The Long Term Disability (LTD) Claims Process


 

Step 1: Submit Your Claim
Three forms are required to initiate an LTD claim:

  • Member's Statement
  • Plan Administrator's Statement
  • Attending Physician's Statement

These forms are available from your school board, your federation or association or an OTIP representative.

To apply for LTD benefits, submit your forms along with the following items, if applicable:

  • Copies of any medical documentation related to your condition (including consultation reports, test results and X-rays)
  • A copy of your auto insurance claim file and accident report, if your claim is related to a motor vehicle accident
  • A copy of your Workplace Safety and Insurance Board (WSIB) claim correspondence and present status, if your claim is the result of an injury at work

 

Step 2: Initial Assessment
Your forms and medical information will be reviewed and you will be interviewed over the phone. The claims decision will be communicated to you verbally and in writing.

If approved, your benefits will start after the required waiting period. Benefits are payable as long as you continue to meet the definition of disabled as provided in your contract. In most instances, during the waiting period and the following 24 months, you are considered disabled if you are unable to carry out the duties of your specific assignment. After this 24-month period, you are considered disabled if you are unable to be employed in gainful employment.

If the decision is to decline benefits, the reasons for the denial will be explained. If you wish to appeal the decision, OTIP Disability Service Representatives (DSRs) are available to help.

Learn more about the appeals process.

Your LTD Benefits and Canada Pension Plan (CPP) Benefits
You may be asked to apply for CPP benefits once your LTD benefits are approved. Your LTD plan directly offsets any benefits paid to you, as a contributor, from CPP.

An OTIP Disability Service Representative (DSR) is available to explain the importance of applying for CPP disability benefits and assist you with completing your application.

Ongoing Claims Management
Once your claim has been approved, a Disability Analyst will follow up with you every two to six months (depending on your condition) to see how you’re doing. OTIP may request updates directly from your medical practitioners and work with medical advisors to interpret the medical information provided.

The Disability Analyst may also ask for additional insight into your condition via an Independent Medical Evaluation (IME). IME practitioners are unbiased specialists in their field of practice and are not employees of OTIP. The IME practitioner will provide a report to OTIP and the results will be shared with your physicians.

Rehabilitation Services
OTIP is committed to helping you feel better and get back to the job you love once you are well. Rehabilitation services may be available throughout the course of your claim.

A professional OTIP Rehabilitation Consultant (RC) in your area will work with you and your doctor to develop a return-to-work plan based on your individual needs. Your RC will also provide you with information, resources and guidance on your path to recovery.

Early Intervention
Early Intervention is a confidential support program, offered at no cost through your LTD plan, which provides support and assistance to help prevent or shorten the duration of an LTD claim. Your participation does not affect future LTD claim submission(s).

How the program works:

  • Your local office notifies OTIP when you have been away from work for the number of consecutive working days specified in your LTD plan
  • OTIP evaluates your needs and provides you with individualized assistance via an Early Intervention Rehabilitation Consultant
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