Long Term Disability for Government of Canada Employees (non-union)

 

Public Service Management Insurance Plan 

The Public Service Management Insurance Plan (PSMIP) LTD benefit plan covers eligible employees of the Government of Canada who are enrolled in the plan and meet the plan's eligibility criteria.  According the the Plan, PSMIP members are provided a 70% income benefit if they cannot work for due to illness or injury resulting in total disability.

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Generally, the plan covers employees who are:

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• Executives, including those appointed under Schedule I of the Financial Administration Act

• Senior Managers, including those appointed under Schedule IV of the Financial Administration Act

• Excluded employees, including those appointed under Schedule V of the Financial Administration Act

• Certain other groups of employees, including judges, Members of Parliament, and certain Governor in Council appointees.

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To be eligible for the PSMIP LTD benefit, employees must meet certain criteria, including having worked a minimum number of hours and having a covered disability that prevents them from performing the essential duties of their occupation. The specific eligibility requirements may vary depending on the employee's job classification and other factors.  

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PSMIP LTD benefit is just one aspect of the overall PSMIP group benefits plan, which provides a range of benefits to eligible employees of the Government of Canada. The LTD plan supplements other disability benefits payable under such plans as the Public Service Superannuation Act (PSSA), the Government Employees Compensation Act, the Canada Pension Plan and the Quebec Pension Plan.

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PSMIP LTD requires "objective" evidence of disability.

Impossible to do for those with "invisible disabilities"​

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To apply for LTD benefits under the PSMIP LTD plan, you will need to complete an application form and provide medical documentation that supports your claim. Your claim will be reviewed by the PSMIP to determine eligibility and the amount of benefits you are entitled to receive.

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To be approved for LTD, the Plan requires "objective" evidence of disability.  The claims states:

 

"Claims for benefits are adjudicated by Industrial Alliance on the basis of all, and only, the objective medical evidence provided on the claimant's condition. To substantiate a claim, the medical information provided must be sufficiently complete, and supported to the fullest extent possible by objective test results and clinical findings, so that an independent physician, possessed of the appropriate medical qualifications, would, on the basis of that information, be able to arrive at a diagnosis of total disability for the claimant's own job.

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Accordingly, the employee should ask the doctor to provide a full, well-documented report that clearly shows the objective medical evidence supporting his or her diagnosis and prognosis. If more than one doctor is involved in the assessment or treatment of the employee's disabling condition, all doctors should supply the Insurer with full medical reports. The onus is ultimately on the claimant to provide the Insurer with sufficient medical proof of total disability. It is important to note that any omissions or unclear statements could result in a delay in settling a claim."

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In addition to LTD benefits, the PSMIP also offers a variety of other insurance benefits to Government of Canada employees, including life insurance, health and dental benefits, and critical illness insurance. These benefits can provide additional financial security and peace of mind for you and your family.  These other benefits may be affected if your LTD claim is denied.

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The PSMIP Definition of Disability is one of the most difficult to meet. 

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To be eligible for disability benefits under the PSMIP, government employees must meet the plan's definition of disability. The definition of disability under the PSMIP Plan extremely problematic for our clients suffering with "invisible disabilities" .   In our view, it is one of the most difficult definitions of disability to satisfy.  The definition states:

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"Benefits are payable for up to 24 months in respect of any medically-determinable physical or mental impairment which a) results in the withdrawal of any mandatory licence required by the employee to carry out his or her occupation or employment, or b) renders the employee completely incapable of performing substantially all of the essential duties of his or her occupation or employment.

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Benefits will continue to be paid, after the 24-month period referred to above, as long as the totally disabling condition prevents the employee from earning more than 66 2/3% of the current annual rate of remuneration for the occupation of the employee or the position held by the employee immediately prior to the date he or she became totally disabled. However, an employee who engages in an occupation or business, except as provided in the Rehabilitation provision of the Long-term Disability Benefit, will be deemed not to be totally disabled. In no case are benefits payable beyond age 65.

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It is important for personnel officers to remember, and to remind potential claimants, that in order to be eligible for benefits under LTD, a claimant must satisfy the Insurer's medical consultants, on the basis of concrete medical evidence, that he or she is totally disabled within the exact meaning set out in the plan."

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Government of Canada Employees who are claiming disability due to a serious difficult-to-prove disability should contact us for assistance in making their claims, appealing and litigating any denials. 

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What happens if your PSMIP LTD claim is denied?

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If your PSMIP LTD claim is denied you may request that it be reviewed by the Board of Trustees. The Board has power only to make recommendations to the Insurer (Industrial Alliance) but it cannot overrule any decisions the insurance company has made. In that sense, LTD denials under the PSMIP are challenging to overturn on review/appeal. The other option is to commence a court action, suing Industrial Alliance for the benefits owed to you under the PSMIP. 

 

You may be struggling to get answers to your questions.

 

We can help you decide if, when, and how to apply for LTD benefits under PSMIP.  If your benefits are later denied or terminated, we can work through what options are available to you to dispute the decision (such as whether to submit the decision for review or litigate) and, more importantly, which option makes the most sense for you and your claim.  

 

You may be wondering if you will lose your job if you do not return to work in if your claim is denied.  You may be considering returning to work before you are ready or in a part-time capacity.  You may be considering early retirement or resignation.  You may be wondering what happens to your pension and other benefits if your LTD claim is denied.  These are all very legitimate concerns and questions that we can address when we speak. 

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We understand the nuances of PSMIP LTD plan and what is required to successfully prove your disability claim. 

 

Mulqueen Disability Law is dedicated to proving disability for "invisible" conditions such as anxiety, depression, PTSD, workplace stress/burnout, chronic pain condition, post-COVID conditions,

immunological conditions and neurological conditions.  

It's what we do. It's what we've always done.

 

Our initial consultations are confidential and free.  We will review and assess your claim and provide you with practical tips, information, insights and strategic suggestions.  We will help you determine how best to proceed.  You help others.  Let us help you.

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PSMIP LTD claims are complex.

 

Unlike other professionals/employees covered under other group policies, Government of Canada employees have unique concerns and issues with respect to the denial of their disability benefits and also with respect to settling their court actions. It is critical that these issues be fully addressed in the litigation and dispute resolution process.

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Some of the issues and considerations unique to Government of Canada employees' long term disability benefit disputes, include:

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• How the denial of a claim or the settlement of a lawsuit will affect the retirement pension, their employment and their future coverage under the plan, including life insurance and future long-term disability claims;

• Whether the employee should apply for their disability pension;

• Whether the employee is able to keep their job while they are on leave;

• Protecting privacy regarding the disclosure of their medical information to their employees and others;

• Rights and responsibilities with respect to participating in rehabilitation programs;

• Efforts to return to their work or efforts to some other type of work;

• The calculation of the  monthly LTD benefit amount; and,

• Whether the plan requires a review of the denial or termination of their benefits or whether the employee can sue for benefits that are denied or terminated.

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How we can help.

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With over 20 years experience litigating LTD claims disputes, we know how to help Government of Canada employees with their LTD benefit disputes under the Public Services Management Insurance Plan (PSMIP). 

 

Courtney Mulqueen also draws on her "insider" experience from defending LTD claims. 

Having worked on the "inside", Courtney leverages her knowledge, insights and perspective to

help her clients in their LTD cases.

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Mulqueen Disability Law knows LTD law and can Government of Canada employees with the litigation of their LTD benefit disputes under the PSMIP LTD plan.  We understand and appreciate the unique stressors of working in Government and how to prove disability (including invisible disabilities) and entitlement to LTD benefits.  

 

While the disability benefits provided through the PSMIP can be an important source of financial support for government employees who become disabled, navigating the claims process can be complex and challenging, particularly if the disability is an invisible condition. It is important for employees to understand their rights and responsibilities under the plan, as well as the process for making a claim and appealing a denied claim.

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We provide the following services to Government of Canada employees:

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• Consultation prior to applying for LTD.

• Review of LTD claims forms.

• Telephone Interview Preparation.

• Consultation during claims adjudication with respect to Authorizations, Requests for Records, and Delays in decisions.

• Review of Denial and Termination Letters to determine how to proceed.

• Consultations regarding Appeals and Preparing Appeal Package.

• Litigation and Negotiation of LTD claims denials and terminations.

• Other "as needed" services and consultation if appropriate.

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If you are a Canadian government employee who is considering making a claim for disability benefits or if your claim has been denied or terminated, please contact us to help you navigate the process and advocate for your rights. With the right support, you can maximize your chances of receiving the disability benefits you need and deserve. Sometimes a little bit of one-on-one help is what you need to help you get your benefits approved or to help you dispute a denial of your claim.

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If we may be of assistance, Initial Consultations are free and provide valuable practical information, insights and suggestions.  Contact us to schedule a time to go through your claim and concerns together.

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