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 (June 2018)
- The Board of Management has met three (3) times since the last Council meeting and considered nine (9) appeals over the reporting period. In seven (7) appeals the Board agreed with Sun Life’s decisions and disagreed in two (2) appeals.
- In seven (7) 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 five (5) of these cases, the Board agreed with Sun Life’s decision. The appeals were therefore denied.
- In two (2) of these cases, the Board disagreed with Sun Life’s decision. The appeals were therefore upheld.
- In two (2) appeals, 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 each file.
- In both cases, the Board agreed with Sun Life’s decision. The appeals were therefore denied.
- The Board continues to receive financial updates and other presentations from Sun Life.
- In that regard, the Board received an update on the DI salary adjustment project which was launched by Sun Life following the implementation of the new rates of pay.
- Through the salary adjustment process, Sun Life identified that some members had been overlooked due to Pheonix issues. In order to identify these members, Sun Life receives quarterly reports from PSPC and remains on target in terms of progress. Salary adjustments are being processed in the order in which collective agreements were signed.
- Sun Life is developing a new website which should go live in 2-3 months. The site will be a resource hub for Plan members and employers.
- Sun Life has partnered with the Centre for Addiction and Mental Health (CAMH) and Assurex Health on their IMPACT study which seeks to provide insight on how a combination of genetic factors impact a participant’s response to medication. Essentially, a patient’s genetic variants are identified and optimal medication and dosage is recommended based on genetic makeup. The Board agreed for Plan members to voluntarily participate in this study since the Plan member’s disability claim is not impacted by the decision to participate and the Plan member can withdraw consent at any time. Following completion of the study at the end of the summer 2018, the overall global results of the study will be shared with Sun Life to decide if this type of testing is valuable for other group plan members.
- Terms of Reference.
- Ten (10) appeals. Of these, three (3) appeals have now been received by the NJC from Sun Life.
Next meeting: September 11, 2018