When your LTD claim is declined or terminated, and you do not agree with the decision, you have the right to appeal Great-West Life’s decision in two different appeal processes or a file review by the Board of Trustees, who represents your interests in these matters. You do not have the right to appear before the Board yourself. Your Long-Term Disability Plan is strictly based on medical evidence, as such; the medical in your file must support your claim.
If there is no new medical available, you can request a file review by Great-West Life’s Appeal Section. In this instance, you must provide Great-West Life with an explanation as to why you believe your claim should not have been denied or terminated. Your entire file will be referred to Great-West Life’s Head Office for a complete review by an Appeal Specialist.
If you provide Great-West Life with new medical information, your entire file will be referred to a Team Manager for a complete review.
File Review Process
The first step is requesting a file review is to contact Canadian Benefits Consulting Group or your Board of Trustee and provide your reason for a review. Notification of your intention to request a File Review is expected to be submitted with sixty (60) days of a claim declination or termination.
To proceed with your File Review by your Board of Trustees, the Plan Administrator will send you an Authorization Form which you must sign, date, and have witnessed. This will allow the Plan Administrator/Insurance Company to openly discuss your claim file with the Board of Trustees. The completed Authorization form should be returned to the Plan Administrator’s office and is valid for 90 days from the date of signature.
Once this has been received, the Board of Trustees, acting on your behalf, at their quarterly meetings with the Plan Administrator, will review your LTD claim file. You will be notified of the outcome of this Review, following the Board’s quarterly meeting. All File Reviews are conducted in strictest confidence by your Board of Trustees.
The Board of Trustees cannot make decisions on your LTD claim. The Board of Trustees will review your file with the Insurance Company on your behalf to ensure your claim has been handled fairly and equitably. The Board must emphasize that it cannot overrule the final decision of the Insurance Company.