What are Disability Benefits?
Do I have disability coverage?
Disability benefits are intended to replace a portion of your salary during the period of time you are unable to work due to an illness or injury. To qualify for Disability benefits you must have short-term (STD) or long-term (LTD) disability coverage included in your group benefits plan, be an eligible covered employee, and satisfy the terms of your group disability plan.To determine if you have disability coverage, and review the details of your disability plan, you can:
Contact your Plan Administrator,
Download the RWAM mobile app to view your benefit booklet.
Download the RWAM Mobile App from your Device’s App Store
Applying for Disability Benefits
Apply for short term disability benefits immediately upon your absence from work, do not wait.
An application form for STD Benefits is available from your Employer, or you can contact RWAM directly to request the claim package.
If you have long term disability benefits only, your employer must complete a Notification of Absence form (RDM053) and submit to RWAM.
RWAM handles benefits for multiple insurance carriers, therefore plan members must contact RWAM or their employer to ensure they complete the correct Disability claim forms. Disability claim forms are not available on the RWAM website.
Once you receive your disability claim package, all forms must be completed in full and submitted to RWAM Disability Management. Claims cannot be reviewed until all three sections of the claim package have been submitted.
1. The Employer Statement must be completed and signed by your employer/plan administrator
2. The Employee Statement must be completed and signed by yourself
3. The Attending Physician's Statement must be completed and signed by your treating physician
Your doctor should provide as much supporting information as possible regarding your medical condition such as copies of:
- Test results (blood work, x-rays, CT scans, psychological testing)
- Office/chart notes
- Specialists’ consultation reports
- Hospital admission and discharge summaries, operative reports
- All other available information relevant to your claim
Except where prohibited by law, you are responsible for paying any fees which your doctor may charge for the completion of forms or for providing medical reports.
Plan Members are not obligated to share confidential medical information with their employers. Plan Members may submit the completed Employee Statement and Attending Physician Statement directly to RWAM Disability Management.
Email: csr-disability@rwam.com
Fax: 519-669-5135
Mail: C/O RWAM Disability Management, 49 Industrial Drive, Elmira, ON N3B 3B1
Disability Claim Submission Process
Once RWAM receives your complete Disability claim package, we will verify that:
- you are enrolled in the group insurance plan
- premiums have been paid
- you were employed and actively at work immediately prior to your disability
Once coverage is confirmed, RWAM or your applicable disability insurance carrier will review all submitted information, including medical documentation and description of your job duties, to determine whether you are “Totally Disabled”, as defined by your group disability plan.
The initial review could result in your claim being approved, pended, or declined. A phone call and a letter will be sent to you explaining the decision on your claim and next steps.
If a claim is pended, you will be notified of the information required to proceed with your claim.
Steps to Avoid Disability Claims Delays
1. Make sure all forms are fully completed and signed.
2. Provide additional details of all factors, both at work and at home, which affect your ability to be at work.
3. Ask your doctor to include their chart notes, reports from all specialists, test results, and any other relevant medical information.
4. Provide copies of any WCB/WSIB, Employment Insurance, CPP/QPP, auto insurance, and any other benefit claim records if you have applied for or are receiving benefits from any other sources.
What if I have applied for Worker's Compensation (WCB/WSIB) Benefits?
In addition to any WCB/WSIB application, it is important that you complete a disability application upon your absence from work.
Applying to your group benefits with RWAM will ensure continuity of benefits if WCB/WSIB benefits are discontinued and ensure that premium for applicable group benefits is waived during your leave, as per your group benefits plan.
If you are approved for WCB/WSIB benefits any amounts paid by WCB/WSIB must be deducted from your disability benefit payments.
Approval of a Disability Claim
If your claim is approved, benefits typically commence according to the “Payable” day for Sickness, Accident, or Hospitalization as indicated by the Schedule of Benefits in your employee booklet.
Benefits are payable to you either weekly, bi-weekly, or monthly according to your group benefits plan.
If your plan is taxable, taxes will be deducted from your eligible payments and a T4 will be issued at the end of the year.
If your plan is non-taxable, taxes will not be deducted and a T4 will not be issued.
Payments are made via Electronic Fund Transfer (EFT) with an Explanation of Benefits issued.
Note: EFT can take anywhere from 1-2 business days to be posted to your account
Additional Medical Evidence Required
Once on an approved claim, medical information will be required to support ongoing total disability.
This could include, but is not limited to, forms being sent to you or your doctor for completion.
Payments of benefits cease when:
1. The medical evidence indicates you are no longer totally disabled; or
2. You have recovered sufficiently to allow you to safely return to work*, or
3. Until you have reached the maximum benefit duration stated in your employee booklet.
* Depending on your group plan you may be eligible to receive an adjusted rehabilitation benefit if initially you need to return to work part-time under an approved rehabilitation program.
Pending of a Disability Claim
In the event that sufficient medical evidence is not received to make a decision about your disability application, your claim will be pended, and further supporting documentation will be requested.
Denial of a Disability Claim
Your claim will be denied if you are not eligible for the benefit, or if it is determined that the medical evidence does not support that you are totally disabled, or if you do not otherwise qualify for benefits under the group disability plan.
If your claim is denied, you will receive a confidential letter directly to you explaining the reason(s) for the denial.
Your employer will be informed of the status of your claim in a separate letter which excludes any confidential medical reasons.
Rehabilitation & Safe Return to Work
Returning to work after an illness or injury is an important step in the recovery process. Your case managers are here to help by working with you, your employer, and your physician(s) to create a safe return-to-work plan designed specific to your needs. This could include modified hours and/or modified duties with a gradual increase until full-time return is achieved.
Our goal is to help you safely and successfully return to work and get back to your regular activities.
Privacy
Your employer is entitled to know that you have claimed disability benefits, along with certain basic information such as the status of your claim, your ability to perform your own occupation and any limitations or restrictions your employer needs to be aware of to provide you with a safe return to work. It is important that you maintain contact with your workplace during your absence. RWAM is committed to protecting the privacy, confidentiality, accuracy, and security of the personal information that it collects, uses, retains and discloses in the necessary course of conducting its business. RWAM will abide by all federal and provincial privacy legislation which governs the protection of all personal information in its custody. For further information regarding RWAM’s privacy policies, please refer to your Employee Booklet, ask for a copy of our Privacy brochure, or visit our website at www.rwam.com.
If you have more questions or you need additional support with your claim, please contact the RWAM Disability Team.
Contact RWAM toll-free at 1.877.888.7926
Please have your RWAM group number and certificate number ready in order for us to assist you with your inquiry.
Have more questions? We have solutions.
Check out Disability Frequently Asked Questions for more information.