- The Plan Sponsor Statements/Employer’s Statements may differ from one insurer to another. I have attached a blank Plan Sponsor Statement from Manulife Financial to provide you with an idea of the type of information the insurer is typically seeking on these forms. This particular form can be accessed online.
- In a perfect world, the employer should have no influence on the outcome of the long term disability claim. The claim is supposed to be decided by the case manager employed by the insurer on the basis of an analysis of the medical evidence, occupational duties and the applicable test for disability under the Policy.
The employer’s involvement should be limited to providing the potential claimant with the ability to access claim forms and facilitating the application process in that regard.
The employer could be interviewed by the insurer and asked to provide information as to the nature of the claimant’s position and work duties and whether there were issues in the workplace.
The employer may also become involved where benefits have been approved and the claimant is looking to be accommodated in a return to work program or the insurer has initiated a rehabilitation program.
In practice, I have seen employers involve themselves in long term disability claims by trying to provide the insurer with negative information on a prospective claimant and suggesting that claims should not be approved. As lawyers, we are always on the lookout for the appearance of collusion between an employer and the insurer as a fertile area for critique of the adjudication process. Insurers have an obligation to adjudicate claims in good faith and should not be unduly influenced by external factors.
If you have a client that is dealing with WCB and requires assistance, please contact me at [email protected] and I can make suggestions for referrals to appropriate individuals. There are many factors that need to be taken into consideration. WCB is also a very technical area and finding someone with expertise in the area is important.