Application for Disability Income Plan benefits

Q.    I have submitted my Initial Application and Payroll Data Form to the 3sHealth Disability Income department. What happens next?
A.    All of the following forms must be received and completed in full before your claim can be reviewed by a claims adjudicator:
  • Employee Initial Application Form – you must fully complete and sign this form.
  • Payroll Data Form – you must complete and sign this form and attach either a blank personal cheque marked “void” or a fully encoded deposit slip. PLEASE NOTE: We cannot accept “line of credit” accounts.
  • Employer’s Initial Application Form – your Payroll/Benefits department must complete and sign this form. In addition, your employer may need to include an up-to-date job description.
  • Physician's Initial Statement – the licensed physician who is treating your disabling condition must fully complete and sign this form. Copies of all available reports and test results should be attached to this form.
We will only consider your application complete when we receive all four parts of the application. Your claim will then be referred to the claims adjudicator who will review your application in detail. The claims adjudicator may request additional medical documentation or other information relevant to your claim in order to be able to provide you with a decision on your application.

Q.    Is a physician’s note considered sufficient medical information?
A.    The 3sHealth Disability Income Plan policy requires that you provide medical evidence that supports the claim that you are totally disabled from performing the duties of your occupation. A physician’s declaration of disability, without accompanying medical evidence that objectively supports disability, is not sufficient to support a claim of total disability.  
In order to avoid delays in the processing of your claim you must provide all relevant test results, and specialists' consultation reports related to the medical condition for which you are claiming benefits.

Q.    Do I have to report other sources of income?
A.    3sHealth Disability Income Plan benefits are reduced by the amount of income that you may be eligible to receive from certain alternate sources such as employment earnings, retirement income, Canada Pension Plan (CPP), Saskatchewan Government Insurance (SGI), Workers’ Compensation Board (WCB) and private disability insurance earnings. For 3sHealth to determine if your 3sHealth disability benefit should be reduced by any such earnings that you have, we require that you report these earnings.

Failure to report alternate source income including alternate employment income can result in an overpayment of 3sHealth disability benefits and can also result in an interruption or termination of your benefits. In addition, it is your responsibility to notify 3sHealth if you  become self-employed while on an approved disability claim, even if you are not receiving any earnings as a result of your self-employment.

Q.    Do I have to apply for WCB or SGI benefits?
A.    3sHealth disability benefits are reduced by the amount of benefits that you are eligible to receive from WCB and SGI. If your illness or injury is a result of a workplace incident, you must apply for WCB benefits for this reason. In addition, your illness or injury is a result of a motor vehicle accident you must apply for income replacement benefits from SGI. 3sHealth will not adjudicate your claim until WCB or SGI renders their decision.

AVOID DELAYS: If you have already applied to WCB or SGI, please ensure that you submit a copy of all correspondence that you have received from WCB or SGI relating to these claims with your 3sHealth claim. Correspondence from WCB and SGI that is required for 3sHealth to adjudicate your claim includes the denial, termination or approval letter and all documents that confirm the amount of WCB or SGI benefits that have or will be paid.

Q.    Do I have to apply for Canada Pension Plan (CPP) benefits?
A.    3sHealth disability benefits are reduced by the amount of benefits that you receive from CPP for disability or retirement.
For this reason you may be required to apply for CPP disability benefits at some point during your 3sHealth disability claim. Your 3sHealth adjudicator will advise you if/when you are required to apply for these benefits. Of course, you may elect at any time to file a CPP disability application on your own accord. If you do so, you must advise 3sHealth that you have applied and ensure that you immediately forward to 3sHealth copies of the CPP denial or approval letter and documents that confirm the amount of your CPP disability benefit when you receive them.

You are not required to apply for CPP retirement benefits. Note, however, that 3sHealth disability benefits are reduced by CPP retirement benefits. For this reason, you must advise 3sHealth if you are receiving CPP retirement benefits and you must provide 3sHealth with a copy of CPP correspondence that confirms the amount of your CPP retirement benefit.

Q.    I have received an over payment of disability benefits. What do I do?
A.    If you receive an over payment of benefits under the plan, you must repay both the amount of the net benefit paid to you and the income tax paid to the Canada Revenue Agency on your behalf. When you have repaid the over payment to 3sHealth you will receive a confirmation from 3sHealth which you can include with your next income tax return.

In order to prevent an over payment it is important that you notify 3sHealth as soon as you return to work or receive income from any other source such as SGI, WCB, CPP or any other employment earnings. This includes retroactive benefit payments from other programs, such as SGI, WCB or CPP as such benefits paid for periods that you have also received 3sHealth disability benefits can result in an over payment of 3sHealth disability benefits. It is important to notify us immediately of any payments you are eligible to receive from other programs. We will let you know if an over payment has occurred and how much you must refund to us. We expect prompt reimbursement of the entire amount owed. Therefore, it is advised that you do not spend any retroactive payments until we have calculated the over payment amount.

If you have been overpaid disability benefits the best thing you can do is contact 3sHealth. 3sHealth will work with you to establish a mutually suitable payment schedule. By contacting 3sHealth immediately you can avoid interruptions to future claims as well as costly legal fees.

Q.    Who should I contact about the status of my application for 3sHealth disability?
A.    Once you have submitted your claim, please allow 7-10 business days to pass before contacting 3sHealth regarding the status of your application.  Once 3sHealth receives all four parts of the application your claim will be forwarded to the claims adjudicator who will review your application in detail.

Q.    Why do I have to pay for medical records?
A.    Under the terms of the plan, it is your responsibility to provide medical documentation in support of your application and to pay any fees associated with the release of this information. The cost of obtaining medical records is not covered under the Plan.

Q.    If my claim is approved how long will I have to wait before I receive my first disability payment?
A.    After you've met your 119-day qualifying period, long-term disability benefits are paid monthly, on the last business Friday of each month. Other sources of income you are eligible to receive, such CPP, WCB, SGI and others will be deducted from your benefit amount. Benefits from all sources are not to exceed 100 per cent of your pre-disability insured earnings.

If you are a member under the CUPE or SEIU plan, you may be eligible for bridge benefits (paid weekly) upon the expiration of your sick time and up to 119 days from your date of disability. If medical evidence supports your continued total disability, after the first 119 days your claim would move to long-term disability (LTD) benefits. Members under the SUN or General plans are not eligible for bridge benefits.

Q.    Is a licensed physician the only care provider who can complete the Physician’s Statement?
A.    No. A change was made to the 3sHealth Disability Income Plan in 2014 to allow medical disability claim forms to be completed by nurse practitioners, chiropractors, and registered psychologists for certain specific time periods.

Nurse practitioners, chiropractors and registered psychologists, within their respective scope of competencies, may complete the 3sHealth disability claim form. 3sHealth can accept a claim for up to eight (8) weeks from the commencement date of disability with sufficiently supportive information provided on a 3sHealth disability claim form completed by a nurse practitioner, chiropractor or registered psychologist. In the case of nurse practitioners only, a claim can be extended beyond eight (8) weeks if disability claim forms completed by the nurse practitioner are accompanied by sufficiently supportive information from a licensed physician.

A letter will be sent advising you that we have accepted the medical evidence provided from these sources. The letter will further explain that if the period of disability continues beyond the maximum period allowed by this policy then it will be required that you seek the care of a physician and that future medical forms related to the claim be completed by a physician.

Q.    Who is responsible for notifying the 3sHealth disability department of my return to work?

A.    You and your employer are responsible for notifying 3sHealth of a return to work. By notifying 3sHealth immediately you can prevent an over payment from occurring. 

Q.    Does 3sHealth share my private medical information with my employer?
A.    Medical restriction information may be shared with your employer for workplace accommodation/return to work planning. 3sHealth does not share any of your personal medical information, such as medical diagnosis and treatment, with your employer. 3sHealth is committed to protecting the privacy of your personal information. We limit access to your personal information to 3sHealth Employee Benefits staff, to any third party authorized by 3sHealth who requires it to administer your benefits, to persons to whom you have granted access, and to persons authorized by law.

Q.    Are disability payments taxable?
A.    Yes. Disability benefits are subject to federal income tax deduction as per the Canada Revenue Agency (CRA) basic tax tables. If you wish to have a different amount of income tax deducted than the basic amount, please advise us in writing.
 
Q.    Will the 3sHealth Disability Plans fund my medical treatment or re-education?
A.    The 3sHealth Disability Plans provide wage-loss benefits only. A wage loss benefit is the potential earnings that you, the insured, were unable to receive due to injury or illness. 3sHealth does not cover any fees that relate to medical treatment or re-education.

Q.    Do I have the ability to return to work gradually?
A.    With supportive medical documentation most employers are able to accommodate modified duties, modified shift schedules and modified work hours. 3sHealth and your employer will work together to customize a suitable return to work program based on your abilities and restrictions. An external vocational rehabilitation consultant may be contacted to provide assistance as well. For more information on gradual return to work programs, please contact rehab@3shealth.ca or your employer.

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