Disability claims refresher

The Doctors of BC disability insurance plans are designed to help members replace a portion of their lost income should a serious illness or injury prevent them from working. Claims submitted under the Doctors of BC plans have a high approval rate (fewer than 5% of disability claims are declined). There are specific reasons why our provider, Sun Life, declines a claim.

If you are faced with a disability, here are a few things to keep in mind:
•    This is your time to switch roles from doctor to patient. You must be under appropriate medical care and the period of your absence from work must be authorized by the doctor treating you. Physicians often do not make the best patients, but not seeing a doctor can result in the denial of your claim or a portion of your claim not being approved.

•    Not following a recommended treatment plan can result in the termination of your benefits or the denial of your claim. Treatment compliance is often an issue with substance abuse-related claims where the very nature of the illness can lead to noncompliance. It’s not uncommon for substance abusers to refuse to enter a recommended treatment program, which can result in the termination of benefits.

•    If you’re off work due to a sickness or injury or have had to reduce your workload due to a disability, report your claim right away. Claims that are submitted late can present challenges for Sun Life as they are then required to go back in time and try to determine if you qualify. Long delays in submitting documents can result in it being impossible for your case manager to reach a decision.

•    When a disability strikes it can be a very stressful time; however, you don’t have to deal with the claim process on your own. Sun Life will assign an experienced case manager to work closely with you. When the case manager receives your completed forms, he or she will:

•    Call you early on in the process to answer your questions.
•    Review your claim to determine its eligibility.
•    Monitor the progress of your claim.
•    Communicate with you regularly on the status of your claim and with your attending physician as necessary.

•    If your claim is not accepted or if your benefits are terminated, you have the right to appeal the decision. Sun Life will advise you in writing that your claim has been denied and they’ll give you details of what information is needed to appeal the decision. 

If at any time during the claim management process you feel you have been dealt with unfairly or you have a complaint about a service provided by Sun Life, contact a Doctors of BC insurance administrator who will help you work with Sun Life, or put you in contact with the Sun Life Ombudsman’s Office.

Three helpful tips:
1. Be timely. Submit your claim immediately.
2. Be thorough. Provide as much information as possible upfront.
3. Be complete. Ensure you fill out all the information and fields on the claim form. Make sure you sign and date the forms. 

The most common missing information is:
•    Physician contact information. Make sure you include the full address, including the postal code and phone number, of all the physicians you have consulted. Include the names of all regular attending physicians and specialists.

•    Signatures. If you are unable to sign the claim form due to your illness, make sure it is signed by your power of attorney for property. Submit the form appointing the power of attorney along with the signed claim form.