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benefits, file their application as early as possible (at least 8 weeks prior to the LTD
benefit start date) to ensure that a decision on their application can be made prior to the
end of the waiting period.
6) What are the advantages and disadvantages of the Local managing the
distribution of the LTD claim kits to their members?
Every Local has established a preferred method of providing advice and claims kits to
members in need in the past. OTIP staff will work with each Local in the coming weeks
to determine the best approach to providing services to members on an ongoing basis.
7) Who is liable if a member does not receive their LTD claim kit from the Local in a
timely manner and as a result of the delay, the member’s coverage is denied?
The member is responsible for their application for benefits under the plan. The Local
and released officers do not assume additional liability under the requirements of the
MOU or the plan. Contractually, a member has up to 6 months after the benefit start date
to submit an LTD claim.
8) When is the ideal time to send the LTD claim kit to the member?
The LTD claim kit can be sent to the member any time after the member has been off
work for 15 consecutive days. The provincial plan recommends that the completed kit be
submitted to OTIP at least 8 weeks prior to the benefit start date. Also see response
under question #5.
9) Does the Board complete the Plan Administrator Statement? Is there an
advantage to the Local completing it? Does it give the Board too much “leeway”
to push for LTD?
The Plan Administrator Statement provides information that only the employer has
access to. The provincial plan recommends that the Local does not attempt to assume
responsibility for the completion of this statement.
10) How will rates be determined in the future? Will they be based on an average
across the province or will locals be identified as to low/high experience levels?
All future premium renewal information will be discussed with the policy holder defined
as the ETFO and ETFO will advise locals.
11) What is the turnaround time on decisions during the provincial LTD adjudication
process?
The time to adjudicate a claim is dependent on the intricacies of the individual claim and
the underlying medical conditions. It takes 8 to 10 weeks on average after a completed
LTD claims kit is received.