Disability Management Committee
The SCFA representatives on the joint union-management Disability Management and Rehabilitation Committee are Linda Gomez and Sally Glock.
Listed below are the roles and responsibilities of key stakeholders when making a disability claim
Employee
- Notify Supervisor and Disability Management Coordinator of absence immediately.
- Have physician complete Work Abilities Form (cost borne by employee)
- Complete Rehabilitation Application, sign off on Occupation Demands form if no detailed job description available, complete short and/or long term disability applications
- Confirm use of banked sick leave (may not use banked sick leave beyond 30 days unless short term disability application approved by Manulife) by completing Banked Sick Leave Authorisation form
- Provide initial and ongoing proof of disability during sick leave, short and/or long term disability and in the event of his/her claim being denied
- Actively participate in the rehabilitation/modified work process
- Provide ongoing information on abilities and return to work information requested by Disability Management Coordinator, Rehabilitation Committee and/or Manulife
- Communicate any modified work problems which arises to Supervisor, Disability Management Coordinator and/or Rehabilitation Committee
- Educate his/herself on the range of services, benefits, etc. provided by the plan as well as the requirements of the plan
- Ensure that his/her Physician provides the Disability Management Coordinator, Manulife and/or the Rehabilitation Committee with required information and that his/her physician responds in a timely manner
- Ensure his/her physician is aware of the full range of benefits, services, etc. provided by the plan
- Participate in claims appeal process by selecting an independent physician to review his/her case, attend hearing, go through additional medical review as required by the Claims Review Committee
Supervisor
- Contact Disability Management Coordinator as soon as aware that employee will be absent for longer than 5 days
- Keep in touch with Employee and Disability Management Coordinator during an employee * s absence
- Completes Occupational Demands Form, if no detailed job description available
- Provide appropriate modified work to temporarily/partially disabled employees
- Monitor disabled employees progress in the modified return to work
Disability Management Coordinator
- To fully understand the range of benefits available under the plan, the requirements of the plan, the disability management process, the rehabilitation process and claims review process
- Contact Employee to initiate rehabilitation process
- If more than 20 days absence is anticipated, send Employee Work Abilities Form, Cover Letter for Rehabilitation Application, Rehabilitation Application, Occupational Demands Form (if no detailed job description available), Banked
Sick Leave Authorization, Short Term Disability Application, and Rehabilitation Brochure.
If less than 20 days absence is anticipated, initially only provide Work Abilities
Form to Employee.
Complete the employer portion of the claim forms prior to sending to Employee, and have Supervisor complete Occupational Demands Form
Initiate contact with Rehabilitation Committee where an Employee is expected to be disabled beyond 20 days and coordinate with the committee and Supervisor to develop and implement return to work program, work accommodation, etc.
Assess an Employee * s condition, restrictions, and the accommodation required, in consultation with the Supervisor
Liaison with Physicians and, in particular, facilitate education of Physicians with respect to the range of jobs available for rehabilitation and early return to work
Monitor Employee * s progress on return to work/rehabilitation program and report back to Rehabilitation Committee, assist in modifying return to work/rehabilitation program as required
Assist Employee in completing CPP application form (after initiated by Manulife)
Provide Employee with long term disability application form
Where necessary, serve as an advocate for Employees, helping to remove roadblocks, etc.
Obtain assistance from Manulife with respect to difficult sick leave claims
Maintain contact with Employee while disabled
Coordinate claims appeal process involving the selection of a Physician, providing all Claims Review Committee members with required information package, notifying Manulife of Claims Review Committee members, coordinating hearing date with Claims Review Committee, advising Employee of hearing date, advising Manulife of final decision
Support and coach Supervisors
Educate employer on the importance of embracing employee return to work programs
Rehabilitation Committee
Direct contact with Employee
Sign Statement of Principle (confidentiality agreement)
Attend monthly Rehabilitation Committee meetings
Complete initial assessment of rehabilitation potential with assistance from Manulife, as required
Prepare rehabilitation or return to work program with assistance from Manulife
Facilitate rehabilitation and return to work
Liaison with Employee I Disability Management Coordinator / Supervisor / Manulife I Physician to facilitate return to work
Review Employee * s progress on return to work/rehabilitation program and modify rehabilitation program as required
Educate Employees on the requirements and benefits of the plan
Manulife
Adjudicate all short term and long term disability claims in accordance with plan described in the collective agreement
Assist in adjudicating difficult claims during the sick leave process
Ensure that an Employee is paid in accordance with the provisions of the plan and in a timely manner
Effective, efficient, open communication with all players
Assist the Rehabilitation Committee in determining appropriate medical and/or vocational rehabilitation
Make recommendations to Rehabilitation Committee based on initial assessment of certain short and/or long term disability claims that have not already been identified by the committee
Accept and implement decision of Claims Review Committee
Physicians
Provide complete medical information in a timely manner
Ensure that all forms (i.e., Work Abilities Form, short and/or long term disability physician form, physician section of rehabilitation form, etc.) are filled in correctly and completely
Work with Employee / Disability Management Coordinator / Rehabilitation Committee / Rehabilitation Providers to assist the employee in returning to work
Responsibility does not include determining whether an Employee is disabled within the definition of the plan but rather to provide all of the medical information required for the Rehabilitation Committee and/or Manulife to make its determination under the plan (diagnosis, symptoms, prescribed treatment)
Educate themselves with respect to the full range of benefits available to an Employee under the plan
Participate on or cooperate with the Claims Review Committee, if * when asked
Rehabilitation Service Providers
Coordinate with Rehabilitation Committee I Disability Management Coordinator I Manulife / Physician I Employee return to work
Claims Review Committee
Objective, third party responsible for coordinating the hearing process with the employee (appellant) in accordance with the Terms of Reference
Educate themselves on the range of services, benefits, etc. provided by the plan as well as the requirements of the plan
Liaison with Disability Management Coordinator
Review claim file in detail as provided by the Disability Management Coordinator, and Manulife, conduct their own medical review, arrive at a decision based on the information provided and submit a written and binding decision outlining their decision and the reasons behind it
Unions
Education, support employees throughout disability process
Liaison with Disability Management Coordinator and HR as required
Employee advocacy
Promote and support disability program, disability management, and mandatory rehabilitation
Participate in return to work planning including participating on the Rehabilitation Committee as required
Initiate and participate in claims appeal process, and select or assist Employee in selecting independent Physician to represent Employee on Claims Review Committee
Other Care Providers
Outsourced providers (Employee Assistance Plan providers)
Assist in return to work and rehabilitation programs
