Can you sue your employer for not assisting you with your claim?


#1

Does an employer, the plan sponsor, have a general duty to assist in filing or helping their employee with a claim?
If your employer has a contractual obligation to provide a copy of the Master Policy and refuses to do so can you add them to a statement of claim, along with your Insurer?

Would it be frowned on?


#2

This is a tricky question. If it is a unionized employment environment, then you 100% stuck with using the union grievance process as a means to get the Policy. You would not be able to do your own lawsuit.

In a non-union situation you could actually sue for something like this. It would be simply and straight forward in that you are asking the judge for an injunction or order for the employer to produce the document. You would be saying they are violating the employment agreement and duty of good faith as the employer.

I have to believe though that you could achieve the same ends by filing a complaint with the labour board. I have not looked into this but off the top of my head that is where I would start. The employer would be breaching its duty of good faith.

I believe you had the favourable insurance act clause that requires the insurer to produce the policy. Beware that the employer may be able to use this to say, you have the legal right to get the policy from the insurance company.

On the first question, no they really don’t have an obligation to assist you other than filling in the Plan Sponsor / Employer report and providing other information necessary for processing of the claim.


#3

I have a question somewhat similar to allyoops.

When I phone my company rep that I would be applying for LTD (should have done by email!) She said she would send the paperwork so that I could have it completed. I did this approx. a month before EI bridge from STD to LTD would end. I didn’t receive any package from the rep for a month, I completed the forms and required MD reports and sent it directly to insurer. After a month of not hearing from the insurance company I emailed one of the Occupational Health workers to obtain the number of the insurance company. On speaking to the insurance rep I found out they were still waiting for the paperwork from my employer. I called the company rep and was told that I was advised to give my paperwork to her so that the whole file could be sent as one package(makes sense), I didn’t recall this part of the conversation (a number of health issues had left me decreased memory). Still it took a long time to hear anything from insurance company and by then I had no income and was told by company rep to apply for welfare!!! After speaking to one of my MD specialists who was quite knowledgable about LTD paperwork he advised that I speak to a lawyer and referred to one he knew. After meeting with the (brainfog moment) practice they sent a letter to the insurance company and within less than 2 weeks I was approved and received first payment.

I know this must sound confusing, but I ask because my employer LTD rep was aware that:
a) my request for the application paperwork was made at least one month prior to receiving the paperwork,
b) She did not send in the employer paperwork for at least a month after I received my paperwork
c) my claim was not completed until the insurer received the letter from the lawyer.

Does this commonly occur
as a non-union employee is there anything I can do because of this delay.

just curious
Connie


#4

Sorry to hear you had to deal with this. Unfortunately, it does happen. Sometimes it is a company-wide issue and sometimes it is just a bad employee. You can put a complaint in with your company on how their LTD rep mismanaged the situation.


#5

Hi David,

What is your opinion on giving medical information to the employer HR rep?
Maybe I am paranoid but but when the HR rep asked me to send the medical forms to her, I said I would send them directly to sunlife.


#6

Giving of medical information is always a person decision. If you don’t have trust with your employer, then I would certainly minimize what you send them. In the early stages you just need to provide verification to your employer that you are medically unable to perform any work duties.

The only time you need to provide more specific information is when (if) you employer has to try and accommodate your disability or limitations. When there is an accommodation process going on you need to give them sufficient information so they can know if and how they can accommodate you.