What if my appeal is rejected?

If your appeal is rejected, here’s what to do:

If your case is well-substantiated, the Public Service Alliance of Canada will refer your case to the Disability Insurance Plan Board of Management. You’ll need to give your Component or Regional Office complete medical information, a brief chronological description of events, and a signed form alled Authorization for Release of Information. This form authorizes the insurer to release all necessary confidential information to the Board, including medical reports which Sun Life has at its disposal. The form is available at Human Resources, Public Service Alliance of Canada Components and Regional Offices.

Officers of Public Service Alliance of Canada Components and Regional Representatives will give you advice in developing your submission to the Board and will then submit a request with all relevant documentation to Public Service Alliance of Canada headquarters (Programs Section). The Public Service Alliance of Canada will then refer the case to the Board of Management. This is the best procedure to follow.

Individual cases can also be submitted to the Disability Insurance Plan Board of Management directly by you, by Public Service Alliance of Canada Components and Regional Offices by or through your employing department or agency to:

Committee Advisor
Disability Insurance Plan Board of Management
National Joint Council
P.O. Box 1525, Station "B"
Ottawa, ON K1P 5V2

The Disability Insurance Plan Board of Management reviews cases referred to it on a "blind" basis. This means that your case is not identified by your name, but by a number. This ensures an objective review of all relevant factors which determine your eligibility for benefits. The Board may ask you or Sun Life for additional medical examinations and reports, or for other information which the committee needs for its decision. Because of this, the process may take several months to complete.

You, your department or agency, Sun Life, and the Public Service Alliance of Canada, among others, are informed about the Board’s decision as to whether the insurer acted within the intent of the DI policy.

Most of the critical issues about your claim are challenged through the procedure above. There may be some administrative issues that would have to be resolved by a grievance. An example would be if your employer deducted the wrong amount of premiums. Since they made that mistake, not Sun Life, you would have to ask your employer to correct it. If they will not correct it voluntarily, the grievance procedure is the correct legal mechanism. There are time limits to filing grievances, so raise the issue with your union rep when you become aware of it.

This grievance procedure does not apply to decisions made by Sun Life concerning adjudication of DI claims, or the evaluation of declarations of insurability submitted to Sun Life in connection with late applications for membership. These are subject to review by the Disability Insurance Plan Board of Management, as described earlier.

What about legal action?

If all other options fail, you may consider legal action. In view of the complexities and usually large legal costs involved, Public Service Alliance of Canada members are advised to consult with their Components and Regional Offices and through them with the Public Service Alliance of Canada headquarters about the prospects of successful court action. Legal costs are your responsibility, unless prior approval of legal action is requested by Components and approved by the Public Service Alliance of Canada Executive Committee.

September 22, 2013
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