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: Laura Mackenzie
Quarterly Report to the National Joint Council (December 2024)
Regular activities:
- The Board of Management has met three (3) times since the last Council meeting and considered seven (7) appeals over the reporting period. The Board agreed with Sun Life’s (SL) decision to decline to provide disability benefits for six (6) appeals, and disagreed with SL’s decision to deny the claim for one (1) appeal.
- In the seven (7) appeal cases reviewed, SL declined to provide disability benefits as it was of the view that the medical information on file does not support a finding of continuous total disability that would prevent the claimant from performing the essential duties of their regular occupation for six (6) appeals and that the medical information on file does not support a finding of a total disability that would prevent the claimant from working in any occupation for one (1) appeal.
- The Board attended a full-day meeting at the SL Headquarters in Montreal, Quebec, and received presentations on SL’s Retroactive Claims Adjustment Project; legislative updates to the Quebec Pension Plan; SL’s claims submissions and adjudication processes; disability appeal statistics; and limitation periods. With respect to limitation periods, the Board raised a concern that claimants may refrain from submitting federal disability claims to SL pending their provincial claim decisions. The Board recommended it be communicated broadly to plan members that these two claims can and should be submitted simultaneously to preserve appeal timelines. The Board again raised a concern with the timeline for hearing appeals at the Board, currently between one (1) to one and a half (1.5) years following receipt by the NJC Secretariat, which is well beyond the limitation period. As a result of previous discussions on this issue, the Board has added additional meetings and streamlined the process for the provision of medical information during the meeting.
- The Board continues to receive monthly financial updates from SL. In the most recent update, the Board flagged that SL had received over 500 claims in the span of one month, which is a number they have not seen before. This was indicative that the backlog of appeals will likely continue.
- The Board tabled their recommendations on the provisions of the Disability Insurance Plan to the Executive Committee.
Outstanding item(s):
- Forty-six (46) appeals. Of these, thirty-seven (37) appeals have been received by the NJC Secretariat from SL and are scheduled for review, and nine (9) are still under review with SL.
Next meetings: May 13, 2025, June 10, 2025