Guide To Short Term and Long Term Disability Claims For Rogers Employees

Rogers Communications employees in Ontario are entitled to short term disability (STD) and long term disability (LTD) benefits in the event they are unable to work due to illness or injury.   It is important to understand your rights when applying for benefits, and what to do if your claim is denied.

This blog post will cover the following topics:

• Short Term Disability Benefits For Rogers Employees
• Long Term Disability Benefits For Rogers Employees
• Making an STD and LTD Claim
• Why Are Rogers’ Employees STD and LTD Claims Denied?
• Appealing STD and LTD Claim Denials
• Litigating STD and LTD Claim Denials
• Conclusion

 

Short Term Disability Benefits For Rogers Employees

Rogers Communications is a large telecommunications company with approximately 23,000 employees. Most of those employees are entitled to short term disability benefits in the event of an inability to work due to illness or injury.  

Rogers retained Morneau Shepell to administer its short term disability plan.  The administrator makes decisions regarding eligibility for STD benefits.  This separation between employer and benefit entitlement through an administrator is necessary because employers are generally not required to review employee’s confidential medical information. 

Morneau Shepell has since become LifeWorks, and after another change is now known as TELUS Health.  

If the administrator (whether it be Morneau Shepell, LifeWorks, or TELUS Health) determines that you meet the test of disability, then Rogers will pay short term disability benefits, sometimes called income continuation, for up to 105 days.  STD pays 100% of base salary for the first 30 days, then 75% for the next 75 days.

Not all short term disability claims are approved. STD benefits are only paid if the administrator determines you are in a state of disability resulting from bodily injury, disease or illness that prevents you from engaging in your own occupation and from performing paid work.  

While this definition of disability sounds like a difficult one to meet, so long as you are unable to perform the important duties of your specific job due to illness or injury, then short term disability benefits should be paid.

 

Long Term Disability Benefits For Rogers Employees

Sun Life is the insurer of long term disability benefits for claims that go beyond the 105 day short term disability timeframe.  This means Sun Life both administers and pays LTD claims to those who qualify.

The test of disability for long term disability benefits is different for the first two years than for claims that go beyond two years.  The initial test is referred to as the “own occupation” period.  To qualify during the first two years, the test of disability is as follows:

 

You will be considered to be totally disabled while you are continuously unable due to an illness to do the essential duties of your own occupation

 

Similar to short term disability claims, you should qualify for long term disability benefits for up to two years after STD ends so long as you cannot do the important aspects of your job due to illness or injury.

After two years, the test of disability becomes somewhat more difficult to meet, and is defined in the insurance policy as follows:

 

You will be considered totally disabled if you are continuously unable due to an illness to do any occupation for which you are or may become reasonably qualified by education, training or experience

 

This means that after two years you will not be considered disabled even if you can’t perform your own occupation, but you can work in another job for which you have the necessary training, education, and experience.  The alternative employment does not mean literally any job.  Rather, the earnings must be commensurate and you cannot be forced to do trivial work you are overqualified for.

These tests of disability – own occupation and any occupation – sound more difficult to meet than they actually are.  If medical issues cause restrictions and limitations that prevent you from doing your work, or a similar job, and you have supporting medical evidence, you should qualify for benefits under both tests of disability.

The Sun Life LTD policy for Rogers employees also contains other terms and conditions that may limit coverage.  For example, you must receive appropriate treatment while on claim, you must communicate with Sun Life regularly, and you must provide ongoing supporting documentation including medical records when requested. Failure to do so could result in claim denial.

 

Making an STD and LTD Claim

The decision to apply for short term and long term disability benefits should be made after speaking with your doctor.  If your primary health care provider does not support you being off work, neither will Morneau Shepell, Life Works, TELEUS Health, or Sun Life.

To apply for benefits, you must first contact the STD administrator.  You will be provided with the necessary information to complete an application, including an Attending Physician Statement form to be completed by your doctor.  You will probably also have to answer specific questions during a telephone interview with the STD administrator.

If your claim is approved, you must continue to provide periodic updates and medical records from time to time.

If it seems likely that your work absence will extend beyond the maximum 105 day short term disability period, then the STD administrator will assist with transitioning your claim to Sun Life for long term disability benefits.

Once Sun Life has the STD file, it will make its own determination as to whether you continue to qualify for LTD benefits.  In other words, being continuously disabled throughout the entire STD period does not guarantee you will automatically qualify for LTD.

Generally, long term disability claims are reviewed more carefully by Sun Life, and sometimes there are other aspects of the insurance policy that can delay or result in a denial of benefits.  Sun Life will probably require another Attending Physician Statement before accepting the long term disability claim, and will probably also require additional updated medical records.  You can expect another telephone interview with the Sun Life adjudicator before the claim is approved or denied.

 

Why Are Rogers’ Employees STD and LTD Claims Denied?

There are many reasons why STD and LTD claims are denied.  These are not specific to Rogers employees, but rather disability claims in general.

Two common reasons for denial are: (1) insufficient evidence of disability on the initial application; and (2), disagreement regarding eligibility beyond two years of LTD payments, when the test of disability changes from own occupation to any occupation.  

 

Lack of Evidence of Disability

It is common for claims to be denied when there is a not a lot of supporting medical documentation, especially for illnesses that are not considered objective.  For example, disability that results from depression, anxiety, post-concussion syndrome, chronic fatigue, chronic pain, fibromyalgia, and long-covid are more likely to be highly scrutinized and denied.  It is not that these conditions are not disabling. Rather, many of the symptoms, restrictions, and limitations are subjective and harder to prove.

 

Change of Definition

Many claims are denied when the test of disability changes from own occupation to any occupation. The any occupation test of disability is more difficult to meet than the own occupation test of disability, but the any occupation test does not mean if you can do any job in the literal sense you don’t qualify.   This test must be assessed having regard to your training, education, experience, limitations, and commensurate earnings. 

Rogers employees who have highly skilled or highly technical jobs cannot be expected to work in low paying, menial, or trivial work.  Similarly, if you do not have extensive education and experience, it is unrealistic to move from a highly physical job to a sedentary office job that requires a different skillset.

 

Appealing STD and LTD Claim Denials

If your claim is denied, you will receive a letter stating the reason for the denial, along with information about the right to appeal.  It is important for you to understand that most appeals are denied. The appeal is to the same insurer/administrator that denied the claim in the first place. Appeals are not decided by an objective or neutral decision maker, so it is unrealistic to expect a different outcome on appeal unless there is new compelling evidence not available at the time of denial.

You are under no obligation to appeal before taking legal action, and should not appeal without first consulting a long term disability lawyer.

 

Litigating STD and LTD Claim Denials

If the appeal is not successful, or if you choose to not appeal, you can start a lawsuit to recover short term disability and long term disability benefits.  A lawsuit does not mean you are going to court.  The vast majority of claims in litigation settle for payment of both past owed and benefits paid into the future.

You will of course need legal advice before starting a lawsuit.  Most LTD lawyers will provide free consultations, and most do not charge any fees unless the case is successful (no win, no fee).  Keep in mind not all lawyers who do LTD work have the same abilities.  Before retaining a long term disability lawyer, consider the following:

• Is the lawyer ranked by Lexpert as a “Leading Legal Practitioner” in long term disability law?  There are only 25 lawyers in all of Canada (both plaintiff and defence) ranked by Lexpert as meeting this criteria.

• Some personal injury lawyers and employment lawyers take on LTD cases, even though they may not be experts. STD and LTD litigation a is highly specialized area of the law, so be sure to find a specialist, not a “jack of all trades”.  

• Will the disability lawyer you initially speak with handle your claim from beginning to end, or will you be passed off to an associate or law clerk? This is common with larger firms trying to bring in as many clients as possible.

• Has the lawyer successfully handled many short and long term disability claims for Rogers employees? Ask for specific examples and the results of those cases.

• Does the lawyer have many positive Google reviews?  The law firm in general might, but what about the specific lawyer who will be handling your claim?

• Does the lawyer offer a competitive contingency fee retainer agreement?  Does the fee structure change if there is a full and final settlement versus reinstatement? Who is ultimately responsible for payment of disbursements, regardless of the outcome?

 

Conclusion

As Rogers employee, you should understand the claims process before submitting a short term disability or long term disability claim.  In the event that your claim is denied, you should seek legal advice from a lawyer with expertise in this highly specialized area of the law.

 

About The Author Michael Jordan is a long term disability lawyer with more than 17 years experience litigating all types of insurance claims.  He is a founding partner of the Bay Street firm Jordan Honickman Barristers, and is one of just 25 lawyers in all of Canada ranked by Lexpert as a “Leading Legal Practitioner” in long term disability law.  Michael represents clients across all of Ontario, with satellite offices in Ottawa and London. Email: mjordan@jhbarristers.com Direct Cell: 416-460-6823