Disability Insurance: Information for PSAC Members

For the first 24 months, as long as you are disabled from working in your own job.  After 24 months, DI plan members will continue being paid benefits when they can provide medical proof that their disabling condition prevents them from doing a “commensurate occupation” for which they are reasonably qualified by education, training or experience.

According to the DI policy, “commensurate occupation” means a job for which the rate of pay is not less than 66 2/3% of the current salary for your regular job.

What about rehabilitation programs?

Sometimes your health situation may enable you to participate in a rehabilitation program, which means re-training or new work. Normally you must request approval in writing from Sun Life during the first 24 months that you receive benefits. If you have received DI benefits for more than 24 months, ask Sun Life’s Rehabilitation Unit for counselling and help.

Always be clear that you are ready to participate in any program that respects your medical limitations. You have options like gradual return to work (for example - half days for the first month), or doing some but not all tasks. No one wants to make you sick again. On the other hand, you may be cut off benefits if you do not cooperate.

What about rehabilitative employment?

The DI plan provides an opportunity for you to participate in rehabilitative employment. Every case is different, but the odds of going back to your old job drop after two years. Wages from any job you get through rehab are not cut from your DI payment. You can keep the extra money—unless your DI plus wages add up to more than your old job.

To get you back to a suitable job, a special payment of up to three times your net monthly DI benefit may be made for training programs, visual aids, special equipment or whatever meets your medical needs. They can even go higher, but then it needs Treasury Board approval.

The plan also allows Sun Life to motivate and encourage workers with disabilities to continue working after their rehabilitation benefits would normally run out. Rehab will help you get back to work. You should cooperate with their plans, as long as they respect your medical limitations.

See Question 12 for more information on accommodation if you plan to go back to work.

If you satisfy Sun Life's medical consultants that you meet the definition of total disability in the DI policy, you are eligible for DI benefits up to age 65. Again you will need concrete and convincing medical evidence.

Sun Life will stop paying benefits if and when your medical situation improves and you no longer fit the DI plan's definition of "total disability".

Processing and approval of your DI claim takes time. Be prepared for delays.  When your DI benefits have been approved, payments start either:

  • After your paid sick leave or injury-on-duty leave expires; or if these payments last less than 13 weeks;
  • After 13 weeks of disability (the “elimination period”).

The 13 weeks does not need to be continuous. It may, under certain circumstances, be accumulated for the same disability over a period of one year.

An elimination period (sometimes called a waiting period) is normal in long term disability plans. Do not wait until the "elimination period" is over. Apply for DI benefits as soon as you have reason to believe your time off work will be longer than the elimination period. You may qualify for employment insurance benefits during the elimination period.

You may have enough sick leave to cover the elimination period. You may also be covered by a combination of sick leave and EI benefits. On the other hand, even after the 13 weeks, you may still be caught up in establishing your right to either DI or workers’ compensation. If you are still waiting and have no income, approach Social Services (normally administered by your municipality) to tide you over.

If the disability is work-related and you find yourself in a situation of financial hardship, you can approach your HR, who will bring the matter to Sun Life's attention.

When Sun Life is approached by an HR office concerned about an employee's situation of financial hardship, they can arrange benefits. You may have to apply for these emergency benefits because appealing a Workers’ Compensation decision is often a slow process. Don’t wait. Call your union representative if you need help.

You will be are required to sign a statement agreeing that you will continue to pursue your Workers’ Compensation claim up to and including the final level of appeal. Following any payment the Workers' Compensation Board will first reimburse Sun Life for the benefits paid to you.

It is always prudent to save for rainy days when all is going well, and thereby reduce the shock of potential financial hardship when things are not going well. Easy to say, not easy to do. But when you get a contract settlement, an overtime cheque, etc. stash some away. You may also look into the possibility of deferring loan or mortgage payments if you are still without income. You are safer to discuss it first than just miss a payment.

Your claim is first processed by a claims adjuster at Sun Life. If the information you give is not sufficient to enable Sun Life to make a decision on the claim, they will request more specific and detailed information. Keep copies of everything you send them. If you give sufficient evidence, the claim is approved. If not, the claim is denied.

If your claim is denied, Sun Life will ask you for more documentation. If, after another review, the claim is still refused and you disagree with that decision, you can ask Sun Life's Disability Management Unit to review your case. This committee, made up of senior claims analysts, may overturn a claims adjuster's earlier decision.

To appeal, send a letter to:

Disability Management Unit
Group Claims Control Department
Sun Life Assurance Company of Canada
PO Box 12500, Station CV
Montreal, Quebec H3C 5T6

Visit their website for phone numbers and other contact information.

You can also give your letter to Human Resources, or ask your PSAC Component or Regional Office to handle your appeal. Don’t forget to show your social insurance number on your letter and on all documents you submit.

After you appeal:

Sun Life will tell you what documents you need to qualify, and will respond on a priority basis to questions from HR about the status of your appeal. In emergency situations, Sun Life will usually answer direct questions from you or your representative.

Have your certificate and control numbers handy.

This voluntary group life insurance plan, sponsored by the Public Service Alliance of Canada for our members and their immediate families, provides life and accidental death and dismemberment insurance according to their needs.

Many members have taken advantage of the free $5000.00 coverage, others have bought more. Check with Coughlin and Associates at the address below.

Coverage for you and your immediate family will be free if all of the following conditions apply:

  • you are currently covered under the PSAC group life insurance plan;
  • you become disabled before you turn 65; and
  • you remain disabled for at least nine consecutive months.

You can’t apply until after you have been disabled for at least nine consecutive months. But don’t wait too long—you only have 27 months after that to apply.

For information, contact

Coughlin & Associates
1-800-216-1107
Email: psacforlife@coughlin.ca
Coughlin and Associates
PSAC Insurance Trust
PO Box 3518, Station C,
Ottawa, ON K1Y 4H5