Disability Insurance Claims: Untangling the issues

When an employee makes a claim for disability benefits, the employer, the employee, the union, and the insurer each have obligations, which may sometimes conflict. In this session, our experts will help you define the roles of these parties in the application, payment and litigation of benefit claims, and in accommodating employees on short and long-term disability.

• Applying for disability benefits: What obligation does an employer have to provide information about short-term disability (STD) and long-term disability (LTD) benefits to an employee? Is there an obligation on the employee to prove entitlement to benefits? Is there an obligation on the employer and/or the union to assist an employee in applying for STD or LTD benefits? If so, does the obligation end if the employee is terminated for cause?
• Navigating the intersection of accommodation, disability benefits, and termination: How does the duty to accommodate apply to employees who are on STD or LTD? Does the nature of the duty depend on the wording of the particular insurance policy? What are the obligations of the employer, the union, and the insurer to an employee who is receiving STD or LTD benefits? Is there an obligation on any or all of these parties to contact the employee for updated medical information or to facilitate a return to work? Are disability benefits payable while an employee is participating in a rehabilitation or vocational program? What level of payment is an employee entitled to on proof of total disability in his or her own occupation? Any occupation? What steps should be taken if the insurer takes the position that an employee is not entitled to benefits on the basis that she or he could be accommodated in the workplace, but the employer and/or the union disagree? When, if ever, is it permissible to terminate an employee who is receiving STD or LTD benefits? Does it matter if the termination would deprive the employee of these benefits?
• Understanding offsets: What happens if an insurance contract stipulates that LTD benefits will be reduced by the amount of benefits paid or payable from other sources (such as Canada Pension Plan disability benefits or workers’ compensation benefits), but the employee does not apply for benefits from these other sources? What if the employee applies for benefits from other sources but is denied? Is there an obligation to appeal? Are statutory severance payments and statutory termination payments deductible from LTD benefits if the policy does not specifically address them?
• Selecting the appropriate forum and remedies: In what circumstances are benefit issues arbitrable? When should an employee file a civil claim in the courts against the insurer? When, if ever, should an employee initiate an internal appeal with the insurer when she or he is denied benefits? When will arbitrators or courts award mental distress damages against the employer or the insurer for the failure to pay disability benefits? Is there a limitation on “forum shopping”?