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 (September 2017)
- The Board of Management has met three (3) times since the last Council meeting and considered eleven (11) appeals over the reporting period. In every case the Board agreed with Sun Life’s decisions.
- In nine (9) 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 all nine (9) cases, the Board agreed with Sun Life’s decision. The appeals were therefore denied.
- 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 each file. In one (1) case, the Board agreed with Sun Life’s decision. The appeal was therefore denied.
- In one (1) appeal case, Sun Life has declined to consider the period after the member’s gradual return to work as a new claim on the basis that at no time did the claimant return to work on a full-time basis. The Board carefully reviewed the information on file. In this case, the Board found no reason to disagree with Sun Life’s decision. The appeal was therefore denied.
- The Board continues to receive financial updates from Sun Life and continues to monitor the overall financial state of the Plan.
- The Board received presentations from Sun Life on the Annual Summary Financial Report for 2016 and the 2017 year-to-date of the 12500 Plan.
- The Board received updates from TBS and Sun Life regarding efforts to reduce the Phoenix-related backlog, as well as the revised Employer Statement Form and Employee Statement form.
- The Board wishes to note the departure of Tony Tilley and Shawn Vincent, PSAC, and thank them for their contribution to the Board.
- The Board welcomed the return of Bargaining Agent Side member James Infantino, PSAC.
- Terms of Reference.
- Eighteen (18) appeals. Of these, eight (8) 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: December 18, 2017