In this article, we discuss everything you need to know about Desjardins long-term disability benefits. This includes information about applying for benefits and appealing a denial.
If you need to win disability benefits from Desjardins — it’s crucial to learn as much about them as you can. We wrote this guide to help you put your best foot forward when dealing with a Desjardins long-term disability claim.
About Desjardins
Desjardins Financial Security Assurance Company is part of the Desjardins Group, which is the largest cooperative financial group in Canada. This makes Desjardins Insurance different from other disability insurance companies, which are almost always for-profit publicly traded companies. Desjardins is headquartered in Quebec, but operates in Ontario and across Canada. It also goes by the names Desjardins Financial and Desjardins Insurance.
Desjardins Financial provides both individual and group disability insurance benefits. This includes short-term and long-term disability. It also includes critical illness and accident insurance.
Desjardins Long-Term Disability
Desjardins Financial provides long-term disability benefits through individual and group insurance policies.
Group insurance policies are common with small to mid-sized businesses. In our experience, Desjardins’ group policies have standard language. Some insurance companies include irregular clauses to push the limits or reduce the rights of the individual. However, Desjardins doesn’t usually do this.
Desjardins also offers individual insurance policies. These policies are usually for self-employed professionals, executives, or small-business owners. You have to buy this type of policy — usually through an independent insurance broker. If you have an individual insurance policy from Desjardins, you can find the rules for your benefits in the insurance policy.
To qualify for long-term disability benefits with Desjardins, you must meet the following four criteria.
You must be:
- covered under a disability insurance plan (group or individual)
- ill or injured after an accident
- continually seeing a doctor
- unable to work because of your physical or mental health (“totally disabled,” according to your policy)
This article is part of our guide to long-term disability in Canada.
Desjardins Short-term Disability
Desjardins Financial provides short-term disability benefits through group insurance policies. These group policies are common with small to mid-sized companies. They also provide short-term disability benefits for municipal and provincial government employees in Canada.
Applying for Long-Term Disability
Desjardins’ application process for long-term disability is similar to most insurance companies. The following are the three forms that you need to submit:
- Employee Statement — you fill this one out
- Employer Statement — your plan administrator (usually your employer) fills this out
- Initial Attending Physician’s Statement — your doctor fills this out
If you already have a short-term disability claim with Desjardins, you don’t have to submit a new one for long-term disability. However, you do have to wait for the elimination period to be over. The “elimination period,” in other words, means that you must be disabled and not working for a specific period of time before you can get approved.
Checking your claim status
The best way to check the status of your disability claim is to contact your Desjardins representative. Try to work with them first. If they don’t respond to your inquiries, then you can file a complaint. However, you should use it as a last resort.
Desjardins Insurance Complaints Process
Like all insurance companies, Desjardins has an official complaints process. This process is for service-related complaints. It’s not meant for complaints about claim decisions, for example. If Desjardins has denied your claim, then you should appeal, not complain.
The first step in resolving a problem within Desjardins is to speak with your claims advisor or call a Desjardins customer service representative.
After that, you can escalate your complaint to a customer service manager.
If they fail to resolve your issue, you can contact Desjardins’ complaint handling team for an additional review. This begins a more formal investigation. The team will contact you to submit documents and information. They will provide you with written responses and information regarding your situation and their decisions.
You can file a complaint with the Complaint handling team by mail or fax:
Desjardins Financial Security
100, rue des Commandeurs
Lévis, Québec
G6V 6R2
Fax: 418-833-5985 or 1-877-833-5985
If you’re still having problems, you can contact the Desjardins Ombuds Office for a secondary investigation:
Desjardins Group Ombudsman
P.O. Box 7, Desjardins Station
Montreal, Quebec H5B 1B2
Telephone: 514-281-7793 ext. 5557793
Toll Free: 1-866-866-7000 ext. 5557793
Fax: 514-281-7855
Appealing a Denial of Disability Benefits from Desjardins
You have the right to appeal any decision Desjardins makes about your long-term disability claim. The most common appeal is when they decide to deny or terminate your long-term disability benefits. Like most disability insurance companies, Desjardins doesn’t have a formal appeals process. Rather, it’s an informal, undocumented process. However, if your Desjardins group benefits are part of a union, the appeal might be documented.
Internal
These are called internal appeals because Desjardins’ own employees handle them. Informal appeal processes still have a structure. You will have two to three opportunities to appeal internally with Desjardins. The second and third appeals will often involve new people reviewing the documents.
Legal appeal
After you have finished internal appeals, you have the right to file a legal appeal. This will result in a final decision for your claim. However, Desjardins does not make the final decision on whether they have to pay your long-term disability benefits. This is because in a legal appeal, the courts are the final decision-makers. Desjardins will often approve your claim or reach an out-of-court settlement with you during the legal appeal.
Long-Term Disability Lawyers for Desjardins Insurance Claims
Many people can win long-term disability with Desjardins on their own. Or with help from a friend or family member. However, sometimes it is hard to win on your own. Even if you are legitimately disabled, and should qualify. This can be very frustrating. In difficult cases, it is common for people to work with a representative. This can be a long-term disability lawyer. Or another person experienced with the process. Many representatives will work on a no-win, no-fee basis. However, do your research before hiring someone.
At Resolute Legal, we have successfully represented people in short- and long-term disability claims involving Desjardins Insurance. We have represented people at all claims stages, including applying for benefits, internal appeals, legal appeals, and lawsuits. If you’re dealing with an appeal, we can review your situation and offer suggestions to improve your chances of success. This is part of our free claim review.
Call us toll-free today at 888-732-0470 or fill out the form below to request a free consultation.
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