Updated: July 23, 2020
Your workplace may have new health and safety requirements including mandatory PPE.
For some plan members, these extra safety measures may cause a medical condition that makes them unable to work.
Where a plan member is unable to tolerate PPE, and it is a requirement of their job, they can make a claim under their provincial workers’ compensation program.
As workers’ compensation is an exclusion in our standard contracts, Sun Life will not pay short-term disability (STD) benefits for a medical condition caused by the inability to wear PPE.
However, if a claim for workers’ compensation is declined, the plan member can then submit a claim for consideration of STD benefits. The plan member must submit a copy of the decline letter from workers’ compensation with their claim form.
Updated March 23, 2020
When the COVID-19 pandemic first emerged, we considered plan members, placed under quarantine by a medical doctor or public health official, eligible for STD benefits. We paid STD benefits even if the plan member was not tested or did not have a positive test result for COVID-19. In doing so, we made an administrative exception.
We will not continue to do so. Effective March 19, 2020, we’ll be adhering to the terms of our STD contracts. This recognizes that the purpose of disability insurance is to replace a plan member’s income when they are too ill to work.
That said, these are extraordinary times and we are putting in place some new special measures as outlined below.
New special measures for COVID-19 illnesses
Plan members and plan sponsors still need to complete an STD statement as part of the application process. However, we are waiving the requirement for an Attending Physician’s Statement. Instead, to qualify for these COVID-19 related STD benefits, plan members will need to fill out this Confirmation of illness form. The Canadian Life and Health Insurance Association (CLHIA) developed this form in collaboration with insurers. It ensures consistency in our approach and the smooth processing of claims.
Positive COVID-19 test result
If a plan member has tested positive for COVID-19 and cannot perform the duties of their job, we’ll:
- Pay STD benefits for at least 14 days
- We’ll waive the waiting period for STD plans with a waiting period of 7 days or less
No positive COVID-19 test result
If a plan member has a flu-like illness but has not been tested or does not have a positive test result for COVID-19:
- We’ll continue to adjudicate each claim based on the definition of total disability
- The waiting period will be applied
We won’t pay STD benefits to a plan member who is not ill. This applies whether they self-isolate:
- at the direction of their employer, or
- following any government or public health directive that recommends employees stay home as a precaution to prevent the spread of COVID-19.
For clarity, if plan members do not have signs of or have not tested positive for COVID-19 but they are placed under quarantine by a doctor or public health official, we will not pay STD benefits.
Employment Insurance (EI) may cover those who are not ill but cannot perform their work at home during self-isolation. EI has waived the 1-week waiting period for benefits to begin. Plan members may also need to discuss alternative work arrangements or compensation options with you.
Communication to plan members
We’ve created an STD communication that can be shared with plan members. The communication provides the details on our COVID-19 STD policy as outlined above.
We understand the complexity of this rapidly evolving situation. We’re here to help and provide as much flexibility as possible.
Updated April 1, 2020
The Government of Canada has many initiatives to help Canadians during this time. This includes changes to some of the processes at the Canada Revenue Agency (CRA).
The CRA announced that they are suspending wage garnishments, also called Requirements to Pay (RTP). During this suspension, we won’t deduct the amount set out in an RTP from Group Disability benefit payments. Plan members will notice this change on their next disability payment. This suspension is in place until further notice. Plan members can contact the CRA if they have questions about their account.
Updated: April 2, 2020
You may have plan members in the process of a gradual return to work following a disability leave. We recognize that the COVID-19 pandemic may have changed the gradual return to work plan.
- For administrative services only (ASO) policies. We will take direction from you on the handling of gradual or modified return to work plans. We can discuss any cases impacted by COVID-19 with you.
- For insured policies. We’ve set out here how we’re handling cases where a plan member’s gradual return to work plans have been impacted.
Updated April 21, 2020
When paying benefits during an absence from work, we need an Attending Physician’s Statement (APS). This typically applies to salary continuance, short-term disability, or long-term disability claims.
These statements give us specific medical information about a plan member’s condition and their expected recovery.
We recognize that plan members may have difficulty seeing a doctor in person right now. However, virtual care options are available in all provinces across Canada. We encourage them to connect by phone or virtually with their health-care providers as much as possible.
Plan members applying for disability benefits must still:
- make every effort possible to get assessed by a health-care provider (phone or virtual), and
- provide medical information to support not being able to work.
An APS is still our standard requirement. If a plan member can’t have it completed by a physician or nurse practitioner, we’ll make an exception during the COVID-19 pandemic. We can accept an APS completed by:
- Occupational health physicians and nurses
- EAP providers
- Other licensed treatment providers
We’ll continue to review this administrative practice and provide updates.
Please contact your Group Benefits representative.
Updated April 21, 2020
We have standard pre-existing condition clauses in our contracts. This can affect a plan member’s eligibility for disability benefits if:
- the health conditions existed before a plan member’s coverage began, and
- the disability occurs within the timeframe set out in the contract
If there is a break in coverage, we typically use the coverage reinstatement date when applying the pre-existing provision. But we are changing our administrative practices for COVID-19-related layoffs.
Pre-existing condition clause – coverage isn’t maintained during COVID-19 layoffs
Let’s assume your plan has a standard three-month continuation of coverage provision. If you lay off a plan member due to the COVID-19 pandemic and coverage is not maintained, here’s what happens:
- The plan member returns to active work within three months. When we reinstate coverage, we will use the previous date coverage began when applying the pre-existing provision.
- The plan member returns to active work after three months. When we reinstate coverage, we will use the date of coverage reinstatement when applying the pre-existing provision.
For plans with a different continuation of coverage provision (such as six months), the conditions described above will apply. However, we will apply the rule using the different time period (for example, six months instead of three months).
Pre-existing condition clause: statutory leaves
Many provinces have laws that protect the earnings and benefits of employees when returning from a statutory leave. This includes legislated emergency leaves.
If the plan sponsor must continue benefits coverage during a statutory leave, the plan member still has the option to waive it. Here is what happens when a plan member waives coverage during a statutory leave.
- Pre-existing condition provision: We reinstate coverage when the plan member returns to work. We will use the previous date coverage began when applying the pre-existing condition provision.