Complex Disability Claims

Jun 05, 2013

Long Term Disability is one of the most valuable and complex elements of your benefits strategy.   It is one of the fundamental components of your program that provides peace of mind to your employees and their families.

Some areas of your benefits program are straight forward and easy to manage, such as paramedical services, or dental services.  A quick glance at your benefit summary can answer questions like does my program cover massage therapy?  How much dental work may I have done in a given calendar year?

Long Term Disability, on the other hand is much more complicated.  There are many different stakeholders involved at various stages of any disability claim, each with their own ideas and bias on how the claim should be managed.  The impact of a Long Term Disability claim can have far reaching implications that ripple out and reach many different stakeholders: the company; the employee; the employee’s family, physician or specialist team; the insurance company, and potentially many others.

Many disabilities are straight forward, have an expected duration, an expected return to work date, and can be very simple and easy.  Unfortunately, there are disabilities that are much more complex.  Sometimes it is challenging even for the treating physician to determine the nature of disability, or clearly observe restrictions and limitations that might prevent work activity and give rise to a disability claim.

Complex disability claims is an area where you can and should look for some guidance and support from your Benefits Consultant.  There are a number of things that a well educated and informed Benefits Consultant can do to help you navigate the complex disability landscape:

  • Be a resource to the plan sponsor and employee by providing guidance and support on the initial stages of the claiming process including claim submission, initial assessment, and establishing other eligibility criteria.
  • Assist in navigating the insurance company processes including independent medical examinations, change of definition, CPP application, etc.
  • Explain why these processes are important and necessary, why they are relevant to the disabled employee, and what they can expect.
  • Act as an advocate for the plan sponsor and employee in the event that the employee is not being treated fairly or on a timely basis by the insurance company.

These are just a few ways that your Benefits Consultant can assist you and your employee in navigating the complex disability process.

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