Canadian Benefits Consulting Group and your Board of Trustees in conjunction with GIDIP is pleased to provide an overview of the GIDIP process.
There may be times in your career when sickness or injury prevents you from working and earning your regular income. Without adequate financial protection, your family’s financial security and way of life may be compromised.
The Board of Trustees
Ross McConkey – Pacific Region
[email protected] | Tel: (604) 295-4220
Astrid Metzler – Western Region
[email protected] | Tel: (403) 828-1584
Terry Carlucci – Central Region
[email protected] | (available via email)
Sophia Michailidis – Eastern Region
[email protected] Tel: (514) 744-5228
Martin Melanson – Atlantic Region
[email protected]| Tel: (506) 875 4902
Role of the Board of Trustee
The Board of Trustees are Union Members who are appointed to oversee the overall operation and administration of the Union Disability Benefit Plan. Their role is to ensure that:
- The Plan remains financially sound; and account for the handling of the Funds.
- The Insurance Contract is administered correctly, consistently, and fairly to all Members. Benefits, of course, may only be paid in accordance with the eligibility requirements of Benefit Plan. The Underwriting Group Insurance Company sets out the Policy requirements concerning the amount and timing of benefits, and, most importantly, the criteria for eligibility.
- To represent the Members when Claims are Contested or a request is received for a File Review.
Reviews are done Quarterly at the Board of Trustees Meeting with the Plan Administrator.
– if a Member provides authorization for the Board of Trustees to review all Medical and other documentation on file for Short Term Disability, then the complete file will be reviewed to ensure that all steps have been taken to allow for the fair assessment of the Claim. At this point, the Trustees may request: the Plan Administrator write for additional Medical information; the Medical Consultant contact the treating Doctor directly; the Claim be paid extra-contractually; etc.
Usually when a claim is paid extra-contractually the Underwriting Insurance Company must be involved. As well, the Board needs to be mindful of not setting a precedent.
– if a release of Medical information is not given to the Board of Trustees, they will review the handling of the file. The Plan Administrator will provide a synopsis of the Claim to show the workflow only if requested by the Board. Medical will not be provided in this instance. If the Board of Trustees do not feel that the claim was handled fairly, recommendations will be made.
– it is of utmost importance that a prudent decision be made, given that the Trustees are ultimately responsible for the administration of the Fund. The necessity of attending meetings cannot be overemphasized. At the very least, it may be said that a Trustee who is not in attendance of the Board of Trustees regular scheduled Meetings is as responsible for the decisions made as are those in attendance; and as such, liable for the consequences thereof.
- Representatives of the Underwriting Insurance Company join the Quarterly Board of Trustees Meetings, when held in the Plan Administrator’s Office, to discuss Long Term Disability (LTD) Claims. If a Member feels they are being treated unfairly, the Board will discuss the handling of the LTD claim to ensure that all contractual obligations have been met by both the Insurance Company and by the Member. If other options are available to expedite a Member’s claim or to provide proof of Total Disability, the Board of Trustees will discuss these with the Plan Administrator and the Insurance Company as to their feasibility.
The Insurance Carrier adjudicates all Long Term Disability claims. Neither the Board of Trustees nor the Plan Administrator can change the decision made by Long Term Disability Underwriting Insurance Company administering the LTD Plan. There must be medical acceptable to the Insurance Company, to support the claim and the Member is given the avenues to follow when their LTD claim is declined for benefit payment. The Trustees can review the LTD file with authorization from the Member, noting that they are just reviewing the file to ensure fair, equitable treatment. If there is medical of which the Trustee is aware and it is not on file, the Trustees can follow-up on this matter but the final LTD decision is with the Insuring Underwriting Company.
When the LTD claim is declined by the present Insurer (Manulife Financial, June 2005), the Member is usually invited to submit further medical documentation to Manulife’s Toronto, Ontario office for further review. The address of this office is provided. If the Member does not have further medical to submit, the Member is advised that they have the opportunity to Appeal the claim’s decision to Manulife’s head office, and this address is provided in the letter to the Member.
- One of the Board of Trustees’ responsibility is to negotiate The Disability Policy terms and benefit levels with the Insurance Company, in consultation with the Plan Administrator, Canadian Benefits Consulting Group Ltd.. The Plan Administrator is employed by the Board of Trustees to assist in all areas of administration including Short-Term Disability payment and Policy renewal consulting services.
Trustees are not compensated for time in administering their Plan. Unquestionably, the role of the Trustee to a Trust Fund is at the same time a rewarding and challenging experience. They make themselves available to Members on Disability and intercede on their behalf when necessary, and/or represent the Member when the Member requests that his claim file be reviewed for ongoing disability benefits. However, as with any other assignment, there are duties and obligations upon the Trustees and the law requires that the Board of Trustees perform his/her duties in the manner contemplated by law.
Duties and Obligations of the Trustee
The Trustee is a person who holds the legal title to property, which is called trust property, on behalf of another person who is called the beneficiary for certain specific trust purposes.
The sole purpose of creating a trust is to enable a Trustee to administer trust property for the benefit of a beneficiary and, as such, the trustee has a duty to account for all of his or her conduct in connection with the administration of the trust. A trust is the fiduciary relationship created between the Trustee and the beneficiary, which means that the Trustee owes a duty of “loyalty” to the beneficiary.
Board of Trustees
A designated number of Union Members are appointed or elected as Trustees of the Trust Plan usually for a specific term of office to represent the Members who participate in the health coverage provided [health, disability, etc.]. These Trustees enter into a legal relationship on behalf of the employee members of the Fund.
Third Party Administrator
Third Party Administrators are appointed and employed by a Board of Trustees who are responsible for the selection of a Fund Administrator. Canadian Benefits Consulting Group specializes in Trust Fund Administration and is the Third Party Administrator for your Fund. Canadian Benefits administers the Group Insurance Disability Income Plan including the collection of contributions, the keeping of records, the processing and control of claims, and fund auditing. Quarterly Meetings are conducted with the Board of Trustees to present the financial status of the overall Plan and to review any concerns. The Trustees of the Fund hold ultimate liability to account for the receipt, deposit and stability of the Fund.
The Funds auditor is charged with scrutinizing the financial books and records on an annual basis on behalf of the Trustees. The accountability for proper books and record keeping is ultimately on the Trustees. The Funds are audited annually and a Financial Statement produced to be distributed to each participating Member as directed by the Board of Trustees.
Contributions are collected bi-weekly by payroll deduction. The Employer forwards payment directly to Canadian Benefits Consulting Group payable to the Trust Fund. Contributions and premiums are calculated on a percentage of payroll and are determined annually. Premiums are negotiated at each annual Insurance Policy anniversary date with the underwriting Insurance Company.
Contributions are what the participating Member pays to fund the cost of premiums plus the expenses of running the Plan.
Premiums are the cost of the Insurance Policy only that must be paid to the underwriting Insurance Company.
Written Trust Agreement that expresses the purposes and functions of the trust and duties and obligations of the Trustees; located at the Third Party Administrator’s Office.
Liability Insurance has been obtained for the Trust Fund and its Trustees to insure against “technical breaches of trust”.
The Policy is a contract of insurance. Benefits may only be made or paid in accordance with the eligibility requirements and the terms of the particular Insurance Policy purchased and in conjunction with the Trust Agreement. The Insurance Policy normally sets out the rules and regulations concerning the amount and timing of benefits, and the criteria for eligibility.
In the case of Short-Term Disability benefits, they are usually paid bi-weekly, and Long Term Disability Benefits monthly unless otherwise negotiated. Long-Term Disability benefits can be deposited directly into a Member’s bank account.
International Foundation of Employee Benefit Plans (IF)
This is a Organization, which the Board of Trustees may join. This Foundation holds Seminars on Employee Benefits and mails out educational material to Members. As well, it can be used to obtain research material in reference to benefit plans and precedent setting decisions.
Instructions for Members and Employers for submission of a GIDIP Short-Term Disability (STD) Claim
Plan Members who are absent 14 consecutive days, because of Total Disability due to illness or injury, should submit a Short Term Disability claim to the Plan Administrator’s office at:
Canadian Benefits Consulting Group
2300 Yonge Street, Suite 3000
P.O. Box 2426
Toronto, ON M4P 1E4
Telephone: (416) 488-7755 or 1-800-268-0285
Facsimile: (416) 488-7774
- Instructions For Members And Employers For Submission Of A GIDIP Short-Term Disability (STD) Claim Application✎ EditSign
- Instructions For Members And Employers For Submission Of A GIDIP Short-Term Disability (STD) Claim Application (Air Canada ONLY)✎ EditSign
- Short Term Group Disability Claim Form✎ EditSign Modified Dec 2013
Your GIDIP Benefits at a Glance
REV. MAY 2019
1. SHORT-TERM DISABILITY (STD) INCOME PLAN
STD I – PHASE I
Benefit payment begins on the 15th consecutive day of Total Disability calculated from the first shift missed or the date your Doctor disables you, whichever is later. For any one period of Total Disability, benefits are payable for a maximum of 15 weeks. “Total Disability” or “Totally Disabled” means that you are completely unable to perform any and every duty of your regular occupation due to sickness or accidental injury; not working for wage or profit, and you are under the regular, active, supervised care of a Physician (doctor of medicine), and you are following the prescribed, recognized treatment for the Totally Disabling condition.
Your weekly Short-Term Disability Benefit is non-taxable and will be paid at the rate of 55% of basic weekly earnings to a maximum of $575.00 for a disability that occurs on and after January 1, 2019 (whichever is less) plus longevity but exclusive of bonus and overtime pay.
Written proof of claim must reach the Plan Administrator’s, Canadian Benefits Consulting Group Ltd., office not later than 90 days following commencement of your Total Disability.
You may be asked to submit Supplementary Medical evidence during your period of Total Disability. To avoid interruption in benefit payment, the prompt submission of the requested medical information will prevent delays. It is the member’s responsibility to provide medical information to support their claim.
Additional medical evidence may be requested directly from your Physician. If this occurs, you will be advised in writing by the Plan Administrator.
2. EMPLOYMENT INSURANCE (EI) SICK BENEFITS
Your Plan incorporates a period of time for which you will be required to claim Employment Insurance (EI) Sick Benefits.
After 17 weeks of Total Disability (2 weeks waiting period and 15 weeks of GIDIP STD I benefits) you are eligible to apply for EI Sick Benefits. EI provides sick benefits for a maximum of 15 weeks. This benefit is taxable.
EI benefits are based on 55% of salary to a maximum of $562 per week in the year 2019.
To avoid interruption of benefit payment, you should file your EI claim two weeks prior to receipt of your maximum STD I GIDIP Benefits.
A Record of Employment (ROE) must be submitted to Employment Insurance as well. This document should be requested from Personnel Services (Employer).
If for any reason Sick Benefits are declined under EI, or there is a lapse between the day your GIDIP STD I
benefit ended and your EI became effective, contact the Plan Administrator, Canadian Benefits, immediately at 1-800-268-0285 or (416) 488-7755.
3. STD II- PHASE II
After 32 weeks of continuous Total Disability, (17 weeks STD I + 15 weeks EI sick benefits), you are eligible to apply for the second phase of your STD benefit.
STD II benefits are non-taxable and paid at the rate of 50% of basic weekly earnings plus longevity pay or the equivalent of the EI maximum benefit level, whichever is less. The maximum eligible benefit period under STD II is 20 weeks. A Long Term Disability Claim Form will be forwarded to you prior to the end of your EI benefit period if you have not returned to work.
You may be eligible for Canada/Quebec Pension Plan (CPP/QPP) Disability Benefits after completion of a 17-week elimination period for this benefit. If you have a prolonged and severe illness, it is advantageous to your retirement CPP/QPP program to apply under the disability CPP/QPP Plan. Benefits under this program are taxable.
For any period of Total Disability resulting from illness or injury, your GIDIP Disability benefits will be reduced by 90% of any amounts received from the CPP/QPP Disability Plan in respect to you.
You may obtain an application for CPP/QPP disability benefits by contacting your local Income Security Programs office.
For the year 2018, the maximum CPP Disability Benefit Level is $1,335.83 (Primary) and $244.64 (Each Dependent Child). Your maximum QPP disability Benefit Level is $ 1,335.83 (Primary) and $244.64 (Each Dependent Child). This amount is adjusted annually for any change in the Consumer Price Index (CPI).
4. WORK-RELATED DISABILITIES
For any period of Total Disability resulting from injury arising out of your employment with your Employer, an advancement of GIDIP benefits may be considered on an assignment basis pending settlement of your Workers’ Compensation (WC) claim.* This is referred to as “bridge-financing”. Under the terms of the GIDIP Policy, the amount of benefits received on account of Total Disability from WC will be deducted from your GIDIP benefit. Therefore, you must complete a Reimbursement Agreement Form allowing Manulife Financial and the Plan Administrator to communicate with WC; and promising that you will repay GIDIP if your WC claim is approved for benefit at a later date.
- Please note, you must meet the medical requirements for Total Disability under the GIDIP plan to be considered for “bridge-financing”.
5. LONG TERM DISABILITY (LTD) INCOME PLAN
There is an elimination (or “waiting”) period for Long Term Disability Benefits of 52 weeks (2 weeks sick time, usually paid by the Employer, 15 weeks GIDIP STD I benefits, 15 weeks EI sick benefits and 20 weeks of STD II benefits).
LTD benefits are non-taxable and calculated at 52% of basic monthly earnings plus longevity, and are paid on the 15th and 30th of each month, in arrears. The definition of ‘Total Disability’ changes after 1 year of receiving LTD benefits.
Once your LTD claim has been accepted, Manulife, the Underwriting Insurance Company, will provide you with any additional details required.
6. RECURRENT CLAIMS
For benefit consideration of a Recurrent Total Disability, a new claim form must be submitted to the Plan Administrator/Insurer for review and you must be under the care of a Physician. Please refer to your GIDIP Benefit Booklet or contact Canadian Benefits if you have any questions.
This brochure is put together as a tool to assist you in understanding your disability plan and is not meant to replace the Group Insurance Disability Policy.
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.
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
Letter of Authorization When Claiming Short Term Benefits
RE: CAW Local 2002 Disability Trust Fund
Group Insurance Disability Income Plan (GIDIP) – Manulife Financial Policy
Claim Status to Employer Monthly
Your GIDIP, both Short-Term Disability and Long-Term Disability Plan, are Policies of Insurance underwritten by Manulife Financial and are sponsored by your Union and administered by a Board of Trustees.
The Trustees overseeing the administration of your GIDIP are Union Members like yourself who are appointed by the Union and volunteer their time to administer the GIDIP and assist Members with their claim concerns. They employ a third party plan administrator, the Canadian Benefits Consulting Group (“Canadian Benefits”), to assist them with these responsibilities.
The Board of Trustees, via Canadian Benefits, provides information about your GIDIP Claim Status to Air Canada in a Claims Status Report on a monthly basis. This Report indicates whether your claim is ‘Pending, awaiting further information’, ‘Active’; ‘Closed Returned to Work’; or ‘Denied’. The majority of claims fall within the first 3 categories.
As a result of the new privacy legislation the Board of Trustees now requires your consent to continue to provide your Claim Status to Air Canada. For the future, the application form for GIDIP benefits will be revised to seek the consent of new applicants for GIDIP benefits to disclose their Claim Status to the employer. For all existing applicants and recipients of benefits, an authorization to disclose claim status to the employer is enclosed.
When your GIDIP benefits are approved or pending
Providing Air Canada with your Claim Status ensures that the following benefits remain active at no cost to you while you are receiving GIDIP Benefits:
- Health Care Benefits
- Dental Care Benefits
- Basic Life Insurance Coverage
- Pension Benefits
- Seniority including vacation entitlement
If your claim is pending, Air Canada will continue your benefits coverage. If your claim is ultimately denied, you will have to reimburse Air Canada for the premium payments, or pay back the reimbursement for any expenses incurred.
When your application for GIDIP benefits is declined
If you are not in receipt of GIDIP Benefits and your claim is not “active” or “pending awaiting further information” Air Canada is not liable to maintain the above noted coverages for you. They will seek repayment from you if you have received reimbursement for benefits expenses during a period during which you were not entitled, or they will request that you pay premiums for the coverage. If and when your GIDIP claim is declined you should contact Air Canada directly to arrange to pay premiums for health/dental and life benefits provided by the Employer should you wish to ensure continued coverage.
What does Air Canada do if the Monthly Claims Status Report shows your claim as ‘declined’?
When your GIDIP benefits are listed as or declined on the Monthly Claim Status Report, you may receive one of two letters from the Air Canada. One is commonly referred to as an “IMMS” (Inability To Meet Medical Standards) letter, and the other is called an “Unauthorized Leave of Absence” letter.
The IMMS letter will advise you that you must contact the Employer’s Medical Office within 14 days for a medical assessment. The Employer may then grant you a “Leave of Absence on Account of Inability to Meet Medical Standards” for up to one (1) year based on certain criteria. If you are unable to return to work within that year, the Employer will terminate your employment. Please note that the Board of Trustees is not involved in this process, and you may ask your Union to file a grievance on your behalf under the collective agreement.
The ‘Unauthorized Leave of Absence’ letter states that the period during which you were absent and did not receive GIDIP benefits will not be considered as accrued time in reference to, Vacation Entitlement, Service Award, and Earned working conditions based on Company Service Date. In both cases, you must prepay premiums for Health, Dental and Basic Life coverage to Air Canada.
What happens if you do not allow release of your GIDIP Claims’ Status to Air Canada?
If Air Canada is unaware of your GIDIP Claim Status, we have been advised that they will stop all benefit coverage for you until you provide proof (satisfactory to them) that you are in receipt of GIDIP benefits. To date, the Claims Status Report transmitted to Air Canada from Canadian Benefits has been satisfactory evidence of the status of claims.
If you are currently receiving GIDIP benefits or are a current applicant for GIDIP benefits an Authorization is enclosed. This seeks your consent to disclose your claim status to your employer. If you consent, please sign and return to Canadian Benefits Consulting Group. A self-addressed envelope is enclosed for your convenience. If you do not return a signed consent form, we cannot convey your claims status to Air Canada and they may stop your benefits coverage until you provide proof that your are in receipt of GIDIP benefits.
Yours in solidarity,
Your GIDIP Board of Trustees
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.
(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
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