Long Term Disability Claims FAQ's
Disability seems to mean different things to different people. What is the definition of disability?
Disability is defined in the Plan as follows:
Disability/disabled? means, for employees whose elimination period commences on or after May 1, 2002 and who make a claim under the Plan, the complete inability, as defined from time to time in Guidelines made pursuant to this Plan, of an employee, because of illness or injury, to perform the regular duties of his/her occupation during the applicable elimination period and the next 24 months of any period of disability. Thereafter, an employee remains disabled if he/she is unable to engage in any occupation for remuneration or profit for which the employee is or may become fit through education, training, experience or rehabilitation, which occupation pays not less than 75% of the current rate of the position, class and step he/she held prior to disability.
Generally, this means:
A disability must be caused by an illness or injury.
In the first 24 months after the elimination period (100 consecutive work days), disability is the "complete inability" to do your occupation. "Complete disability" is looked at from a common sense perspective and is interpreted as the substantial inability to do your occupation.
After the first 24 months, the definition or test for disability changes from your occupation to "any occupation" that you have the ability to do, considering your education, training and experience, that will pay you 75% of what your occupation paid you. Under this definition, the availability of these jobs is not a consideration. So long as you are capable of doing the jobs, you are not considered to be disabled.
The term waiting period, or elimination period, often comes up in discussions related to LTD benefits. How is the waiting period defined?
The waiting period, or elimination period, is the time between the onset of a disability and the date LTD benefits become payable. The elimination period is defined as 100 consecutive work days of short term illness leave or 100 days of short term illness due to the same or related causes, as defined in Article 22 of the applicable collective agreement.
I have heard the term "pre-existing condition" mentioned from time to time. What does this term mean?
A pre-existing condition is one where:
An employee shall not be entitled to long term disability benefits from this Plan if his/her disability resulted from illness or injury with respect to which medical treatment, services or supplies were received in the 90 day period prior to the date of hire unless he/she has completed 12 consecutive months of service after the date of hire during which time he/she has not been absent from work due to the aforementioned illness or injury.
While awaiting the outcome of my LTD claim my salary was increased. Will my monthly LTD benefits increase?
When a member's salary is increased during the elimination period, the LTD benefit is calculated on the new salary. However, if the increase in salary occurs after the elimination period has concluded, the LTD benefit is based on the salary in effect at the end of the elimination period. Specifically the salary used is the normal salary an employee is receiving or is entitled to receive on the last day of the elimination period.
It should be noted that monthly earnings for the purpose of calculating a member's Pension Plan contributions are based on the current rate of pay for the position, class and step he/she held prior to disability, with matching contributions being made by the employer.