The Disability Board of Management is responsible for the overall administrative and financial management of the Disability Insurance Plan, including the review of the contract of insurance, review of any financial or service agreement, the financial status of the Plan, the services of the Insurer, the administrative fees and charges, the adequacy of reserves, the premium levels, the disposition of disputed claims, and other matters referred to it by the National Joint Council on the overall operation of the Plan, and for making appropriate recommendations to the National Joint Council.
Committee Advisor: Jennifer.Ballantyne@njc-cnm.gc.ca
Quarterly Report to the National Joint Council (September 2018)
- The Board of Management has met once (1) since the last Council meeting and considered three (3) appeals over the reporting period. In the three (3) appeals the Board agreed with Sun Life’s decisions.
- The Board wishes to note the departure of Dan Couture, from CRA and thank him for his outstanding contribution to the Board.
- In two (2) appeal cases, Sun Life declined to provide disability benefits as it was of the view that the medical information on file did not support a finding of continuous total disability that would prevent the claimant from performing each and every duty of the regular occupation. The Board carefully reviewed the information on each file.
- In both of these cases, the Board agreed with Sun Life’s decision. The appeals were therefore denied.
- In one of these cases, the Board requested that Sun Life review their calculation of the elimination period to determine if the periods of sick leave were appropriately taken into consideration.
- In one (1) appeal, Sun Life declined to provide disability benefits as it was of the view that the medical information on file did not support a finding of continuous total disability that would prevent the claimant from working in any commensurate occupation. The Board carefully reviewed the information on file.
- In this case, the Board agreed with Sun Life’s decision. The appeal was therefore denied.
- The Board continues to receive financial updates and other presentations from Sun Life.
- In that regard, the Board received a presentation from Sun Life on the Annual Summary Financial Report for 2017 and the 2018 year-to-date of the Disability Insurance Plan.
- The Board also received an update on the revised disability claim guide. The new guide will be accessible online from the Public Service Health Care Plan (PSHCP) website along with three new physician forms (musculoskeletal, mental health, and general) all aligned with industry standards.
- Terms of Reference.
- Seventeen (17) appeals. Of these, five (5) appeals have now been received by the NJC from Sun Life.
Next meeting: November 6, 2018