UBC Disability Benefit Plan Claims Process: Guide for Staff

Introduction

This guide for staff describes the process of applying for long-term disability benefits. If you are on medical leave and unable to work for more than a four- or six-month period (depending on your employee group) due to illness or injury, you may qualify for long-term disability, which will provide you with a monthly income based on a percentage of your pre-disability gross monthly salary.

For staff employees, the long-term disability plan is called the Disability Benefit Plan (DBP). Sun Life is the University’s insurer of the Disability Benefit Plan.

The claims process includes the following steps, each of which is described in detail later in this guide:

We’ve also included a list of Useful Links  and  Frequently Asked Questions. For more information on disability benefits, please visit our  Income Replacement Plan & Disability Benefit Plan page  and select your employee group.

 

DBP Claim Process Flowchart

Click to see the full-size chart

DBP Claims Process

Getting to know the key players and their roles

  • You will need to notify your UBC Department that you require a leave of absence and provide medical documentation to support your request. If you are medically cleared to work, your department may need to provide you with modified working hours and duties depending on your illness or injury.
  • The UBC Benefits Claims & Finance Associate will verify your DBP coverage, help you with the DBP claim application process and act as the primary contact/liaison for any questions regarding your claim.
  • The UBC Leave of Absence Desk will invoice you for the cost of your continued benefits coverage if you take an unpaid leave of absence before the start date of your long-term disability benefits.
  • Your Union or Employee Group (if applicable) is an important resource for general support and informative advice.
  • A Sun Life Abilities Case Manager will assess your DBP claim and be involved in the ongoing management of your claim.
  • A UBC Workplace Health Services (WHS) Return to Work Advisor (if applicable) can help guide the process before the claim, and/or once there is a predicted return to work, help facilitate your safe and sustainable return to work.

Your responsibilities

You must complete the elimination period before you can begin receiving benefits under the DBP. This period begins with the first day you miss work due to your illness or injury, and is either four or six-months (depending on your employee group). During the elimination period, you are responsible for:

  • Submitting your application to Sun Life at least eight weeks before the end of the elimination period. This will give Sun Life the time they need to conduct their assessment and let you know their decision on your claim before the end of your elimination period, if possible.
  • Contacting the UBC Leave of Absence Desk if you have used up your paid sick leave at any point during the elimination period.
  • Participating in discussions regarding your return to work when the opportunity is identified and return to your own occupation as soon as it is safe and healthy for you to do so.

Stage 1: Inform your employer

Contact the UBC Benefits Claims & Finance Associate if you want to discuss eligibility criteria and learn more about how to submit a claim.

It is important to let your Department know that you will need to be off work due to illness or injury. You will be required to provide medical documentation to support your request for a medical leave. Alternatively, if you are currently involved in the Workplace Health Services Remain at Work/Return to Work Program, you will have a Return to Work Advisor managing your case with your department.

You may also want to talk with your department about your eligibility for paid sick leave during the elimination period, or the options available to you if you use up your paid sick leave. Disability benefits are not payable until the end of a four or six-month elimination period (depending on your employee group) has been satisfied, so it is important to learn about your options.

For information on the length of your elimination period, please contact the Benefits Claims & Finance Associate or visit our Income Replacement Plan & Disability Benefit Plan page.

For information on your eligibility for paid sick leave, please visit our Leaves page , or contact your department’s administrator.

Your Union or Employee Group can also play an important role during this time. Please contact their office if you want additional information on options that may be available to you.

Stage 2: Decide if you want to maintain your group benefits, if applicable

If you are approved for disability benefits, your coverage for the benefits you were enrolled in on the day before the start date of your disability benefit payments will continue at no cost to you. This benefits coverage will continue while you are receiving disability benefits, provided that your employment status with the University does not end.

Ideally, you will have enough paid sick leave so that you will continue to receive your full salary during the elimination period. However, if you do not have enough paid sick leave to cover the length of your elimination period, you will be required to take an unpaid leave of absence.

If you are on an unpaid leave of absence during the elimination period, the UBC Leave of Absence Desk will mail you an invoice with the cost of continuing your group benefits. You can choose to continue all, some or none of your benefits. You are responsible for paying the full cost (employee plus employer share) for any benefits you choose to continue. If you have any questions about your benefits invoice*, please contact the Leave of Absence Desk at (604) 822-9290 if your last name begins with A to K, or (604) 822-8979 if your last name begins with L to Z.

If you choose not to continue all or some of your benefits while you are on unpaid leave, please know that if you are approved for DBP, you will not receive coverage for these discontinued benefits for the duration of your approved long-term disability claim.

Note: On the benefits invoice* the Disability Benefit Plan (DBP) is referred to as ‘IRP’.

Stage 3: Apply for Employment Insurance Sickness Benefits, if applicable

As noted in Stage 2, if you do not have enough paid sick leave to cover the length of your elimination period, you will be required to take an unpaid leave of absence. You may be eligible for Employment Insurance (EI) Sickness Benefits through Service Canada during this period. Once you have submitted an application, there is a one-week waiting period for EI benefits, during which time you will not receive any benefits. If approved, you may receive EI Sickness Benefits for a maximum of 15 weeks.

If you are approved for disability benefit payments while receiving EI Sickness Benefits, you must report this to Service Canada.

For more information on the EI application process, please visit the Service Canada website   or call 1-800-206-7218.

Stage 4: Complete the long-term disability Application Forms

You can access the application forms online. You will need to print, complete and submit the forms.

Please contact the Benefits Claims & Finance Associate if you require a paper copy of the application forms.

The application package includes:

Introduction Letter

The introduction letter provides instructions on the claim process and lists the Contract number and Division/Billing group number. If you obtain the IRP/DBP application forms online, please contact the Benefits Claims & Finance Associate either by email or phone to confirm the Plan Sponsor information.

Plan Member’s Statement

You are responsible for completing this form. In the Plan Member’s Statement, you are required to provide Sun Life with information about your condition, how it occurred, your general medical history and your expected sources of income and benefits while you’re on leave.

Important Reminders:

  • Be sure to answer all the questions in full to avoid delays, and include a detailed job description and resume showing your previous job experience and education history. Please keep in mind this is a standard form and that the questions are intended to cover a variety of conditions. If you need more space to answer any of the questions, you can attach additional pages to the form.
  • When completing the section on your general medical history, you only need to provide 3-years of medical history, not 5-years as indicated on the form. If this information is difficult and unreasonable to obtain, please contact the Benefits Claims & Finance Associate.
  • Ensure that all dates you provide (such as the date you were first unable to work, the date of the accident, etc.) are correct as they are essential to Sun Life’s assessment of the claim.
  • Please provide the required document outlined in the “Automatic deposit of your disability payments” section of the Statement if you would like to have your payments deposited directly into your bank account. For chequing accounts, Sun Life will require a personalized VOID cheque.
  • Please read and sign the Declaration and Authorization, which allows Sun Life to exchange information with your doctor and any other health care professionals who are involved in your care. Also, please sign Part 1 of the Attending Physician’s Statement before giving the form to your physician to complete.

Attending Physician’s Statement

This form is to be completed by your doctor. In the Attending Physician’s Statement, your doctor is required to provide Sun Life with specific medical information about your condition and your expected recovery.

Important Reminders:

  • Your doctor’s Attending Physician’s Statement must provide a diagnosis and prognosis of your condition. This form can be completed by any medical professional who is a doctor of medicine and has treated you for your condition (i.e. your family doctor, a doctor at a walk-in clinic, a specialist, etc.).
  • If your doctor has conducted tests, all of the findings must be included in the Statement or as an attachment.
  • If you have seen a specialist for your condition, your doctor must attach copies of all consultation and clinical notes with the Statement. Often, Sun Life must follow up to request these documents, which can delay the assessment of a claim.

NOTE: Do not change or write anything on the Attending Physician’s Statement, except to complete and sign Part 1: Plan Member Information. Any changes to the Statement must be initialed by your doctor.

Plan Sponsor’s Statement

This is to be completed by your Department when your claim has been initiated. Once Sun Life has received the Plan Member’s and/or Attending Physician’s Statement, they will contact the Benefits Claims & Finance Associate to request the Plan Sponsor’s Statement. The Benefits Claims & Finance Associate will work with your Department’s Administrator or Human Resources Manager to complete the Plan Sponsor’s Statement and submit the form to Sun Life. To expedite the process, you may also contact the Benefits Claims & Finance Associate directly to notify them that you have initiated a claim.

A copy of this form is included in the DBP application package, so that you are aware of the information Sun Life requests from the University.

Stage 5: Submit your long-term disability claim

Sun Life requires three forms, as described above: the Plan Member’s Statement, the Attending Physician’s Statement and the Plan Sponsor’s Statement.  Sun Life recommends that completed claim forms be sent at least eight weeks before the end of the elimination period. This provides Sun Life with sufficient time to review your claim and obtain any additional information that they may require to complete the assessment of your claim.

It is a good idea for you to follow up with your doctor and the Benefits Claims & Finance Associate to confirm they have completed, signed and faxed Sun Life the Attending Physician’s Statement and Plan Sponsor’s Statement forms. Sun Life cannot assess your claim until they receive all three forms from you, your doctor and the University.

Please send your forms directly to Sun Life using their secure fax number. You do not need to mail information that you send in by fax, so you will have a copy for your records.

Be sure your group Contract number, Division/Billing group number and your Member ID number (this is your UBC employee number) are clearly shown on your Plan Member’s Statement and Attending Physician’s Statement before submitting your forms. If you need to confirm these numbers, please contact the Benefits Claims & Finance Associate who will be able to provide you with this information.

Sun Life Contact Information:

Mailing Address: PO Box 48810 Stn. Bentall, Vancouver, BC V7X 1A6
Fax Number: 1 (866) 639-7829

Important Note: If the plan member is not able to complete and sign the Plan Member’s Statement and Part 1 of the Attending Physician’s Statement due to a medical condition, and has no power of attorney, an immediate family member may complete the forms. If the claim is approved, Sun Life will pay up to a maximum of $10,000 in disability benefits without power of attorney on file.

Stage 6: Sun Life reviews your claim

The Sun Life Abilities Case Manager will consider a number of different factors when assessing the information on your claim. Sun Life looks at the medical information, information about your ability to function and carry on daily living activities, your occupational demands, your work environment and how your illness would affect your ability to perform the demands of your occupation.

As part of this review, the Sun Life Abilities Case Manager will be contacting you to conduct a telephone interview. This phone conversation will give you the opportunity to ask questions about your claim.

Stage 7: Sun Life notifies you of their decision on your claim

After reviewing your claim, Sun Life may decide to:

  • Approve your claim
  • Ask for additional information
  • Decline your claim

Claim Approval

If Sun Life approves your claim, they will notify you in writing and send a redacted copy of this letter to the Benefits Claims & Finance Associate.

The Benefits Claims & Finance Associate will also notify you in writing that your claim has been approved. This letter will also include information about the current status of your benefits coverage at UBC.

If you are entitled to receive benefits from other sources as a result of your disability, the amount of benefit paid may be reduced by additional sources of income, such as:

  • CPP or QPP disability benefits (excluding dependents’ benefits);
  • Disability payments from any other government plan (excluding Employment Insurance and Veteran Affairs Canada benefits);
  • Worker’s Compensation benefits;
  • Income replacement benefits from any automobile insurance plan or policy;
  • Income from other group benefit, pension or retirement plans provided by any employer when benefits are based on UBC earnings, and as a result of UBC employment, including any coverage resulting from your membership in an association of any kind;
  • Payments or earnings from any employer for any work for wage or profit as approved by the Plan Administrator (Sun Life), except for vacation pay and payments from the Living Benefits Loan Program;
  • Any past or future wage loss recovered through a legally enforceable cause of action against some other person or corporation in accordance with provisions under Third Party Liability.

For a complete list of reductions and limitations, please go to our Income Replacement Plan & Disability Benefit Plan page  and select your employee group. If available, please carefully review the Sun Life Benefits Booklet/Handbook for your employee group. There will be a link under your employee group’s plan if there is a current version available.

For more information on CPP or QPP disability benefits, please check the Service Canada website.

If you are eligible to apply for CPP disability benefits, Sun Life will require you to do so if your claim is approved. Sun Life will send you written notification with the required application forms. Please note that CPP disability benefits are taxable. If you are receiving CPP disability benefits, CPP will waive your pension contributions while on disability, making it possible for you to receive a full retirement pension.

While you are receiving benefits through DBP, you have important responsibilities to help manage your claim. Sun Life and UBC expect that you will make reasonable efforts to explore and pursue rehabilitation options where appropriate. Sun Life will request updated medical information on a regular basis and ask that you keep your contact information updated.

Important Note: During your claim, if Sun Life does not receive a requested update from you and/or your physician after several reminders, they may suspend your disability benefit payments.

Pending Decision

For some claims, Sun Life may determine that they don’t have enough information to make a decision. In these cases, Sun Life will try to get the additional information they need as efficiently as possible. This might involve an independent medical exam or a separate evaluation of your functional abilities. Sun Life will let you know as soon as they determine that more information is needed. Your Sun Life Abilities Case Manager may also need to contact your doctor and/or the Benefits Claims & Finance Associate to ask some further questions or obtain any missing information before a decision may be made.

Please contact your Sun Life Abilities Case Manger to understand what additional information may be needed for them to reach a claim decision.

Claim Decline

If Sun Life does not approve your claim, they will call you to explain why your claim has been declined, and they will mail you a decline letter outlining their decision. The Benefits Claims & Finance Associate will be notified and provided a copy of the decision letter for your file records. Any confidential medical information will be redacted from the University’s copy of this letter.

If you have already used up your paid sick leave, you will be placed on unpaid leave, and the Leave of Absence Desk will mail you an invoice outlining the cost of continuing your group benefits and pension (if applicable). The maximum length of time you may maintain your benefits and pension while on an unpaid leave is 24 months.

If you are medically cleared to return to work, you may also wish to consider participating in Workplace Health Services’ Remain at Work/Return to Work Program. For more information on this program, and how it may be beneficial to you, please visit our Remain at Work/Return to Work page.

For other options that may be available to you, please contact UBC Advisory Services. Each Faculty and Unit is assigned to an Advisor and Associate.

Submitting an Appeal

If you wish to appeal Sun Life’s decision, please contact your Sun Life Abilities Case Manager to learn how to submit an appeal and the information you will need. You can only appeal Sun Life’s decision three times. If you submit medical tests/reports separately, Sun Life may consider these to be separate appeals. We therefore recommend that you collect all necessary information to submit a strong appeal.

Frequently Asked Questions (FAQs)

How long does it take Sun Life to assess the claim once all forms have been submitted to Sun Life?

Once all three claims forms are received, Sun Life will complete the assessment of the claim within 10 business days. Additional time may be required if more information is needed to reach a decision on your claim.

Will Sun Life share medical information with my employer?

No, the medical information you provide to Sun Life is confidential and will not be shared with the University. Sun Life does not provide any information regarding medical diagnosis to your employer and will only share information regarding the claim status and your prognosis for return to work. The authorization you sign on the Plan Member’s Statement outlines what information will be shared (and what won’t be) and with whom.

How much is my monthly benefit payment amount?

Your monthly benefit payments are calculated based on your employee group and your pre-disability gross monthly earnings. These benefits are non-taxable.

When does my benefit payment end?

As long as you continue to meet the eligibility requirements, you will continue to receive disability benefit payments up to the following (whichever occurs first):

  • Date you are no longer totally disabled
  • End of the maximum benefit period
  • Your normal retirement date (the last day of the month in which you turn 65)
  • The date you are incarcerated in a prison or mental institution by authority of a criminal court
  • The date you pass away

Please see our website for more information on termination of benefit payments.

What is my responsibility during the total disability period?

You must make reasonable efforts to recover from your disability, including participating in any reasonable treatment or rehabilitation program, and accepting any offer of reasonable modified duties from the University. Learn more on rehabilitation assistance and gradual return to work programs.

Please ensure you notify Sun Life and the University of any changes to your contact information (i.e. phone number and mailing address). To update the University, please do so through the Self Service portal.

If you have difficulty accessing the portal, you may also submit a Personal Data Change form to Payroll, which can be found  online under ‘Payroll Forms’.

What is a Gradual Return to Work/Rehabilitation program?

Once your Sun Life claim has a prediction that you are functionally able to return to work, Workplace Health Services (WHS) will help you with your re-entry into the workplace. WHS will facilitate a workplace accommodation, if required, by communicating with all parties involved. WHS can help you make a healthy, safe and sustainable return to work.

To determine your WHS Return to Work Advisor, please visit the Remain at Work/Return to Work page for their portfolio listing. Your Sun Life Health Management Consultant may also contact the Benefits Claims & Finance Associate to initiate a referral to a WHS Return to Work Advisor.

During your rehabilitation program, you will continue to be eligible for DBP benefits. Your monthly benefit will be reduced by 50% of the income you receive under the rehabilitation program. The Benefits Claims & Finance Associate will report your gross rehabilitative earnings and taxes at the end of each month to Sun Life. Please go to our Income Replacement Plan & Disability Benefit Plan page, select your employee group and refer to the Sun Life Booklet for any contract stipulations regarding your monthly benefit amount calculations during the rehabilitation program.

What happens to my benefits premiums when I begin a Gradual Return to Work?

When you return to rehabilitative employment from total disability, the DBP will continue to pay your benefits until you work three consecutive months of 50% FTE or more. At that point, benefits will revert to normal cost sharing.

Normal cost-sharing means that you are responsible for paying the employee share of any benefits costs (contributions/premiums) that you paid before going on disability leave, with the exception of the IRP/DBP premiums and any Optional Life Insurance premiums that are waived by Sun Life.

Contact

If you have any questions, please contact us:

Benefits Claims & Finance Associate
disabilityclaims.info@ubc.ca
(604) 822–8696