I would like some advice regarding the following:
I became disabled in Oct 2015 after several years of working only 4 days a week. When I stopped working, I received a letter from my employer that my disability benefits are 70% of the reported insured annual salary, i.e., 70% of my full annual salary. But when Sunlife approved my claim, they calculated it as 70% of my earnings for 4 days per week, which is much less than what the employer indicated. I contacted my Compensation Advisor to clarify and she confirmed to both me and Sunlife that I should be getting 70% of the full unreduced salary and that I was always an “Indeterminate – Full-Time employee”. I then asked Sunlife in April 2017 to recalculate my benefit as 70% of the full unreduced annual salary, but they refused, claiming that their ‘current practice is to consider the salary earned for the amount of hours a week actually worked during the 12 months prior to your date of disability…’. I checked the Policy and it had the following:
“…the Monthly Benefit shall be 70% of Insured (emphasis mine) Earnings, as at the date of completion of the Elimination Period, divided by 12, less all Other Income earned in or attributable to a particular month”
My Compensation Advisor also confirmed that my DI deductions were not prorated, i.e., they were always made at the unreduced, full-time salary rate (so my “insured earnings” were my full-time salary rate). Because the Policy referred to ‘Insured earnings’ and the Compensation Advisor assured me that I should be getting 70% of the unreduced salary, I requested Sunlife again to recalculate the benefit as 70% of my full salary (as opposed to 70% of 80%). I then followed up with my Case Manager at Sunlife and his reply, from Sept 13, 2017, was that:
“… I have referred this request to a manager, as well as our Senior disability program consultant. This request had then to be addressed by the Treasury Board of Canada, and is now being handled by our Director. My apologies for the delays, but this is not a request which I can handle “ASAP”. The only thing I can do is inform you if I have heard back from our Director, and at this point in time, I have not. I will inform you as soon as I am able to provide you with an update on this matter.”
My questions are as follows:
It seems unreasonable that this is taking so long to resolve. I started receiving benefits in Jan 2016, asked for the recalculation in April 2017, it is already Sept 2017, and soon it will be 2 years since I stopped working in Oct 2015. It’s a substantial amount of money that I am not receiving. Should the Compensation Advisor/HR not resolve this on my behalf? Is there anything I can do to ‘push’ Sunlife to resolve this more quickly?
Thank you very much