SISIP Financial & CAF LTD Claims

The Canadian federal government offers it’s soldiers group insurance benefits through SISIP Financial and Manulife.Current serving Canadian Armed Forces (CAF) members, former members and their families are given access to financial advisors and insurance service representatives throughout Canada, located most often on bases/units/wings. SISIP provides long-term disability and critical illness coverage through the CAF disability group insurance plan. This coverage if offered to members of the Regular Force, Reserve Force on Class C Service, as well as Primary Reserve Force on Class A & B Service.

CAF members often rely on disability claims to provide the needed financial, medical and social support after succumbing to an injury or illness while serving their country. That being said, coverage is extended to those who are injured or suffer from a medical condition that is not attributed to their military service.

The CAF Long-Term Disability Structure

All long-term disability insurance plans, offered by the CAF, are governed by the Treasury Board of Canada (TBC), with SISIP Financial acting as the administrator of the plan and Manulife as the insurer. According to their website, there are some distinguishing difference in the type of coverage offered to those in the Reserve Force and the Regular Force.

  • Regular Force
    The TBC is responsible for paying 100% of all insurance premiums for claims involving all service-related illness and injuries. In the case of claims involving non-service injuries and/or illness, the TBC is responsible for paying 85% of the total premiums, while the Regular Force group member is required to pay the remaining 15%

  • Reserve Force:
    The TBC is responsible for paying 100% of all premiums for those receiving a basic salary of $2,700 a month, for Primary Reserve Class A or B service of less than 180 day. As of Summer 2018, all rates for those serving for 180 days or less are under review by the SISIP and CAF, with an expected increase to be put in effect. As of now, Primary Reserve Class B and Class C members who have served for more than 180 days are supported with the TBC paying 100% of all premiums.

Once a long-term disability claim has been reviewed, and all required documentation is received before one’s date of release from the CAF, long-term disability benefit payments should be initiated within a 4-6 week waiting period. The long-term disability benefits are terminated typically 24 months (two years) after the effective date of one’s release from the CAF.

Limitations and Exclusions

CAF members will not be eligible for long-term disability, or total disability benefits if their disability was a result of one’s participation in a criminal offense. Coverage will not be supported if the injury was self-inflicted or deemed to be self-destructive (except in the case that medical evidence is provided and it is established that such acts were a result of a mental health illness). You will not be able to receive long-term disability benefits if you are applying for coverage for an illness or injury that was acquired or diagnosed six months prior to becoming insured under SISIP.

##Total Disability
Some CAF members succumb to total disability and are deemed totally disabled upon release from the CAF. In these cases, members show clear signs and have supplied objective medical evidence to SISIP that confirms that they are completely impaired. When someone is considered to be incapacitated with such a disability, whether be due to a physical or mental impairment, they are prevented from being able to perform any of their daily work duties, or occupations which one is qualified to do, whether be through education, training or experience. In these cases, it is important that a disability claim and coverage is intact, filed accordingly, and ready to be accessed to provide a full spectrum of long-term support. Long-term disability coverage for those deemed “totally disabled” will continue benefits up until the 65th birthday of the group member.

Canadian Armed Force Long-Term Disability Denied

If you have been denied long-term disability coverage, provided through your group benefits plan through SISIP financial, you are required to go through the SISIP long-term disability appeal process. Before appealing a denied disability claim, especially for long-term disability, we suggest you speak with an attorney that specializes in long-term disability and denied claims.

  1. First Level of Appeal
    The deadline for submitting a first level appeal is one year after the date you have received a long-term disability claim denial or termination decision. Within this time frame of 1 year, you are advised to contact Manulife Insurance to discuss your claim and reason for an appeal request. At this time, Manulife may request further personal information and documentation. Before submitting all the needed information and documentation as per Manulife’s request, make sure to also include a detailed letter of appeal. In this letter you want to make sure that you outline clearly the reason for your appeal as well as any other information you think is needed to be noted by Manulife. Make sure that this letter of appeal is signed, dated, and includes your Service Number for the CAF. This letter of appeal can be sent to Manulife with attention to the SISIP Services, or sent electronically. Upon receipt of this information, Manulife will review all documents and determine whether your long-term disability claim appeal has been accepted or denied. You will be informed of this decision most often through the phone and through a letter in the mail.

*For the purpose of ensuring that all documents are received by Manulife, we suggest you send all things related to your long-term disability claim through registered mail.

  1. Second/Final Level of Appeal
    If you have received a denied long-term disability claim as the result of a first level appeal review, and you wish to contest this decision, you are asked to submit a second and final appeal in writing to SISIP Financial. This appeal needs to be received by SISIP Financial within 30-days of you receiving the first level appeal denial. In this letter you are asked to outline in detail the reason for your appeal, and again any further documentation or information you think will support you claim for review by SISIP Financial. Make sure that this letter of appeal is signed, dated, and includes your Service Number for the CAF. Once this letter of appeal is received by SISIP Financial, you will also be requested to provide a copy of your original CAF long-term disability claim file from Manulife. This information will also be used in SISIP’s review. Once all letters, documentation, and claim files are received by SISIP, your second and final level of appeal for long-term disability coverage will be reviewed. SISIP will inform you of their decision of either granting you long-term disability benefits, or your appeal will be denied and claim file terminated.

*If you need an extension to the second level of appeal, beyond the 30-day limit, contact SISIP Financial as soon as possible.

Contact a Lawyer

If you are member of the Canadian Armed Forces and have filed a long-term disability claim that has been denied, or if you are part of the CAF and are thinking of appealing a denied long-term disability claim, we highly suggest you speak with a lawyer. By gaining insight into your legal rights, and having help navigate through the disability insurance claim process, we ensure that you will receive the proper benefits and financial support you are entitled to at this time of injury or illness.

Facing a denied insurance claim, especially for long-term disability, can be very stressful. At TSF LAwyers, we understand that type of work, perseverance and attention that is needed for CAF long-term disability claims. We proudly support all CAF members and work passionately for those who are faced with disability insurance denial. Contact us today; we provide free consultations and are willing to travel to you if need be.

1 thought on “SISIP Financial & CAF LTD Claims”

  1. Pingback: 1interested

Comments are closed.