Long Term Disability Income adjudication review directive

Overview

This directive describes the review process under the Long Term Disability Income Continuance Plan, including the adjudicator's review and review by an independent appeal board.

Adjudicator's review

When the adjudicator has ruled that an employee is not eligible for benefits or that benefits are to cease:

• the deputy head may request that the adjudicator review the claim
• the employee may request that the adjudicator review the claim and may, at the employee's expense, be represented by the employee's representatives

An employee must submit a request for a review within thirty (30) calendar days of the claimant being notified of the decision.

New or additional medical information or other written submissions that are intended to be part of the appeal must be submitted within ninety (90) calendar days of the claimant being notified of the decision.

An employee who requests a review may make an appointment and meet with the adjudicator to make representations. The employee may meet with the adjudicator only once.

On receiving a request for review, the adjudicator will review the employee's case, taking into account a representation by the employee's representatives or any new information, and make a decision.

Appeal board review

On receiving the adjudicator's first level appeal decision, the employee may request that the claim be reviewed a second time by an independent appeal board.

Again, the employee must request a review within thirty (30) calendar days of the claimant being notified of the first level appeal decision and submit any new or additional medical information or other written material within ninety (90) calendar days of the claimant being notified of the decision. An employee who requests a review may make an appointment and meet with the appeal board to make representations only once.

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