Updated December 1, 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. Earlier this year we changed our administrative process for COVID-19-related layoffs. We were using the previous date coverage began when applying the pre-existing provision. As of January 1, 2021, we’ll be returning to your standard contract terms for pre-existing conditions.
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.
Updated: October 19, 2020
The first months of the COVID-19 crisis were unprecedented with many unknowns. We committed to doing all we could to support our Clients and plan members in those turbulent times.
In March of 2020, as an administrative practice, we began waiving the waiting period for COVID-19 positive short-term disability (STD) claims to help plan members impacted by this virus. We did this for STD plans with a waiting period of 7 days or less.
We’re all now settling into the ‘new normal’ and learning to adapt to this pandemic. As part of normalizing our practices, we’ll return to administering the STD waiting period according to the terms of the contract.
COVID-19 claims with a date of disability on or after November 1 will be treated as any other illness and standard waiting periods will apply. This ensures fair treatment to all plan members submitting a STD claim, no matter what the underlying issue.
For plan members diagnosed with COVID-19 or experiencing symptoms of COVID-19, we’ll continue to waive the requirement for an Attending Physician’s Statement. Instead, plan members can 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.
New Federal Government relief measures to support Canadians during the pandemic
On October 2, Bill C-4 received Royal Assent. This included the introduction of new relief measures, including the Canada Recovery Sickness Benefit (CRSB).
The CRSB will provide up to two weeks of financial support for workers who:
- are unable to work because they are sick or must self-isolate due to COVID-19, or
- have an underlying health condition that puts them at greater risk of getting COVID-19.
Plan members may consider applying for this benefit when not in receipt of STD benefits, for example, during the waiting period. Please note, workers can’t receive any other benefits while receiving the CRSB. This includes any STD benefits from an insurance carrier.
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 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.