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Survivors Finances and disability Short-term and long-term disability benefits: the process

Short-term and long-term disability benefits: the process

Brenda Hockley, Sunlife Financial

Ms. Brenda Hockley is Manager, Health Management Services, Group Disability Western Region with Sun Life Financial. She received her BSc. (Honours) in Kinesiology from the University of Waterloo in 1986. At The Canadian Back Institute, she grew the company from one to fourteen clinics. In 1992 she entered the field of vocational rehabilitation and served the short- and long-term disability-insurance communities in Ontario and BC with Crawford Canada. She then moved to RBC Insurance in the short- and long-term disability markets. Ms. Hockley is on the Board of Directors of the Vocational Rehabilitation Association of BC and is a Registered Rehabilitation Professional and Certified Vocational Consultant.

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Most short-term disability plans provide coverage for 8 to 52 weeks. Once the insurance company approves your claim it will be regularly reviewed. The insurer will ask your medical team about the next steps for treatment and will regularly phone you for updates. The goal in this period is for you to return to work in your own occupation with or without accommodations. If your medical team states that you are unable to return to work during this period and you may have a long-term disability plan and meet the qualifications, you can apply for benefits under it.

Most long-term disability plans have periods that cover whether you can return to your own occupation or any occupation. To receive disability benefits during the own-occupation period, you must be totally unable to perform any and all aspects of your own occupation. This period depends on your insurance contract and can vary.. The most common period of own occupation is 2 years. During this time, your case manager at the insurance company gathers information about your ability to perform your own occupation.

After the own-occupation period ends, the any-occupation period begins. Your case manager at the insurance company will review your ability to perform any occupation that:

  • you have acquired skills and qualifications for
  • does not compromise the functional restrictions and limitations that your doctor says prevent returning to work in your own occupation
  • provides an income similar to the one you had before going on disability

Regular updates required

Once your claim for long-term disability benefits is approved, the case manager will ask for regular updates:

  • treatments planned for you
  • your ability to do activities of daily living
  • non-medical factors that influence your time off work (for example, parent or child care, moving to another home)
  • your occupational requirements
  • situations at your workplace that can cause you stress (for example, lack of workplace supports, poor performance before your cancer diagnosis, job restructuring)
  • the openness of you and your employer to modified work while you are on disability benefits
  • the benefits of providing supports for returning to work (for example, tests, assessments, vocational rehabilitation)

The case manager may ask for assessments by healthcare professionals, who will provide these updates. Based on these assessments the insurance company may fund services to help you return to work.

Help with getting back to work

Case managers from the insurance company may have access to vocational rehabilitation consultants. These professionals work together with your case manager to improve your health and facilitate your successful transition back to work. They do this by:

  • identifying and confirming factors that may slow your recovery
  • developing a health management plan to resolve, or reduce the impact of, the identified factors so that you can eventually prepare to go back to work
  • working with your employer to put in place any job accommodations or modifications you may need
  • developing a graduated return to work plan with your employer

If you cannot return to your own occupation, the case manager and vocational rehabilitation consultant will help you return to work in a different occupation by identifying the skills and training you need for that occupation.

The vocational rehabilitation consultant creates a vocational rehabilitation plan for you. To create this plan, the consultant gathers information about your circumstances to decide which goal is best suited to getting you back to meaningful employment. The consultant starts with the first goal on the following list and works down through the list to find the most feasible goal:

  • Returning you to the same work with your same employer
  • Returning you to the same (modified) work with your same employer
  • Returning you to different work with your same employer
  • Returning you to similar work with a different employer
  • Returning you to different work with a different employer
  • Re-training and/or re-educating you for a different occupation that does not compromise your functional restrictions and limitations

Your case manager will also help you get ready to return to work, when it is possible based on your restrictions and limitations. If you are returning to work gradually your case manager will help calculate a top-up to your employment earnings and complement them with disability benefits. There may be times after you return to work that you need to go on disability again (for example, chemotherapy or surgery). While waiting, though, the insurance company will expect you to work. Your case manager will help you to return to work between maintenance treatments or while waiting for medical procedures.

*New as of December 14 2017
Nurse practitioners now allowed to complete medical reports required by the CPP disability program
On December 14 2017, the Minister of Families, Children and Social Development, Jean-Yves Duclos, highlighted an important change to the Canada Pension Plan (CPP) disability program, in support of his commitment to improve delivery of programs and services for all Canadians. As of that date, treating nurse practitioners (NPs) can provide patients with medical evidence required by the CPP disability program.
NPs are now able to independently complete the initial medical report included in the application kit for CPP disability benefits, as well as the medical forms associated with the automatic reinstatement and reassessment of CPP disability benefits and the Disability Vocational Rehabilitation Program.
“We understand the emotional and financial stress that a serious health condition can place on an individual and their family. Health professionals play a key role in the CPP disability benefit process. Allowing nurse practitioners to complete the medical reports required by the CPP disability program will simplify the overall process and make the program more accessible for Canadians,” Minister Duclos stated in a news release.
“The changes to the CPP disability program allow NPs to practise to the full extent of their regulated scope of practice. It is great news for people applying for disability benefits and will allow timely access to care for millions of patients whose primary care is delivered by NPs. Canada’s health-care system will benefit from less duplication of services, fewer barriers to care and lower health-care costs as a result of these changes,” added Barb Shellian, president of the Canadian Nurses Association.