Disability claims

Note: The qualifying period is the minimum number of consecutive months that an insured must be disabled before they qualify for disability benefits.

We cannot consider a claim until the qualifying period has been met.

• If the Client sends us a claim prematurely, we write them a letter saying we cannot consider the claim until the qualifying period is met.
• We send the Client another E14 - Disability claim - Attending physician's statement of disability to be completed once the qualifying period is met, because we need current medical information. Most physicians charge to complete these forms, which may result in additional expense for the Client.

The most important thing a Client can do to ensure a speedy decision is to complete these forms in full:

• E13 - Disability claim - Claimant's statement
• E14 - Disability claim - Attending physician's statement of disability
• E15 - Disability claim - Employer's statement

These forms provide us with all the information we need to assess a disability claim, yet they are often submitted incomplete. When we have to write to a Client's doctor for additional information, there may be as much as a 2-3 month delay before we receive a response.

There may also be additional charges for information on top of the fee for completing the Attending physician's statement of disability. This can get costly for the Client.

These reports are usually available from the physician completing the Attending physician's statement of disability, usually for a nominal photocopy fee.

Many claims require test results and specialist reports to determine the extent of the disability. They provide us with objective evidence to support the degree of physical limitations listed by the Client's physician. Although we ask for copies of these reports on the claim forms, we often don't receive them. We then have to write back to the physician and a decision on the claim is delayed.

For example, for almost every claim for back problems or back pain, we write for copies of the test results and specialist reports that are in the physician's file. If your Client provides these reports at the beginning of the claims process, it reduces the time and cost to reach a decision on the claim.

Family physician or specialist?

• The physician who is treating the Client for the disability in question should be the one to complete the forms. If the Client is being treated by a specialist, that specialist should complete the forms.
• If the Client is either (a) seeing many specialists, or (b) sees a specialist infrequently, the family physician should complete the statement because he or she will likely have an overview of the medical condition and reports from all of the specialists.
• In all claims for psychological conditions where the Client is seeing a psychiatrist, the psychiatrist should complete the form. We often have to write to the treating psychiatrist for additional information if the family physician completes the form.

• Since prorating may be required, we cannot consider a claim for disability income until we review the Client's income information. Refer to Income information for disability income claims.
• Even if we approve the claim, we cannot do any disability transactions until we receive income information. If we have not received the Client's income information and we have made the decision to approve, we normally e-mail the advisor to let them know what we need.
• If there is no advisor involved with the claim, we write to the Client directly to request income information

Please ensure the forms are completed after the qualifying period has been met.

If your client has been disabled for more than 1 year, as per the contract we can go back 1 year from the date we receive notification of disability provided that proof of disability is received within 6 months of notification. If proof is received later than 6 months after notification we will only go back 1 year from the date proof is received.

The following forms are required to make a disability claim:

• A Claimant's Statement,
• Attending Physician's Statement and
• Employer's Statement (to be completed by the owner if self-employed)

Note: Physicians may charge a fee to complete certain forms. The person making the claim is responsible for any fees for this information.

If the client is receiving any additional disability benefits please also provide proof of these benefits as listed on pg 3 of the Claimant Statement (ie. WSIB, CPPD etc).

Proof of these benefits may include:

• A copy of the approval letter, or
• A copy of a benefit statement of T4A (for CPPD benefits).

PLEASE MAIL DOCUMENTS TO:

Sun Life
PO Box 1601 Station Waterloo
Waterloo, ON N2J 4C5
Suncode 300A50

OR FAX DOCUMENTS TO : 1-866-487-4745