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 2019)
- The Board of Management has met twice (2) since the last Council meeting and considered five (5) appeals over the reporting period. In four (4) appeals the Board agreed with Sun Life’s decisions and it disagreed with (1) decision.
- The Board wishes to note the departure of Corinne Blanchette, from UCCO-SACC, and thank her for her contribution to the Board.
- In four (4) 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 file.
- In three cases, the Board agreed with Sun Life’s decision. The appeals were therefore denied.
- In one (1) appeal case, Sun Life declined to continue disability benefits beyond a specific date on the basis that the claimant did not make reasonable efforts to promote recovery in accordance with the terms of the Plan.
- In this case, the Board agreed with Sun Life’s decision to terminate benefits as the member was not found to be totally disabled beyond the change of definition. However, the Board recommended that benefits be extended for the full period up to the date of the change in definition.
- In one (1) appeal case, Sun Life was of the view that the claimant had a pre-existing condition prior to the commencement date of insurance and therefore was not eligible for disability benefits under the terms of the Plan.
- In this case, the Board recommended that Sun Life adjudicate the claim based solely on the medical documentation.
- The Board continues to receive financial updates from Sun Life.
- In that regard, the Board received confirmation from Sun Life that the premium rate continues to be too low to support the current and forecasted claims experience.
- The Board reviewed information from the most recent financial reports in the context of the financial forecast for the next few years and arrived at a consensus to support a recommendation of a 20% premium increase effective July 1, 2019 or as soon as administratively possible.
- The Board also received a presentation from Sun Life on the Plan Claimant Survey Results based on the new methodology which aims to capture the opinions of claimants regarding treatment throughout the claim process.
- Terms of Reference.
- Seventeen (17) appeals. Of these, four (4) appeals have now been received by the NJC from Sun Life. An additional meeting will be scheduled in July to review appeals.
Next meeting: September 10, 2019