Introduction to Industrial Alliance

Industrial Alliance Financial Group (iA) is an established insurance provider to small and large businesses. While more popular in the province of Quebec, IA is used by employers in Ontario to provide there employees with group insurance plans that provide medical care, paramedical care, as well as short-term disability and long-term disability insurance. iA’s short term disability insurance provides 17, 26 or 52 weeks of coverage to employees in case they succumb to an injury or illness which requires a prolonged absence from work. This coverage provides regular income during the time of leave. IA’s long-term disability insurance provides coverage when an extended period of time, surpassing the 52 weeks of a short-term disability plan, is needed by an employee in the event of an illness or injury. This type of insurance benefit provides regular income to the disabled plan member for a period of time and up until the age of 65.

In this article we will outline the short-term disability and long-term disability income insurance claims process, as well as what to do when AI insurance has denied your claim.

Short-Term Disability Income Insurance

When you are in need for short-term disability (17-52 weeks of leave from work with regular income), you will have to submit an initial request through your group insurance plan administrator. If you do not know who is your plan administrator at work, speak with your manager or the HR department. Once in contact with your plan administrator, they will initiate the disability claim process with iA Insurance. They will ask you to complete and submit a Disability Claim Form called the “Policyholder’s Statement (F54-907A)”. Upon receipt of this Disability Claim Form, a representative from iA will contact you, the plan member, and conduct an interview where they will ask for specific details and required personal and medical information to proceed with the filing of your disability claim. You will also be asked to complete and sign a “Authorization for the Collection of Personal Information – Disability”, also known as form F45-900A. iA will initiate and communicate directly with the attending physician(s) for evaluation of your disability claim, upon receipt of these forms.

The decision for whether your disability claim for short-term disability income benefit was approved or declined with be communicated to you and your group benefits plan administrator by phone and in writing, delivered through post.

Extension of Disability

If you have been granted an extension of disability, when the disability leave you need to manage or heal from your illness or injury requires more time than what was provided through your initial short-term disability coverage, you will be asked to fill out a “Disability Claim Form – Extension of Disability (F54-382A)”. Your physician will also have to sign and complete this form. Your plan administrator may also be asked to provide other information directly requested by iA.

*Make sure, if you submit a “Disability Claim Form – Extension of Disability”, you sign part 4 of the document, “Member Confirmation/Authorization”, which is a section of the “Member’s Statement”. A signature will also be needed in two parts of the claims form, preceding the “Attending Physician’s Statement”. Failure to complete these sections, and sign where required, may delay the filing process for extension of disability, or terminate your short-term disability coverage.
*Your physician must complete the section in the “Attending Physician’s Statement”, requiring insight on your mental and/or physical health condition. Without the proper completion of this section, your claim will not be processed, and/or may be terminated or denied.

Returning to Work from Short-Term Disability Leave

You and your plan administrator for group benefits will have to complete and return to iA a “Notice of Return to Work (F54-268A)” form. In this document you will indicate the type of return to work that is being initiated at this time. Most often the types indicated are gradual, part-time or full-time return. This form will also request the number of hours worked per week.

Long-Term Disability Income Insurance

Employees seeking long-term disability benefits and coverage through their group insurance will have to contact their plan administrator to initiate this process. There are two different ways in which an employee can access long-term disability benefits.

  1. For plans which provide short-term disability income benefit, you will have to apply for short-term disability coverage before long-term disability is granted. Once you are approved and are on short-term disability income insurance, and you know you will need to apply for long-term disability, speak with you insurance plan administrator at work. They will contact iA insurance and begin the long-term disability claim process. When your short-term disability is coming to an end, before the benefit period expires, you will be informed of the status of your long-term disability claim. You may be required to provide more information for your long-term disability insurance claim at this time.

  2. If your group insurance plan does not have a short-term disability income benefit, your plan administrator will initiate the long-term disability claim process with iA insurance. You will be asked to complete and submit the “Disability Claim Form- Policyholder’s Statement (F54-907A)”. An iA representative will initiate a phone interview with you, the plan member, to obtain any further personal and/or medical information required for the long-term disability claim process. You will also be asked to complete and sign the “Collection of Personal Information – Disability form (F54-900A)”. iA insurance will get in contact and communicate directly with the attending physician for your claim. Like with the short-term disability claim process, you and the plan administrator will be made aware of your long-term disability approval or denial through a phone call and by a letter sent through the mail.

Seeking an Extension of Disability for a Long-Term Disability Claim

If you require disability leave and coverage from work that surpasses the the date specified in the initial request for long-term disability, your plan administrator may either:

  • ask you to complete, along with your physician, the “Disability Claim Form – Extension of Disability (F54-382A)”, or
  • provide further information requested by iA Insurance, once they are aware of the request for an extension of disability for a long-term disability claim. Your Plan administrator may ask you for further information and documentation at this time.

*When you complete the “Disability Claim Form – Extension of Disability”, make sure you sign part 4 of this document, titled “Member Confirmation/Authorization”. This part is found in the “Member’s Statement” section. If you fail to do so, your request for an extension of disability may not be processed and your long-term disability claim may be terminated.
*Make sure you sign the two parts of the “Attending Physician’s Statement”, as requested on the forms. You physician is also required to complete these sections and provide the needed information regarding your psychological and/or physical health condition.

Returning to Work from Long-Term Disability Leave

When you are able to return to work from your long-term disability leave, contact you plan administrator at work and make sure to complete the “Notice of Return to Work (F54-268A” form. In this section you will specify whether your return will be gradual, part-time or full time. You will also be requested to supply the number of hours worked per week.

Denied Industrial Alliance Disability Claim

If your disability claim has been denied, either for short-term disability or long-term disability, read our article herefor more information.

It is important for you to know, when facing a denied disability claim:

  • Do not worry or panic; when dealing with an injury or illness you do not want any added stress!
  • If you believe you claim has been wrongfully denied, and have provided all the required medical documentation, contact a disability insurance lawyer immediately

Your group insurance policy is there to act as a safety net when facing an illness or injury which requires leave from work for an extended period of time. You are not suppose to incur further loss, financially, mentally or physically at a time when you need support the most. It is important that you speak with an insurance claim lawyer, especially one who specializes in long-term disability, to make sure you have access to the proper support when facing a denied disability insurance claim. Navigating through the appeal process on your own can be taxing on your current state; TSF Law will help make this entire process as smooth as possible, and work diligently in pursuit for optimal results.

At TSF Law, our staff is familiar with denied Industrial Alliance disability claims, and have defended many clients who have been treated unfairly by their group insurance providers. We offer free consultations and promise to always be there for you through the entire process. Do not hesitate to call us today.