4. How long will I receive payments under the Disability Insurance Plan?
Generally speaking, Sun Life will consider whether you are 'totally disabled' from your own occupation for the first 24 months following the elimination period. After 24 months, Sun Life will then consider whether you are 'totally disabled' from any occupation. You will continue to receive Disability Insurance (DI) payments until age 65, as long as you continue to meet the definition of total disability as defined in your DI Plan Member Booklet. There are other requirements you must meet in order to continue to receive disability payments, including continuing to explore new employment opportunities, pursuing appropriate treatment or attempting modified work duties.
5. What are my responsibilities while I receive Disability Insurance benefits?
While you are receiving Disability Insurance (DI) benefits, Sun Life will talk to you about returning to work, at the appropriate time. You are expected to participate in these discussions with the goal of returning to your own occupation as soon as it is safe and healthy for you to do so. Please note that while you may not be able to return to your own occupation, you will be expected to consider any reasonable offer of modified work with your employer and/or participate in any training required to qualify for an alternate occupation.
6. Once I've been approved for benefits, how often is medical information requested?
A clear understanding of the progress of your recovery is essential in preparing for a potential return to work. Periodic updates on your medical condition and functional abilities will help Sun Life determine your progress. The frequency of these status reports will be determined by the unique circumstances of your claim, your medical condition and treatment plan. Sun Life will follow up with you and your treating physician(s) by telephone or mail.
Your Abilities Case Manager will work with your doctor and/or Sun Life's Health Partners (Medical Consultants) to ensure you are receiving appropriate treatment. In some cases, Sun Life may require you to undergo an Independent Medical Evaluation (IME) to get more information. Sun Life will arrange the IME appointment, provide you with advance notice and send a copy of the results to your treating physician.
7. What if I receive income from another source? How will that impact my benefit?
It is your responsibility to report all sources of income, including compensation or profit, while monthly benefits are payable.
A change to your monthly income may have an impact on your disability benefit. As a result, if you are currently in receipt of, or become eligible to receive, any of the following benefits, it is your responsibility to notify Sun Life immediately. By doing so, your Disability Insurance (DI) benefit can be adjusted in a timely manner thereby eliminating or reducing the possibility of an overpayment.
Possible sources of new income may include but is not limited to, any or all of the following:
- Receipt of an immediate Public Service Superannuation Act (PSSA) or lump sum payment;
- Receipt of a Canada Pension Plan (CPP) or Quebec Pension Plan (QPP), Government Employee Compensation Act (GEAC), or provincial Worker's Compensation Act benefit;
- Receipt of a settlement for the same disability for which your disability benefit was approved by Sun Life; and
- Changes in the above mentioned benefit(s) for which you are already in receipt. A retroactive award from another source may reduce your disability benefit and may result in an overpayment. If this situation occurs, you are expected to reimburse Sun Life the amount overpaid.
Your benefit payment will not be reduced by income you receive from a private individual disability plan.
8. Does Sun Life share medical information with my employer?
No. All medical information obtained by Sun Life concerning your claim is strictly confidential and not shared with your employer.
Sun Life will only advise your employer about limitations or restrictions that will affect your ability to perform your occupation, a modified occupation or another occupation with your employer (as outlined in the Authorization you signed on your Employee's Statement).
9. What if I return to work with some restrictions?
Your Sun Life Abilities Case Manager and your employer will work with you to develop a return to work plan that accommodates your abilities and restrictions. Your return to work plan could include, for example, a graduated return to work and/or a return to modified or part-time duties to help you adjust. Should you require specific vocational expertise to assist in your return to work, Sun Life will involve a Health Management Consultant. Your doctor will be made aware of your return to work plan.
Sun Life's involvement with your disability claim will normally end once you have returned to work without restrictions.
10. Will I receive a tax slip?
A tax slip will be issued, as the Disability Insurance (DI) benefit payments you receive are taxable income. Tax slips are mailed by the end of February every year, for the previous tax year.
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