Weekly Disability Income Benefits

How to Make a Claim

If you become disabled, contact your Plan Administrator ASAP who will provide information concerning Weekly Disability benefit claims and required documentation. Satisfactory written proof of claim must be submitted within 6 months of the date you become disabled.

The plan provides you with income to replace income lost because of a disability due to disease or injury. Benefits begin after the waiting period is over and continue until you are no longer disabled or until the end of the benefit period, whichever comes first. Check the Benefit Summary for the benefit amount, waiting period and benefit period.

  • Weekly disability income benefits are payable after the waiting period if disease or injury prevents you from doing your own job. You are not considered disabled if you can perform a combination of duties that regularly took at least 60% of your time to complete.
  • If you have not seen a physician before the end of the waiting period, benefits will not be payable until after your first visit to the physician.
  • Separate periods of disability arising from the same disease or injury are considered to be one period of disability unless they are separated by at least 2 weeks of continuous full-time work.
  • Because your employer contributes to the cost of the weekly disability income coverage, benefits are taxable.
  • Your weekly disability income benefits will terminate at the end of the plan year (March 31st) coinciding with or next following your 75th birthday.

Maternity

Members insured for weekly disability coverage are eligible to apply for benefits related to pre-delivery and post-delivery complications or other medical conditions as a result of pregnancy and that prevents the Member from performing their job duties.  Members who are pregnant, meet the working criteria for disability coverage, and are unable to work due to medical or safety reasons, are eligible to apply for weekly disability benefits prior to giving birth.

Eligible Members are entitled to weekly disability benefits for the health related recovery period following a delivery.  The recovery periods are as follows:

  • 4 weeks for natural child birth
  • 6 weeks for cesarean birth

If on weekly disability, once the baby has been born, it is the responsibility of the plan member to contact the disability claims manager to inform them of the baby’s date of birth.  Disability benefits will continue as noted above.  Members who worked right up to the birthdate, may apply for either the 4 or 6 week disability coverage, as noted above.

The 14 day waiting period and all eligibility requirements will apply.  The Member is responsible for providing the medical information to identify the medical and functional restrictions that support their inability to work.  The Member is also responsible for contacting the disability claims manager to confirm the date of birth.

If the Member experiences post-delivery medical complications that do not resolve within the 4 to 6 week recovery periods, they may be eligible for continued benefits.  The Member will need to provide medical to support this.

Other Income

Your weekly disability benefit is reduced by other income you are entitled to receive while you are disabled. Other income includes:

  • benefits under a legislated automobile insurance plan where permitted by law

Earnings received from an approved rehabilitation plan are not used to reduce your weekly disability benefit unless those earnings, together with your income from this plan and the other income listed above, would exceed your weekly earnings before you became disabled. If it does, your benefit is reduced by the excess amount.

Vocational Rehabilitation Benefits

Vocational rehabilitation involves part-time work with your employer that is intended to help you return to your job or other gainful employment with your employer on a full-time basis. A plan will be approved if it is appropriate for the expected duration of your disability and it facilitates your earliest possible return to work.

Medical Coordination Benefits

Medical coordination is a process of early involvement to ensure that you are diagnosed quickly and receive appropriate treatment on a timely basis. The goal is to enable you to return to work as early as possible and to prevent the disability from becoming long term or permanent.

Limitations

No benefits are paid for:

  • Any period in which you do not participate or cooperate in a prescribed plan of medical treatment appropriate for your condition.

Depending on the severity of the condition, you may be required to be under the care of a specialist.

  • Any day you do any kind of work for pay or profit
  • Illness or injury for which benefits are payable under the Quebec Automobile Insurance Act
  • Any disability covered under any Worker’s Compensation Law or
  • Any illness or accidental injury sustained prior to becoming eligible for coverage or prior to the effective date of the plan
  • The scheduled duration of a lay-off or leave of absence.

This does not apply to any portion of a period of maternity leave during which you are disabled due to pregnancy.

  • Any period of employment, except in an approved rehabilitation plan.
  • Any period after you fail to participate or cooperate in an approved rehabilitation plan.
  • Any period after you fail to participate or cooperate in a recommended medical coordination program.
  • Disability due to or associated with cosmetic treatment.
  • Any period of confinement in a prison or similar institution.
  • Disability arising from war, insurrection or voluntary participation in a riot.