LETTER 10 – APPLICATION FOR LTD
This letter is used to provide employees with general information regarding benefits and the administrative process involved in making an application for Long Term Disability Plan benefits. It is typically sent out to the employee during the third month of STIIP.
PLEASE NOTE
The language in this DRAFT letter is intended for use only as a model. Each case is unique and specific language will be required in every instance. Any italicized and bolded text or any text between these two symbols < > needs to be removed or replaced appropriately for each case. Your own ministry letterhead must be used. Your Early Intervention & Return to Work Specialist is available to provide advice.
PLEASE ENSURE THAT THE “Application for Long Term Benefits Information Sheet” (see pages 3-5 of this document) and the “Option to Continue Benefits” form ARE ATTACHED TO THIS LETTER
<Date>
<Employee’s name>
<Employee’s address>
Dear <Employee>:
Re: Application for Long Term Disability (LTD) Benefits
As your Short Term Illness and Injury Plan (STIIP) date is recorded as starting <date> and ending <date>, it is timely that we review some information that may be important to assist you in understanding the benefit plans and processes. This letter and attachment will provide you with some information on how the Great West Life Assurance Company (GWL) administers the Long Term Disability (LTD) benefit and how it may affect you.
Optional: It has come to my attention that, as a result of your absences due to illness, you have been unable to meet the conditions of the re-qualifying period per The Communications, Energy and Paperworkers Union of Canada Collective Agreements, Appendix C<BC Nurses Master and Component Agreements, Appendix 3 or Professional Employees Association Collective Agreements, Appendix A>. Although your most recent absence due to illness is noted as starting on <date>, you have not been able to work the required 15 consecutive work days in order to re-qualify for STIIP benefits since <date>. In the absence of medical documentation on file to specify the nature of the illness, and whether it may or may not be related to other absences, all absences are deemed related. Your STIIP start date is therefore listed as <date>, and your six-month STIIP period will end on <date>.
After three months of receiving STIIP benefits, application may be made for LTD benefits. The LTD instructions, LTD application and Attending Physician’s Statement can be accessed at: www2.gov.bc.ca/myhr (all in lower case) then search for LTD Application.
Alternatively if you do not have access to the internet you can contact Great West Life at 1-888-292-4111 to request that a copy of the application form be mailed to you. It is very important that you complete the LTD application forms as soon as possible.
Employees must submit all portions of their completed LTD Plan application, including the doctor’s portion, within four weeks following the end of the STIIP period. An employee who fails to submit their fully completed application for LTD benefits within the four week period will be presumed to have abandoned their claim for LTD benefits.
If you have any questions or concerns regarding the content of this letter or would like to discuss your decision to apply for LTD, please call <name> at <phone number>. It is important that you understand the administrative process and certain situations that may have a financial impact on you while you are on a health related absence.
Yours truly,
<Supervisor’s Name>
<Title>
Attachments:
Application for Long Term Disability Benefits Information Sheet
Option to Continue Benefits Form
pc: Benefits Officer, CEP, PEA or BCNU
<Name>, Early Intervention & Return to Work Specialist, BC Public Service Agency
Great West Life (via e-mail to )
Application for Long Term Disability Benefits Information Sheet
It is very important that you complete the LTD application forms as soon as possible. You are encouraged to apply for LTD benefits even if you have returned to work on a trial basis or believe that you may be returning prior to the end of your STIIP period.
Employees must submit all portions of their completed LTD Plan application, including the doctor’s portion, within four weeks following the end of the STIIP period. An employee who fails to submit their fully completed application for LTD benefits within the four week period will be presumed to have abandoned their claim for LTD benefits.
The approval process may take two to three months, following receipt of your completed application form, depending on the nature of your disability and the medical information required by GWL. During this time, GWL will require medical information from your doctor to assess your case. Please note that if there is a delay in submitting your completed LTD forms, you may be without pay from the end of your STIIP period until your claim is adjudicated by GWL. If benefits are approved after the end of the STIIP period, you may be eligible to receive LTD benefits retroactively to the day after the last day of STIIP.
Please note that it is your duty to advise your employer of any other disability income that you may be, now or in the future, in receipt of due to this injury or illness. In order to satisfy your obligations under the Master Agreement in relation to the employer’s right to wage integration, please inform Disability Benefits Administration at the BC Public Service Agency and GWL if you have a claim with WCB, ICBC, have been approved for Canada Pension Plan (CPP) benefits, or are in receipt of any other disability income benefit(s). (Please refer to CEP Master Agreement, Appendix C, Section 1.05 and 2.06; PEA Master Agreement, Appendix A, Section 1.05 and 2.06; UPN/BCNU Master Agreement, Appendix 3, Section 1.05 and 2.06). This information is required as these disability benefits are 100% deductible from both short and long-term disability plan benefits. As part of this integration of benefits, you may be required to repay any benefits that have already been paid to you.
You may be required to apply for CPP as a condition of the LTD plan. If applicable, GWL will notify you in writing and will send you a CPP application form.
Advise GWL immediately when you receive the decision (or monies) from CPP. GWL will require a copy of the correspondence from CPP declining or accepting your application. There will be a phone number for GWL in the instructional package for you to use if you have any questions.
When Your LTD Decision is Pending
If your STIIP benefits run out and you are waiting for a decision on LTD, your status will be classified as “stop pay” with the Ministry and as a result, you will cease to be covered for employee benefits (such as extended health, medical, dental, group life). During this period you will be considered to be on a leave of absence without pay. You will have an option to pay the premium to continue employee benefits coverage. To do so, you will need to complete an Option to Continue Benefits form (“BCPSA 15” form). This form can be found as attached or on line at www2.gov.bc.ca/myhr (all in lower case) then click on “A-Z Index” at the top of the screen, scroll to letter “O”and select the Option to Continue Benefits While on Leave of Absence Without Pay. If you do pay premiums for selected benefits and subsequently become accepted on LTD, any premiums you paid after the date LTD coverage begins will be refunded.
Group Benefit Plans
If GWL approves your LTD claim, your group benefit plans will be continued by Disability Management Programs as follows:
1. Public Service Pension Plan (Superannuation): Pensionable service will continue to be credited under the Public Service Pension Plan as long as you are accepted under the LTD Plan. You will not be required to contribute.
2. Medical Services Plan (MSP): Your coverage will continue. Please note that premiums paid by the LTD Plan are a taxable benefit.
3. Extended Health Care and Dental Plans: Your present coverage will terminate at the end of the month in which your STIIP benefits cease. This coverage will be continued under the LTD Plan, at no cost to you.
4. Group Life Insurance: The premiums will be paid by the LTD Plan, except for the $2.00 monthly premium for Optional Spouse and Dependent Coverage, which (if applicable) will be deducted from your LTD Plan payment. (Please note that premiums paid by the LTD Plan are a taxable benefit.)
Seniority and Vacation Credits
An employee accepted under the LTD Plan does not earn seniority or vacation credits. However, seniority earned up to the last day of STIIP will be retained if you return to work within 9 months following termination of LTD benefits.
While service and classification seniority is not earned during the LTD period, you will earn seniority for the hours worked on a rehabilitative trial. However, if you are on an accepted WCB claim, you will continue to accrue seniority until such time as your WCB claim expires.
Vacation credits are also not earned during the STIIP period unless an employee is in receipt of 10 days’ pay at the “straight time rate” during a particular month. Days for which STIIP benefits are paid are not included in the calculation and are therefore not considered days paid at the “straight time rate”. If you have any questions about your vacation credits during STIIP, please contact your manager or supervisor.
LTD Benefit Payments
If you are on an approved LTD claim, your benefits are paid once a month at the end of the month, not bi-weekly. The following will be deducted from your benefits:
· income tax
· the premium for Optional Spouse and Dependent Coverage under the Group Life Insurance Plan (if applicable)
When Your Application for Benefits is Not Approved Under the LTD Plan
If your application for benefits is NOT approved under the LTD Plan, and if you have not returned to work on a rehabilitative work trial after the STIIP period, your status will be as follows:
· the Ministry will place you on “stop pay” status
· coverage under the Public Service Pension Plan, Medical Service Plan, Extended Health Care Plan, Dental Plan, and Group Life Insurance will be cancelled
· service seniority will stop accruing as of the day after your STIIP benefits cease
· eligibility to earn vacation credits will stop as of the day after your STIIP benefits cease
If You Do Not Apply
If you do not apply for LTD benefits, GWL will not have a diagnosis of your original claim. Without a diagnosis, a review of your future absences for payment cannot be made. Therefore, you will not be entitled to receive any STIIP or LTD benefits for absences due to illness or injury, for any medical reason, until you have a full return to work for a continuous period of six months or more. This six-month period is known as the Successive Disabilities period and is a condition of the LTD Plan.
As outlined above, there are significant impacts of not applying for LTD benefits. You are encouraged to submit your LTD application to Disability Benefits Administration as soon as possible. (NOTE: there is a deadline to apply. See page 3: “An employee who fails to submit their fully completed application for LTD benefits within the four week period will be presumed to have abandoned their claim for LTD benefits.)
Appeals
If denied benefits by GWL, you are entitled to dispute the LTD benefit decision by initiating an appeal directly to the Plan Administrator, Disability Benefits Administration. The appeal process may take anywhere from three to four months. During the time you are awaiting the appeal decision, your status will be classified as “stop pay” and you will be on a leave of absence without pay with the Ministry. However, during the waiting period you will continue to be covered by group life, extended health, dental and medical plans.
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