Since the introduction of the Short Term Disability Plan, our members have had difficulty navigating all the “ins and outs” of the plan. Strict timelines, no access to the grievance procedure, and the two (2) levels of appeal are causing a great deal of confusion for those who try to access the plan.
After a change in process in September 2014, the Short Term Disability Plan made the employee responsible for starting their own claim. Previously, the supervisor would have started the claim after you called in to advise them of your absence. Many members have got themselves into trouble as they waited for their supervisor to start the process and did not submit their employee statement and physician’s statement within seven (7) days.
The Employer sent this information out to the members in September 2014 but unless you were in the Short Term Disability process at that time, the information was likely set aside and forgotten about.
If you have an approved claim you may be eligible for up to thirty (30) weeks of benefits (15 weeks of STD & 15 weeks of Medical EI + STD).
20.09 Eligibility and Approval
(a) an employee shall be eligible for short term disability benefits when he or she is incapacitated by illness, or a non-work related injury, or is hospitalized.
(b) in order to be eligible for short term disability benefits, and remain covered once approve, an employee must:
(I) be under the care of a physician; and
(ii) follow the treatment deemed appropriate for the illness or injury; and
(iii) provide the required medical information to the Disability Management Provider; and
(iv) in case of an illness or injury related to substance abuse, agree to receive ongoing, active professional treatment deemed appropriate for the condition being treated.
You need to provide medical to Great West Life/Morneau Shepell. The more detailed the medical is when you first submit it, the better the chance of claim acceptance. All too often, we see a doctor’s note stating: “needs to be off work for 2 weeks”, “unable to work due to……”. According to Great West Life and Canada Post, that is not sufficient. While we realize that a doctor’s time is valuable and they don’t like to fill out the forms from a third party benefits provider, it is a part of the process in order to be eligible for benefits.
Balancing the member’s medical privacy and the detailed medical required is difficult. Ensure that the medical provided is specific, and pertinent only to what is preventing you from going to work.
You need to be “completely incapacitated” to be entitled to wage loss benefits. That is the threshold that needs to be met.
What if My STD Claim is Denied?
If your claim is denied, there are two (2) levels of appeal. IT IS THE RESPONSIBILITY OF THE MEMBER to file the appeal. You MUST notify the insurance provider within seven (7) days of your intent to appeal. You then have thirty (30) days, from the Notice of Appeal, to submit supporting medical documentation. Make sure you READ the denial letter carefully. It usually gives the reason for the denial.
REMEMBER the more comprehensive your medical is when you file your claim in the first place, the greater the chance you can avoid the appeal process.
What if My First (1st) Appeal is Denied?
If you get denied the second time, the Union will determine whether the decision should be appealed. Currently the Vancouver Local’s appeals are done through the Pacific Regional Office. They can be reached at (604) 525-0194.
In Solidarity,
Jennifer Savage
President
ck/CUPE-3338