The following information is relevant and accurate according to the information received at the time of distribution. Always consult with your benefit policy and insurance carrier for any deviations for specific coverages
Recovered employees returning to work
Currently, in Canada, of the 14,000 confirmed COVID-19 cases, close to 3,000 people have recovered.
In addition to employees ready to return to work after recovery from the virus, employers may also have plan members in the process of a gradual return to work following a disability leave.
The pandemic may well have impacted the expected return to work
For insured policies…there are basically four situations where a plan member’s gradual return-to-work may be impacted by the current pandemic. As always claims are assessed based on the terms of the contract and evaluate on a case-by-case basis.
The availability of work is not a consideration when determining total disability.
Scenario #1: An employee is ready to return to work and not totally disabled, but there is no job to return to…
When an employee has recovered and is no longer eligible for disability benefits, the insurer will stop paying benefits and close the disability claim.
Scenario #2: An employee is participating in a gradual return-to-work program—but COVID-19 has impacted their job…
If an employer is continuing to pay the plan member’s salary, the insurer may:
- Continue to pay rehabilitation benefits according to the gradual return-to-work schedule, up to the expected full-time return-to-work date, so long as the plan member is expected to reach full-time hours,
- Then the claim will be closed.
If the employer is no longer paying the plan member’s salary, and the plan member was close to the end of there gradual return to work program, the insurer may:
- Continue to pay full disability benefits up to the expected return to work date,
- Then close the disability claim
The insurer may do this if the plan member is expected to reach full-time hours. Additionally the insurer may also direct employees to discuss their options and explore government financial support options.
If the employee had just started their gradual return-to-work program—and it is unclear whether they would have been capable of reaching full-time hours—the insurer may return the plan member to full disability benefits and continue with case management.
Scenario #3: A plan member on disability claim is improving but continues to be totally disabled—but their job is no longer available due to COVID-19…
The insurer will likely discuss options with both the employer and employee to see whether alternate work arrangements are even possible.
If no accommodation is available, the insurer may:
- Delay the beginning of a gradual return-to-work plan,
- Continue to pay the employee’s full disability benefits while they remain on disability, and
- Continue with ongoing case management.
Scenario #4: A plan member continues to be on disability but is in a permanent part-time work arrangement that is no longer available…
In such a case, the insurer may return to paying the plan member full-time disability benefits. If the employee will not be able to return to their position in the future, the insurer may request the plan member to apply for CPP disability benefits if they have not already done so.
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