In this article, we discuss everything you need to know about Canada Life’s long-term disability benefits. That includes a discussion of rules, as well as information about applying for benefits and appealing a denial.
If you’re wondering about Great-West Life’s long-term disability, you’re in the right place.
- About Canada Life Insurance
- Canada Life Long-Term Disability Rules
- Canada Life Short-term Disability Benefits
- Applying for Canada Life Long-Term Disability Benefits
- Canada Life Complaints Process
- Appealing a Denial of Canada Life Long-Term Disability
- Tips for Winning Canada Life Long-Term Disability
- Next Step – Get Your Free Books
About Canada Life Insurance
The Canada Life Assurance Company is one of the big three life insurance companies in Canada. It was formed in January 2020, when three insurance companies merged together — Great-West Life Assurance Company, London Life Insurance Company, and the Canada Life Assurance Company.
Canada Life sells and administers a range of insurance and financial products, including short- and long-term disability benefits plans. Canada Life sells individual and group disability insurance plans to consumers and employers. They also act as a third-party administrator for disability plans set up and funded by large employers or non-profit groups.
This article gives you an overview of Canada Life and the disability benefits it offers.
Canada Life Long-Term Disability Rules
There are no general rules applicable to all Canada Life long-term disability claims.
If you need to file a long-term disability claim with Canada Life, you can find the rules in your specific group policy or plan document. It will include information on eligibility, payment amounts, and claim procedures. But, these group policies and plan documents are unique. So, the only way to know the rules for your situation is to get a copy of the document that applies to you.
The group benefits booklet or certificate of insurance is a summary of your benefits. You can request a copy of this from your employer, union, or association. It includes all the information relevant to your claim. Therefore, you don’t need a copy of the original policy that your employer or association bought.
Individual insurance policies
Canada Life also issues individual insurance policies. These are usually for self-employed professionals, executives, or small-business owners. You must buy this policy from Canada Life, usually using an independent insurance broker. If you have an individual insurance policy from Canada Life, the rules for your benefits can be found in the insurance policy. Be sure to look out for any amendments or riders attached to it.
Non-profit disability plans
Sometimes Canada Life will act as the administrator of a disability plan. The plan might be set up and funded by a government, large employer, or other association, for example. But, in these situations, Canada Life acts as the administrator of the plan. So this means the organization that funds the plan lets Canada Life exercise authority. For these types of plans, there is no insurance policy. However, the rules for the benefits will be set out in a document called the “Plan Text” or something similar. We call these non-profit disability plans.
With non-profit disability plans, you may have restricted rights for appeals. These plans may have strict procedures and deadlines that don’t follow the rules applicable to regular long-term disability insurance policies. You may be unable to pursue your appeal using the lawsuit process, for example. You may have a collective agreement with a grievance process that you have to follow.
Looking for more information on long-term disability? Check out our guide on long-term disability in Canada.
Canada Life Short-term Disability Benefits
There are no general rules for Canada Life short-term disability claims; the benefits and claims process will be unique and based on your particular group insurance or income continuation plan.
If you need to file a short-term disability claim with Canada Life, the first step is to get a copy of the benefits booklet for your specific policy; this should tell you what you need to know. Your benefits will be summarized in a document called the group benefits booklet or certificate of insurance. You should be able to get this booklet from your employer or association.
There are two potential roles that Canada Life might play in the payment and administration of benefits. They might be the insurer, administrator, and payor of benefits under a group policy. Or, they might act only as the third-party administrator of benefits paid by your employer or association.
Whether Canada Life is the insurer or the third-party administrator will not change the claims process in most situations. However, Canada Life’s role as a third-party administrator does become relevant if you need to file a legal appeal or lawsuit for payment of benefits. If Canada Life is a third-party administrator, you would need to take legal action against the actual payer of benefits. This is usually your employer or association.
Applying for Canada Life Long-Term Disability Benefits
When applying for long-term disability with Canada Life, you will need to complete three forms: a claim form that you fill out, a medical form your doctor fills out, and a form your employer fills out.
You can usually ask your employer for the forms. Or, you can find them on GroupNet, which is Canada Life’s secure online portal. Canada Life also has a “find a form” tool on its website. So you can find the disability claim forms there, as well.
If you’re a Canada Life plan member, there are two ways to submit your forms. You can either go fully paper or fully digital. So, when you need to submit forms, you can print them and send them through the mail or submit them online. However, keep in mind it is quicker and easier to submit them digitally.
Checking claim status
The best way to check the status of your disability claim is to contact the advisor that you’re working with at Canada Life. Alternatively, you may be able to check the status of your claim on GroupNet.
If the advisor doesn’t respond to your inquiries, you can follow Canada Life’s complaint process. Try to work with the claims representative and use the complaint process as a last resort.
Canada Life Complaints Process
Canada Life has an internal complaints process. This is for complaints related to the service you have received. The process is as follows:
First, raise your issue with your claims advisor — if you’re working with one. If not, or if they are unhelpful, contact a customer service representative. There are different phone numbers to call depending on your claim type and location. You can find the complete list here.
If your problem isn’t solved, you can escalate your complaint. To do this, you will have to call the appropriate phone number for your claim type and location (usually the one you used in the first step). You must specifically ask to have your complaint escalated. When you do, you’ll have to explain the details of your complaint — including why you disagree with or are dissatisfied with Canada Life’s handling of your situation and how you think it should be resolved. You’ll want to have any related documents on hand, as well as a complaint tracking number if you have one. Once you have detailed your complaint, they should give you an explanation of their process and an estimate of when you will hear back.
Finally, if you’re unsatisfied with these steps, you can submit your complaint to the Ombudsman for a final review. You must complete step 2 before escalating your complaint to the Ombudsman.
Ombudsman
The Great-West Life Assurance Company
Ombudsman’s Office T 262
255 Dufferin Avenue
London, ON
N6A 4K1
Phone: 1-866-292-7825
Fax: 1-519-435-7679
Email: [email protected]
Appealing a Denial of Canada Life Long-Term Disability
There isn’t one single process for appealing a disability claim denial from Canada Life (or any other insurer); you must follow the appeal rules that apply to your specific disability plan. If you don’t already have one, start by getting a copy of the booklet that describes your specific disability benefits. You can get this from your employer or association.
Internal appeal
Generally, your short or long-term disability appeal will involve two or more opportunities to appeal directly to a Canada Life claim representative. This is usually handled by the representative who has already denied you, but it is sometimes handed off to a more senior member. This is called an internal appeal.
Once you receive your denial letter, you must notify Canada Life in writing about your intention to appeal before the end of the appeal deadline. Deadlines vary but can be anywhere from 30 to 90 days. The denial letter should include the deadline.
Ideally, you should also get any new medical information to the claim representative before the deadline. If you have delays in getting the information that you need, be sure to notify Canada Life before the deadline. They will usually extend your time if you let them know in advance.
So, what information do you need to get to them? Again, your best point of reference is the denial letter, which will state the reasons you were denied and outline the additional information they need to approve your claim. Another thing you can do is request a copy of your claim file; this will give you a clear picture of how they are interpreting your case and reveal some areas where you and your lawyer can make clarifications. In the claim file, you might find out if they are suspicious of you (performing surveillance), the independent medical records they have to combat yours, and more.
Once you have more context as to why they denied your disability benefits, you should be able to gather the appropriate information and appeal their decision.
Legal appeal
If you’ve been unsuccessful after a couple of internal appeals, you may want to move forward with a legal appeal. This lawsuit is filed through your province’s court system. And is ultimately decided by a judge.
The insurance company will usually assign a new lawyer and a new claim representative to your case. Sometimes these get approved right away. This is because there’s a new team of people who can look at the whole situation with fresh eyes.
If you decide to pursue a legal appeal, you’ll probably want to hire a lawyer. There are lots of technicalities that you might not be prepared to deal with on your own.
If you’re appealing a long-term disability claim in a situation where Canada Life is acting as a third-party administrator, then you’ll need to determine what the different rules and deadlines are.
Tips for Winning Canada Life Long-Term Disability
At Resolute Legal, we always say education is one of the most valuable tools for winning disability benefits. We believe that learning about your competitor (Canada Life) and the disability claims process will give you the best chance at success. So, in this section, we are going to share some key things we’ve picked up about Canada Life after years of litigating against them and provide some tips on how you can beat them at their own game.
Meticulous documentation
Canada Life and its staff are very meticulous in their documentation. When we order a client’s file from Canada Life, it is always extremely detailed. They have telephone records with very specific notes and categories, and they will have documentation of all communications between you and the insurer. Canada Life’s staff are also very structured in how they communicate with you. They have forms that lay out what needs to be said on certain calls as well as what answers they need to get from you. So, if you’re appealing a denial of Canada Life long-term disability, you should expect they will have ALOT of information on you.
For that reason, you usually can’t win benefits by proving your claim manager or the adjuster was incompetent or fumbled the ball. So, you will want to work with an experienced disability lawyer or pick a sophisticated appeal strategy to win the benefits you deserve.
We also recommend keeping a very detailed record of information. So, if they were ever any disputes about what was said, you could back up your account with documentation. You can do this by taking notes during and after calls with your claims manager, screenshotting and saving all communications between you and the insurer and keeping copies of any medical information you have.
Planning
Canada Life is also known for planning ahead. They will ask their claims manager to assess your claim and come up with a plan for how they should proceed with your claim. For instance, if they are skeptical of you, they will create a plan that requires you to undergo more medical assessments and independent medical examinations.
So, you shouldn’t expect that your claims manager is just flying by the seed of their pants and asking you to do things without much thought. They will almost always have a very structured plan in place with the goal of getting you off benefits and back to work.
The reason we mention this is because it will require you to be more sophisticated and methodical in how you deal with them. You can’t rely on them to drop the ball or forget to do important tasks. Canada Life is going to have all its ducks in a row, so you have to make sure you have things squared away on your end as well.
Secure email service
Another thing to keep in mind when trying to win long-term disability benefits from Canada Life is the way in which they communicate. A few other large insurers do this as well, but Canada Life encourages claimants to use their ‘secure email service,’ which is basically a privatized email server that encrypts all communication between you and the company. This service is actually great because it provides an extra layer of protection for you and your information — we actually use a service like this with our clients at Resolute Legal. However, the issue is that Canada Life completely controls this platform, so at any point in time, you could be restricted and lose access to all emails between you and the insurer.
The other thing to keep in mind is attachments expire after 21 days. So, you will have to save a copy in order to access it again. Canada Life actually says this in their secure email service guide: “Always save the original email with an attachment. This is how you’ll need to access any secure messages after 21 days.” They also “recommend you save/print the message and any attachments for your records.”
As you can see, it is extremely important to keep a record of all your emails with Canada Life, especially if you are using this service — they even tell you to do it! So, for good measure and to avoid forgetting, take screenshots or print off all emails and attachments as soon as you get them.
Income thresholds in the definition of disability from any occupation
Canada Life is also unique in that a lot of its group policies have explicit income thresholds that form part of the definition of disability from any occupation. This is important to know because this income threshold is literally baked into their definition of disability for any occupation. Meaning under the policy, you won’t be considered totally disabled from any occupation if you are able to earn more than that amount (i.e. 60% of your pre-disability income).
In our experience, other insurers tend to leave it more vague, and they won’t include a specified amount. This can make things difficult because they can argue that basically, any income (i.e. 40%) would prove that you weren’t disabled from any occupation.
So, in a way, Canada Life’s explicitness can make things easier for you. There are no debates over how much you can earn. Instead, the dispute shifts to whether you are able to earn more or equal to the specified income threshold.
Note: Not every Canada Life policy will have an income threshold baked into their definition of disability from any occupation. So, make sure to read your group benefits booklet or individual policy.
Internal medical reviews
Canada Life also relies heavily on internal medical reviews. This means they either have a doctor on staff or contracted who will look at your medical files and give opinions. Due to this reliance, they are more aggressive in getting copies of your medical files rather than just asking for a report or update from your doctor(s).
They want the full file because they want their doctors to go through it and provide opinions on whether your doctors are giving appropriate care and treatment. They also want to see whether your healthcare providers are documenting things properly. If their doctors come back and say that there are issues with the treatment or documentation, Canada Life can then use that opinion to deny your claim.
In our experience, Canada Life will rarely terminate a claim without having their internal or contracted doctors back them up. In contrast, smaller insurers with fewer resources will often make claim decisions without the support of an internal doctor.
So, to avoid a denial based on an internal medical review, make sure you are participating in all medically accepted treatments and your doctor is properly documenting the process.
In-house lawyers
It is also important to know that Canada Life has its own lawyers who work in-house. These lawyers are stationed around the country, and they handle all of Canada Life’s disability claim lawsuits. From a lawyer’s perspective, having an in-house law team is usually a better experience for us because the claims typically move smoother and faster as opposed to a contracted lawyer who is handling several other cases and matter types.
With that said, these lawyers are extremely skilled at what they do. Their only job is to handle these types of claims, so they really know their stuff. They also have a reputation for providing high-quality evidence to base their claim against you. That means they’ve hired good doctors to conduct independent medical evaluations and have gotten opinions and testing from vocational experts.
So, if you want to have any chance at winning your case, you will need to select a very sophisticated legal approach. This can be difficult to do without a law degree or experience with disability claims. So, you should always consult with a disability lawyer.
Our team at Resolute Legal has years of experience dealing with Canada Life. We know their tactics and can beat them at their own game. You don’t have to let them deny you the benefits you deserve. Call us today at (888) 732-0470 for a free case evaluation.
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