Your disability benefit is calculated based on a flat rate or percentage formula that is applied to your salary at the time you became disabled. Please refer to your benefit booklet, which can be found on our plan member website, to determine the formula for which your benefit is calculated at.

A pre-existing condition is a condition that is present before your Effective Date of Coverage and for which you have had a medical consultation, been prescribed medication, or received treatment or diagnostic measures. Please refer to your benefit booklet, which can be found on our plan member website, for more details about when and how the pre-existing condition exclusion applies.

We will mail a slip annually, provided the benefits you are receiving are a taxable income. To confirm this, you can reference your benefit booklet or ask your Group Administrator.

For long-term disability claims, the Change of Definition refers to a change in the definition of what it means to be disabled according to your contract. Please refer to your benefit booklet, which can be found on our plan member website, for details on the Change of Definition and at what point in your claim this change occurs.

Yes, there are certain exclusion criteria for which disability benefits are not payable. Please refer to your benefit booklet for more details on exclusions, which can be found on our plan member website.

No. Any medical information obtained by your Disability Claims Specialist is strictly confidential and will not be shared with your employer unless authorization or consent is provided.

During your claim, you are required to maintain contact with your Disability Claim Specialist and Human Resources Representative. Some examples of your responsibilities include, but are not limited to:

• Providing updates regarding your situation
• Providing updates regarding your contact or banking information
• Participating in discussions regarding your return to work, which may include returning to modified work that is deemed reasonable based on your functional status

• Short term disability: Your payments would continue for as long as you are considered disabled, based on the definition of being disabled as per your contract, or until the maximum benefit period specified in your Benefit Booklet is reached. At which time STD benefit payments will stop and, depending on your benefits plan, you may transition back to work or apply to be assessed for LTD coverage.
• Long term disability: Your payments would continue for as long as you are considered disabled, based on the definition of being disabled as per your contract or reaching the term age for your policy (whichever comes first).

Long Term Disability (LTD) payments are made once a month via direct deposit. Short Term Disability (STD) payments are made weekly via direct deposit.

Please refer to your benefit booklet, which can be found on our plan member website, for more details on the definition of disability applicable to your claim.

This is required in case you are unable to return to your job. We will work with you and your employer to see if you can return in another capacity, or assist you in finding alternate employment.

It’s important that our Disability Claims Specialists have all relevant medical information to assess your claim properly and in a timely manner. The form must be completed in its entirety and we cannot accept a note on a doctor’s prescription pad. If there is missing information, a decision on your claim, and potential benefits may be delayed.

If you disagree with your claim decision you have the right to appeal. The process to appeal the claim decision will be explained to you both verbally and in writing.

We will work with you to develop a return to work plan, once you are medically capable. Our rehabilitation consultant will design a comprehensive plan that responds to your needs.

Medavie Blue Cross will work with you and your treating physician to ensure you are able to return to work. We will advise your employer of your ability to return to work, whether it is in a modified capacity or to full duties. Medavie Blue Cross may require specific information from your physician to confirm your functional abilities.

Your treating physician will need to provide Medavie Blue Cross with additional medical documentation to support your inability to return to work in a modified or full capacity. MBC will specify these details in a letter to you.

If your treating physician is recommending light duty work and if that work is available—and deemed to be safe and suitable—you may be required to return to work and perform those duties, with the goal to return to full duties, where possible. MBC may require specific information from your physician to confirm your functional abilities.

MBC and your employer will work together to identify suitable and safe work, as well as create a gradual return to work plan that accommodates those restrictions. The work being provided could be a modification of the job you were performing before your absence or an alternate job in a different department. There is also a possibility that you will return to work on graduated hours with the goal of re-integrating you back into the workplace, with the ultimate goal of returning to your regular full duties, where possible.

The amount of Short-Term Disability or Long-Term Disability benefit you are entitled to is coordinated with any other income payments which you may be entitled to as a result of your current disability. Your monthly benefit amount may be reduced by any other income or benefits payable to you from specific sources, such as the Canada Pension Plan. A full list of income sources is outlined in your benefit booklet.

If you receive a retroactive (lump sum) award from another source listed in your benefit booklet, such as Canada Pension Plan, you must notify Medavie Blue Cross immediately as this may result in an overpayment. If this situation occurs, you will be required to reimburse Medavie Blue Cross the amount overpaid.

The reduction based on other income typically applies to LTD only, however, may apply to STD depending on the contract or booklet wording.

For further information regarding this, please consult your benefit booklet.

Salary Continuance coverage is similar to Short Term Disability (STD) in that it provides protection for when you’re unable to work for a limited period of time due to an injury or illness. The main difference between Salary Continuance and Short Term Disability (STD) is that your employer manages your salary payments and approves your return-to-work plans based on the recommendations of our in-house disability team.

The decision to provide Salary Continuance or general Short Term Disability coverage is one your employer will decide.

Unlike Short Term Disability (STD), Medavie Blue Cross does not have the ability to stop your salary continuance directly, but we will advise your employer whether your absence from work is medically supported. If the information we receive does not support your inability to perform the essential duties of your job, or if you do not provide medical information to support your absence, our advice to your employer may be that your application for salary continuance should not be supported.