Employers often provide group benefits to their employees as an incentive for working with their company, as well as to guarantee that there is a financial support when a worker is unable to carry out their work duties. There are more than thirty different insurance companies that offer their services to Canadians and group benefits to Canadian employers. Great West Life Assurance Company (GWL) is used by many employers to offer their employees shod-term disability and long-term disability income benefits.
When you have fallen ill, or have succumbed to an injury that has refrained you from being able to attend work, or carry out your work duties, you must file a claim with your group benefits insurance provider to seek the proper financial coverage and leave from work. Employees who are provided with GWL insurance are given an income benefit guide that provides information about the claims process, needed documentation for a claims submission, an outline and copy of needed forms, as well as any deadlines that may apply to the claims process.
Part One: Submitting a Claim
To begin the claim process through your GWL insurance provider, you are required to complete an Employee’s Statement form and authorization request. This form asks general information about you, your disability, as well as information about your job and employment duties. This information is required by GWL to properly access your claim.
Your doctor also, at this time, is required to complete something known as a Physicians Statement form. With this form, your physician must include any specialist notes, imaging results, test results and other medical documentation that supports your disability claim. GWL asks that these forms be submitted at least 8 weeks before the end of your waiting period. The waiting period is the certain amount of time specified in your insurance policy that must pass before you are able to receive the benefits which you are seeking in your insurance claim. If your Employee’s Statement and Physicians Statement forms are submitted after the required 8 weeks, benefits may be delayed and your claim may be denied.
Claim Interview & Income Declaration
When GWL initiates the assessment process, they usually appoint a representative to manage your claim. After receipt of your first round of forms for your disability claim, a GWL representative may phone you to obtain further information regarding your:
- Job
- Employment history
- Medical history
- Current disability
- Sources of other income you may have
If your disability does not enable you to speak on the phone, alternative arrangement will be made to accommodate such. Furthermore, a GWL representative may not call you if you have supplied efficient information and supporting documentation for your long-term disability claim, and they do not require any further information.
Also, you will be sent an Income Declaration form in which GWL asks you to sign and declare any other income you may be entitled to at this time. This is to help GWL understand any other money resources you may have for financial support while requesting disability benefits. This money is other than what you would be making at work, had you not succumbed to an illness or injury. If you have no other source of income, then state such on the form and submit the Income Declaration form to GWL. Once this form is received by GWL, you have completed the claim submission process
Important Things to Remember
Forgetting to do these things, and proofreading your claims forms can result in a denied disability claim:
- Complete all empty fields and answer all required questions on each form
- Put your Group Plan Number on all forms
- Sign all form/document when asked
Claim Assessment & Approval
While you are submitting a claims package to GWL, your employer will also submit their own set of forms and statements to GWL regarding your disability claim. Once all the required forms, medical records and documentations have been received by GWL, your disability insurance claim will be assessed for approval by your Case Manager.
If your claim is accepted in accordance with the terms of your group disability plan, GWL will send you a summary of the benefits that have been approved for your claim, as well as any other benefits that may be available to you at this time. If your claims has any limitations, you will receive a letter which explains the reason for the limitations. Your benefit cheque, which you are entitled to after an approved claim, will be issued to you “on the later of the date which is one month after your waiting period ends; and the date on which the initial claim assessment is completed”.
Denied Long-Term Disability Income Benefit
When you have received a denied disability claim, you will receive a letter outlining reason for you denied claim. If your claim has been denied and you do not receive any disability benefits from GWL, there are several things you need to do:
- Make sure that all your forms have the correct information, group plan number, signatures and filled in fields. Clerical errors do account for a handful of denied disability claims and while they do cause a delay in receiving the sought after benefits, often correction to such errors can be made.
- If you have been told that you did not provide sufficient documentation or medical records to support your claim, speak with your physician. If you have documentation that was not provided in your insurance claim, but may support your claim, it is possible to appeal GWL decision. Before you begin the appeal process, consult with a disability insurance lawyer to review your options. Also speak with your Case Manager to understand the process for having those documents assessed.
- If your disability claim has been flat out denied for reasons you do not think are legitimate, or if you have received a denied insurance claim which you believe was denied in bad faith, contact a long-term disability lawyer as soon as possible. By speaking with a long-term disability attorney, you will gain a full understanding of your legal rights and insight on how they can support you fighting a denied insurance claim.
Who We Are
TSF Law is one of the top disability insurance and long term disability law firms representing clients in and out of Ontario. We pride our self in providing top quality services to those who have received denied disability insurance claims and denied income benefits. Our group of lawyers understands how difficult it can be to navigate an insurance claim, especially after receiving a denial of benefits. We understand that when someone is faced with an illness or injury that is prohibiting them from being able to work, their focus should be on healing and managing their reality, rather than dealing with mounting stress from the insurance company or employer. Contact us today for a free consultation and to speak with a lawyer about your denied claim.
