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: David.Le@njc-cnm.gc.ca
Quarterly Report to the National Joint Council (March 2018)
- The Board of Management has met twice (2) since the last Council meeting and considered eight (8) appeals over the reporting period. In five (5) appeals the Board agreed with Sun Life’s decisions and it disagreed in three (3) appeals.
- The Committee welcomed a new Employer Side member, Nathalie Leblanc, from NSERC.
- In six (6) 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 four (4) cases, the Board agreed with Sun Life’s decision. The appeals were therefore denied.
- In two (2) cases, the Board disagreed with Sun Life’s decision. The appeals were therefore upheld.
- In one (1) appeal case, Sun Life declined to consider the appeal as it was of the view that the appeal was untimely.
- The Board carefully reviewed the file and disagreed with Sun Life’s decision as it was noted that there was medical documentation on file dated within the 24 month limitation period to appeal the decision. The Board has requested that Sun Life consider this medical documentation to support the claimant’s appeal and adjudicate the claim accordingly.
- In one (1) appeal case, Sun Life declined to consider the appeal as it was of the view that the claimant was not covered under the terms of the plan at the time of disability.
- The Board carefully reviewed the file and did not disagree with Sun Life’s decision to deny benefits given the terms of the plan.
- The Board continues to receive financial updates from Sun Life and continues to monitor the overall financial state of the Plan.
- 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.
- The Board was advised that CRA was the first department to undergo retroactive claims adjustments and Sun Life anticipates completing all CRA adjustments by February. This exercise however, may need to be repeated given the wage reopener clause between the PSAC and CRA which went to arbitration in January.
- For all other departments, PSPC is in the process of compiling plan member data which will eventually be submitted to Sun Life for business acceptance testing prior to beginning any retroactive claims adjustments.
- Terms of Reference.
- Twelve (12) appeals. Of these, five (5) appeal files have now been received by the NJC from Sun Life. The Board continues to schedule additional meeting dates for appeal review.
Next meeting: June 12, 2018