3
12) Describe the provincial adjudication process.
In order to approve a claim, a member must provide objective medical evidence from
their treating physician(s) that the medical condition(s) disables them from performing
the essential activities of their teaching assignment.
13) There is an OSSTF decision through the Implementation Committee about LTD.
What's that decision about? How does it affect ETFO's LTD plan?
The OSSTF have confirmed via the Implementation Committee that a member who has
had a LTD claim declined cannot be denied access to any remaining sick leave days
available under the collective agreement. This interpretation by the Implementation
Committee would apply to ETFO collective agreements as well.
14) Members were mailed a letter to their home with a general outline about the LTD
change. Are there more issues that need to be covered with members? Who will
communicate the changes to members and how are they being communicated?
OTIP will provide additional information through ETFO and/or your local office as
questions arise.
15) How will I get access to the FAQ if I am not a local President?
The FAQ document will be posted on the ETFO Provincial website,
www.etfo.ca
, and
local websites.
Pre-Existing Conditions
1)
Our local LTD plan has a 12 month limitation for pre-existing conditions. If a
member was previously declined, what is the impact if the waiting period is longer
under the new provincial plan?
Members who are currently covered under a local plan will continue coverage under the
ETFO provincial plan and are not subject to the pre-existing limitation. Eligible members
who are actively at work will be added to the mandatory plan effective November 1, 2013 if
they did not previously opt out or were declined coverage. Only new members are subject
to the pre-existing limitation.
2)
If a member’s application for LTD benefits was previously declined, will the member
be declined again after one year if their medical condition returns?
Members previously declined for coverage based on medical evidence are included in the
provincial LTD plan. The coverage will be subject to a pre-existing medical condition
limitation for the first 12 months of their membership in the plan. The claim would be
declined if it is filed based on a date of disability within the first 12 months of coverage
(absence from the classroom or physician diagnosis and treatment). All other situations or
medical conditions would be allowable claim submissions.