Disability Claims Process
Your plan administrator will provide you with the necessary claim forms. There are three forms to complete:
Plan Sponsor Statement to be completed by your plan administrator.
You are responsible for the completion of:
- Statement of Insured to be completed by yourself.
- Attending Physician Statement is to be completed by your doctor.
If you have both Short-Term Disability (STD) and Long-Term Disability (LTD) with SSQ Insurance, only one set of forms is required for both claims.
Please submit your claim forms as soon as possible following your absence from work. For Long Term Disability (LTD) plans without STD, SSQ Insurance recommends that you submit your claim forms eight weeks prior to the end of the LTD waiting period.
Claim assessment by SSQ Insurance:
SSQ Insurance’s disability case manager will review the information provided to determine if we have received the necessary information to assess your claim.
If we only receive two of the above forms, we are unable to assess your claim which is considered incomplete. In order to help with the process:
- We follow up with your Plan Sponsor for their statement, if it is not received by SSQ Insurance.
- We follow up with you for the statement of Insured and/or Attending Physician statement, if not received.
Claim decision and payment
Within 5 business days from date of receipt of an STD claim, and 10 business days from date of receipt of an LTD claim, SSQ Insurance’s decision will be one of the following:
- STD payments are issued weekly.
- LTD payments are issued monthly, at the end of each month.
- The payment period and the amount payable, depends on your policy.
- Payment is issued after the waiting period has ended.
A suspend decision is shared with you verbally, followed by a letter to yourself and your Plan Sponsor outlining all additional requirements for the claim review.
A decline decision is shared with you verbally, followed by a letter to yourself and your Plan Sponsor.
The letter addressed to you will outline the reason for the decline, appeal rights and timelines, and the statutory limitations under the Act.
If you appeal a claim denial decision and the decline is upheld, the complaints process is outlined in our second decline letter, or the first decline letter for Saskatchewan residents as required by the provincial legislation.
Ongoing claim management
If your claim is approved, it may be approved for a limited period. The dates will be outlined in your approval letter. It is your responsibility to provide additional information to support entitlement to benefits beyond the period approved.
You will continue to receive disability benefit payments as long as you meet the definition of disability as defined in your policy.
Return to work
We will work with you and your employer to develop a return to work plan, to help you re-integrate to the workforce.