Plan member's guide to submitting a Disability Insurance claim
The Disability Insurance (DI) Plan is an insurance plan available to employees of the federal public service, who are represented by bargaining agents. The Plan, administered by Sun Life Assurance Company of Canada (Sun Life) provides benefits to eligible employees who become disabled as a result of illness or injury. "Totally disabled" means that you have an illness or injury that prevents you from performing each and every duty of your regular occupation. This guide is designed to help you through the claim submission process and to answer any initial questions you may have with respect to filing a claim for DI benefits. To further assist you, a pamphlet entitled "A Step-by-step Guide to the Disability Insurance Plan Claim Process", which clearly illustrates how your DI claim is adjudicated, will be sent to you by Sun Life upon receipt of your DI claim.
Reporting your absence
If you become disabled and your disability is expected to be prolonged beyond the 13-week elimination period or the exhaustion of your sick leave, whichever is later, you should notify your departmental Compensation services or the Public Service Pay Centre. You are also responsible for reporting ongoing absence to your employer.
To apply for Disability Insurance (DI) benefits, your DI claim forms should be completed and forwarded along with all supporting medical evidence to Sun Life, ideally at least eight weeks prior to the end of your elimination period, but no later than 90 days after the end of your elimination period. You are responsible for providing Sun Life with sufficient medical proof of total disability.
The Disability Insurance (DI) package contains three forms:
- Employer's Statement, which your employer completes and faxes to Sun Life;
- Employee's Statement (enclosed with this guide), which you must complete and fax to Sun Life at 1-866-639-7849. If you are unable to fax this information, you can mail it to the Sun Life address indicated on the form.
- Employee's Medical Information and Attending Physician's Statement
- Part 1 – Employee's Medical Information, to be completed by the employee;
- Part 2 – Attending Physician's Statement, which you take to your doctor to complete and fax to Sun Life. Note: Your doctor may charge a fee to complete this form. If so, you will be responsible for paying that fee.
1. Completing the Employee's Statement
This statement provides Sun Life with information about your condition, your general medical history, your expected sources of income and benefits while you're on leave, and your expected return to work date.
- Be sure to answer all the questions in full to avoid delays when Sun Life assesses your absence, and include a detailed job description and resume, including previous job experience and education history. (You may attach extra paper to the form if you need more space.)
- Be sure that all dates provided (date you were first unable to work, date of accident, etc.) are correct since they are essential to Sun Life's assessment.
- Remember to complete the "Automatic deposit of your disability payments" section. If your claim is approved, your payments will be deposited directly into your bank account. For chequing accounts, a personalized VOID cheque will be required.
- Please read and sign the Declaration and Authorization portion of the form, which allows Sun Life to exchange information with your doctor and any other health care professionals who are involved in your care. Also, please sign Part 1 of the Attending Physician's Statement before giving the form to your physician to complete.
2. Have your physician complete the Attending Physician's Statement
This statement provides Sun Life with specific medical information about your condition and your expected recovery.
- The Attending Physician's Statement must show a clear diagnosis and prognosis for your condition. (This doctor can be your family doctor, a doctor at a walk-in clinic, a specialist, etc. – or a medical doctor licensed to practice medicine who has treated you for your condition.)
- If your doctor conducts tests, all of the findings must be included on or with the Statement.
- If you have seen a specialist for your condition, be sure to have your Attending Physician send copies of all consultation and clinical notes with the Statement. (Often, Sun Life must follow up to request these documents which can delay the assessment of your claim).
Note: Do not change or write anything on the Attending Physician's Statement. Any changes to the Statement must be initialed by your doctor.
3. Sending your Disability Insurance claim package
- Follow up with your doctor and employer to confirm they have completed, signed and faxed their Statement forms to Sun Life. Your claim cannot be assessed until all three forms have been received; from you, your employer and your doctor.
- It is recommended that you submit the completed claim forms to Sun Life at least eight weeks prior to the end of your elimination period. This provides Sun Life with sufficient time to review your claim and obtain any additional information required in order to complete the assessment for benefits.
- In the event there is a delay in getting this information to Sun Life, it is important to note that there are time limits for submitting claims under the Disability Insurance (DI) contract. Sun Life must receive your completed statements no later than 90 days after the end of the elimination period or exhaustion of your sick leave, whichever is later. If you fail to abide by this time limit, you may not be entitled to some or all benefit payments where the delay impedes Sun Life's ability to assess your claim.
- Faxing your forms, using Sun Life's secured fax number, is the fastest way to send your forms. It is also convenient as you do not need to mail information that you send by fax, so you will have the originals for your records.
Be sure your Certificate Number (begins with the letters CG) is clearly indicated on your Employee's Statement and your portion of the Attending Physician's Statement before faxing/mailing. If you do not know your Certificate Number, please contact your departmental Compensation services or the Public Service Pay Centre who will be able to provide this information.
Your information is confidential
Sun Life is committed to respecting your privacy and protecting your personal information. The information you provide for your Disability Insurance (DI) claim is highly protected and treated with sensitivity. Your personal and medical information will not be disclosed to other parties, including your employer, without your written consent.
* Where there is a discrepancy between this Guide and the Disability Insurance (DI) Plan Document, the terms of the plan will prevail.
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