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Submit a Disability claim even if you are submitting to WSIB / Worker’s Comp

This bulletin is an excerpt from the group benefits newsletter of The Co-operators Life Insurance Company.

If a plan member has a work-related injury, it is important for them to submit a completed disability claim application form and any other supporting documents to Beneplan, who will submit to the insurance company, within the time periods required by the group plan, even if they have applied or intend to apply for WSIB/WCB.

By doing this, their claim is not compromised should their WSIB/WCB benefits be denied or discontinued.

Most group disability plans require the group benefit amount to be directly reduced by the WSIB/WCB payment amount. Regardless of this reduction, plan members are still eligible for the Disability Waiver of Premium, and in some cases, Life and AD&D premiums, for the duration of their claim if their claim is approved. Disability benefits approved by the WSIB/WCB are adjudicated and managed by the insurance company in the same manner as other claims.

In some instances, WSIB/WCB may decline further benefits; the carrier(s) will continue to adjudicate the claim based on the policy definition of total disability. If a person’s WCB benefits stop and a claim was not received by our office, we will need medical evidence to support total disability from the date of loss, not the date the plan member’s WSIB/WCB benefits were terminated. This may lead to disruptions in their wage loss benefits.

It is important to note that group plans contain a provision indicating a time frame in which a claim application must be furnished to the insurance company; failure to provide proof within this time may invalidate a claim. To avoid disruptions and to comply with plan requirements, employees should submit claims to The Co-operators in accordance with the terms of their group policy, in addition to submitting a claim with WSIB/WCB.