The Claims Process
The Insurer, currently Industrial Alliance, is expected to make prompt and proper payment of any LTD benefits to which you become entitled. If you are totally disabled and think the disability will last long enough to qualify for benefits, your first step, if your organization is served by the Public Service Pay Centre (see the list of organizations served by the Pay Centre: https://www.tpsgc-pwgsc.gc.ca/remuneration-compensation/services-paye-pay-services/paye-centre-pay/calendrier-schedule-eng.html), is to notify your manager and ask that they complete the Employer’s portion of the LTD forms. These forms are available from your departmental Compensation services or the Public Service Pay Centre (https://www.tpsgc-pwgsc.gc.ca/remuneration-compensation/services-paye-pay-services/paye-centre-pay/cn-cu-eng.html). Following this, your manager submits the forms, along with a pay action request (PAR) form (found at: https://www.tpsgc-pwgsc.gc.ca/remuneration-compensation/services-paye-pay-services/form/html/446-5-eng.html) via a trusted source, to the Public Service Pay Centre.
If the department is not served by the Public Service Pay Centre, then the Employer/Public Service Pay Centre portion of the LTD forms, once completed by your manager, should be forwarded to your Compensation / Human Resources organization so that they can send them directly to Industrial Alliance.
Your responsibility, as the employee, is to complete Part I of the LTD claim form and to arrange for completion of the Attending Physician’s Statement. It is important for both you and your doctor to complete these statements as clearly and completely as possible. If you or the doctor wish to add extra information to help explain your case, this is perfectly acceptable.
Claims for benefits are adjudicated by Industrial Alliance only on the basis of the objective medical evidence provided regarding your condition. To substantiate a disability claim, the medical information provided must be sufficiently complete and supported to the fullest extent possible by objective test results and clinical findings, so that an independent physician, possessing the appropriate medical qualifications, would, on the basis of that information, be able to arrive at a conclusion.
For the first 24 months of LTD benefits, you must satisfy Industrial Alliance that you are totally disabled to the point where you cannot perform substantially all of the essential duties of your job due to a medically-determinable physical or mental impairment.
After the first 24 months, you must satisfy Industrial Alliance that your medical condition prevents you from earning more than two-thirds of the current salary of your former job.
Accordingly, you should ask your doctor to provide a full, well-documented report that clearly shows the objective medical evidence supporting your diagnosis and prognosis. If more than one doctor is involved in the assessment or treatment of your disabling condition, all doctors should supply the Insurer, Industrial Alliance, with full medical reports. The onus is ultimately on you to provide the Insurer with sufficient medical proof of total disability. It is important to note that any omissions or unclear statements could result in a delay in settling your LTD claim.
The completed forms should be returned to your Compensation / Human Resources organization, which is responsible for completing Part 2 of the claim form and passing the claim on for processing. If you prefer, the Attending Physician’s Statement can be detached and mailed directly to Industrial Alliance at the following address:
Industrial Alliance Insurance and Financial Services Inc.
Group Life and Disability Claims Department (PSMIP)
522 University Avenue
It is your responsibility to follow-up with your physician to ensure that the medical report is completed in a timely manner and that it is forwarded to Industrial Alliance without delay. This series of steps should be completed within 90 calendar days of the date that you became totally disabled.
The Insurer has the right to request additional medical information from your doctor(s) as often as may be reasonably required. In addition to these supplementary reports, the Insurer frequently uses independent medical consultants with medical expertise relevant to your case, to provide the necessary additional objective medical evidence. This is often the only objective for the Insurer to assess, or monitor the course of, a disability and to ensure that LTD benefits are not paid to persons who are not eligible or who have recovered to the point where they no longer qualify. It is important to note that failure to co-operate in the advancement of your LTD claim through the approval process may result in its rejection.
If Industrial Alliance is unable to retain independent medical specialists with the relevant expertise in your community or region, you may be asked to travel to another location for a medical examination. If this is necessary, all of your reasonable travel expenses, including the cost of necessary medical assistance, will be paid by the LTD plan. You are expected to cooperate in this process.