Waiting periods before submitting your claim
Depending on your insurance product or rider, an elimination period and/or waiting period may apply to your disability period.
The elimination period is the minimum period during which you have been continuously disabled and for which no disability benefits are paid. Depending on the case, the elimination period can range from 0 to 180 days. Your elimination period can be found in the “Summary of Coverage” for your policy.
The waiting period is the minimum period during which you must be continuously disabled; however, benefits are paid for this period, either retroactively to the end of the elimination period, if applicable, or to the beginning of the disability.
DISABILITY: INFORMATION
AND
CLAIMS PROCESS
We are very sorry to hear that you are facing a disability that is impacting your life. Your health and wellbeing are important to us, and we are here to assist you as best we can.
First steps:
- Submit your claim online
- We will review your situation and provide you with the necessary forms
- Once we have received all the required information, we will let you know the next steps
Before you complete the online claim form, please take a few moments to carefully read the following information on disability claims and the eligibility conditions. This information is key to helping you understand the claims process and what is required for your claim to qualify for payment.
Determine whether your medical condition is eligible for a disability claim
First, take some time to carefully read through your insurance coverage, including the definitions and any exclusions and limitations for your disability coverage. This will help clarify what your insurance covers and what it does not.
Your medical condition must meet the definition of disability in your insurance policy: a state of continuous incapacity that prevents you from:
- performing the duties of your occupation; or
- performing the majority of your activities of daily living, such as bathing, feeding yourself or getting dressed.
You are eligible to make a claim if:
Your insurance policy is still in force.
Your work leave continues beyond the waiting period (or elimination period) indicated in your policy.
You have received a recognized diagnosis and are under the care of a doctor.
Your health condition is serious enough that it imposes functional limitations that prevent you from carrying out your work or daily activities, according to your policy.
Your health condition is not excluded from your insurance coverage.
If your health condition does not meet the above criteria, you should not submit a claim as you will not be eligible to receive benefits.
If your disability meets all these conditions
Before you begin, make sure you have the following information at hand:
- Your policy number (if available)
- Contact information for the insured person
- Employment information
- Disability start date
- Doctor’s diagnosis
- Details of the accident, if applicable
- Dates of hospital stays, if applicable
Frequently asked questions
What are the steps for submitting a disability insurance claim?
- First, submit your claim online by filling in all the required information, taking into account the waiting period applicable to you.
- We will perform an initial analysis of your claim and then contact you about the forms and documents we will need based on your situation (e.g., a statement from your attending physician). If your claim is not eligible due to a specific provision of your coverage, we will notify you.
- We will start the full analysis of your claim once we have received all the required documents.
- It is sometimes necessary to request documents from external organizations such as hospitals or medical archives.
- We’ll stay in touch with you throughout your claim.
Your request will be processed on a priority basis according to the date we receive the documents. Processing times are sometimes beyond our control and vary depending on how quickly documents are received from external agencies.
What are the criteria for my disability claim to be considered?
- All required forms must be fully completed.
- You must have been unable to work for at least the entire waiting period.
- You must have a recognized medical diagnosis that results in functional limitations and restrictions that prevent you from performing your work or daily activities, as defined in your coverage.
- You must be under the care of a doctor.
Why do I have to fill out another form after completing the online application?
The online application allows us to open a claim file. We ask a few questions to determine whether the minimum eligibility requirements have been met.
- If these requirements are met, we then need a more detailed statement, completed by you, in order to continue our analysis of the file.
- If the eligibility requirements are not met, we will unfortunately be unable to continue the process. In this case, you would be saved the trouble and expense of obtaining medical forms.
Why would my claim be refused or inadmissible?
There may be several reasons, such as:
- Your disability is due to an illness, but your insurance only covers accidents.
- Your condition is related to a specific exclusion or limitation in your contract.
- You returned to work before the end of your waiting period.
- Your health condition is not covered by your contract.
- Your contract was no longer in force at the time of your disability.
Are forms from another insurance company or organization accepted?
Yes, but only attending physician’s statements and employer forms are accepted. The insured’s statement and iA Financial Group authorization forms must always be completed by the insured.
Why might additional medical information be requested, beyond that already provided by my doctor?
We would need to know your medical history in the following two situations:
Policies issued in the last two years
We check medical histories, even if they are not related to the disability, to ensure that the information provided at the time you enrolled in the policy is accurate and complete. This procedure is standard for all insurers.
Complex medical conditions
The company must obtain additional medical information to assess and determine eligibility for benefits, in accordance with the terms and conditions of the policy.
In such cases, if the request is made by us, we will bear the costs of obtaining this information.
Why might a follow-up phone call or additional medical form be necessary even when the doctor has indicated an indefinite work leave?
The duration of this period can vary from one to several months. It is therefore essential for us to check whether your health condition has changed and whether it still corresponds to the definition of disability set out in your policy. To do this, we need up-to-date medical information to support your file and keep track of your health condition. This also enables us to determine whether we can provide additional assistance, such as a medical expertise or rehabilitation, to help you resume your activities and plan for a return to work, in accordance with the provisions of your insurance policy.
Why do I need to provide an original authorization?
In most cases, copies of original documents are acceptable. However, some healthcare facilities require an original authorization. We will be sure to indicate this clearly.
How do I return the requested documents to you?
The letter we send you will include all the information you need to return the documents to us.
How are benefits paid out?
You will receive payment by direct deposit or cheque, whichever you prefer.
Why am I not receiving the benefit amount indicated in my insurance policy?
In the case of income replacement insurance, the benefit amount has been calculated on the basis of your employment income at the time your policy was taken out. In order to confirm this amount, we will ask you to provide us with proof of your employment income prior to the start of your disability period. We will contact you to let you know which documents are required.
In the case of loan insurance, we will ask you to provide supporting documentation for your loans at the time of the disability up to the amount specified in your policy. Please note that loans already covered by another insurance policy are not included in your coverage.
In the case of overhead expense insurance, we will ask you to provide supporting documentation for your overhead expenses up to the amount specified in your policy.
When will benefits be paid?
The length of your disability must first exceed the elimination period.
If you return to work, you will receive a benefit for the entire eligible period of your disability.
If your disability continues after this period, an initial payment will be made, followed by monthly payments towards the end of each month, by direct deposit or cheque.
What can I do if I disagree with the decision made in my case?
You have 60 days after receiving our denial letter to send us additional information, if applicable.
What can I do if my doctor reschedules my follow-up appointment and you are waiting for this information?
Let us know and we’ll see what we can do until your next appointment.
Are my benefits taxable?
If you pay your own insurance premiums, your disability benefits are not taxable.
If an employer is paying the premiums for an employee, i.e., the insured person, then the benefits are taxable. The insured person is responsible for declaring the total amount received, as iA Financial Group will not issue any tax information slips.
Talk to your accountant or a tax specialist for a full understanding of your situation.