SISIP Long-Term Disability: A Complete 2024 Guide

Dealing with long-term disability (LTD) claims can be challenging, especially for members of the Canadian Armed Forces (CAF) who rely on the Service Income Security Insurance Plan (SISIP) for disability coverage.

SISIP LTD is a unique program designed specifically for CAF members and veterans, providing income replacement in the event of injury or illness that prevents them from working.

This comprehensive guide covers everything you need to know about SISIP LTD benefits, including how to apply, what happens after two years of receiving benefits, the payment schedule, and how to appeal a denied claim. Whether you’re an active CAF member or a retired veteran, this guide will help you understand SISIP LTD and ensure you receive the financial support you need.

Complete Guide to SISIP Long-Term Disability Claims

About SISIP and Long-Term Disability

The Service Income Security Insurance Plan (SISIP) is a long-term disability (LTD) insurance program that provides financial support to members of the Canadian Armed Forces (CAF) who are unable to work due to injury or illness. The program is administered by Manulife and offers crucial income replacement for both Regular Force and Reserve Force members.

• For Regular Force members: SISIP LTD provides an income replacement benefit regardless of whether you’re injured in the line of duty or not. This benefit replaces up to 75% of your income, and if you are medically released, SISIP will replace your income for up to two years.
• For Reserve Force members: SISIP LTD provides income replacement only if you’re injured while on duty for Reserve service.

If you qualify as “totally disabled”, SISIP will continue to provide income replacement until age 65.

Coverage under SISIP LTD is automatic for:

• Regular Force members who enrolled on or after April 1, 1982
• Reserve Force members who enrolled on or after December 1, 1999

CAF members covered by SISIP LTD can expect benefits to replace up to 75% of their pre-disability income. Other sources of income, such as Canada Pension Plan (CPP) benefits or other employment income, may reduce the total amount received.

SISIP’s long-term disability benefits typically kick in after short-term disability benefits or other forms of income support, such as employment insurance (EI), have been exhausted.

• LEARN MORE: Going from Short-Term Disability to Long-Term Disability FAQ

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How to Apply For SISIP Long-Term Disability Benefits

Applying for SISIP LTD benefits is an important step for any CAF member dealing with injury or illness that limits their ability to work. The process requires detailed documentation that demonstrates your medical condition and inability to perform your job. Understanding the process is essential to avoid delays or denials. Learn how to obtain your LTD policy here.

Step-by-Step Guide to Applying for SISIP LTD Benefits

1. Gather the Required Forms

You will need to obtain several forms before submitting your LTD claim. These include:

• Employee Statement: Completed by you, the CAF member, outlining your medical condition and how it prevents you from working.
• Attending Physician’s Statement: A medical form completed by your doctor explaining your diagnosis and the impact on your ability to work.
• Military Service Details: Documentation of your service record may also be required.

2. Submit Your Claim

Once your documents are ready, submit them directly to SISIP through Manulife, who administers the plan. You can submit these documents through mail or through SISIP’s online portal. Ensure all paperwork is complete to avoid delays.

3. The Waiting Period (Elimination Period)

After submitting your LTD claim, you will typically have to wait through an elimination period (also referred to as the qualifying period), which can last between 90 to 180 days depending on your policy. During this time, you may continue to receive STD benefits, or other forms of financial assistance, until your LTD benefits kick in.

4. Approval or Denial of Your Claim

SISIP (through Manulife) usually takes 5 to 20 days to process LTD claims, but it could take longer depending on the complexity of the case or if additional documentation is required. You will be notified by SISIP if your claim is approved, or if it has been denied, the reasons for denial will be provided in writing.

During this process, you may encounter challenges dealing with adjusters who handle your claim. It’s important to understand how to communicate effectively and handle any difficulties that arise. Learn more about how to manage difficult adjusters here.

5. What to Do If Your Claim Is Denied

If your LTD claim is denied, don’t lose hope. You have options to appeal the decision, which will be discussed in detail in the SISIP Appeal Process section of this guide. You may need to submit additional medical evidence or clarify certain aspects of your condition to strengthen your case.

You can also get a free consultation with a disability lawyer at Samfiru Tumarkin LLP to understand your options.

Additionally, being on LTD can sometimes raise employment-related concerns, such as how your employer handles your position or benefits during your disability. Find out how employment issues interact with long-term disability claims.

Tips for a Successful LTD Application

• Ensure Complete Medical Documentation: Incomplete or vague medical records are one of the main reasons LTD claims get denied. Make sure your doctor provides detailed documentation that clearly shows why you are unable to work.
• Submit Forms Promptly: Delays in submitting required forms can prolong the approval process. Submit your documents as soon as they are completed to avoid unnecessary waiting periods.
• Track Your Claim: If you submit your claim online through the SISIP group benefits portal, you can monitor the status of your application and respond quickly to any requests for additional information.

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SISIP Long-term Disability Payment Schedule

SISIP LTD payments are designed to replace a portion of your pre-disability income. Generally, this is up to 75% of your salary, though the actual amount can be reduced by other sources of income such as:

• Canada Pension Plan (CPP) Disability Benefits
• Canadian Forces Superannuation Act (CFSA) Benefits
• Other Employment Income

Payments are typically made monthly and will continue as long as you meet the eligibility criteria under the SISIP policy.

When Are Payments Made?

SISIP makes LTD payments on a monthly basis, with specific, predetermined payment dates throughout the year. These dates are posted on the SISIP website and remain consistent month-to-month.

Once your claim is approved, you can expect to receive your LTD benefits according to this fixed schedule.

Delayed or Missed Payments

There may be cases where your SISIP LTD payment is delayed. Common reasons for payment delays include:

• Incomplete Documentation: If additional medical records or forms are required but not provided, this can cause delays.
• Policy Review: In some cases, SISIP may conduct a policy review after a certain period (such as two years on LTD), which could temporarily halt payments until the review is complete.

If your payment is delayed or you miss a scheduled payment, it’s important to:

• Contact your SISIP disability case manager to inquire about the status.
• Check the SISIP group benefits portal for any updates or requests for additional information.

LTD Payment Schedule After Two Years

After receiving LTD benefits for two years, SISIP (via Manulife) reassesses your eligibility, as the criteria for continuing benefits change. The switch from “own occupation” to “any occupation” occurs at this point. This reassessment can affect whether you continue receiving payments, which will be covered in more detail in the section about the two-year mark for LTD.

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Tracking Your SISIP Disability Claim Status

Staying informed about the status of your SISIP LTD claim is crucial. You can check the status by contacting SISIP/Manulife directly or speaking with your SISIP representative.

If additional documentation is needed, SISIP will inform you. Make sure to respond promptly to any requests for information to avoid delays in receiving benefits. You can reach out to SISIP’s general customer service department for assistance with account access or claim status inquiries.

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What Happens After 2 Years of SISIP LTD?

Like many other long-term disability programs, SISIP LTD reassesses your eligibility after two years. Initially, SISIP assesses whether you can perform your “own occupation” as a CAF member. After two years, the definition of disability shifts to “any occupation” that you are reasonably qualified to do based on your skills and experience.

This change makes it more difficult to continue receiving benefits. However, if you can demonstrate that you are unable to work in any capacity, you should continue to receive SISIP LTD.

SEE MORE:
• Return to Work and Long-term Disability FAQ
• 5 common terms you must know before applying for LTD
• List of disability insurance companies in Canada

SISIP’s Reassessment Process

As you approach the two-year mark, SISIP (via Manulife) will conduct a thorough reassessment to determine if you are still eligible for LTD benefits. This may involve:

• Medical Reassessments: SISIP may request updated medical records from your doctor to evaluate whether your condition has improved or if you are still unable to perform any occupation.
• Vocational Rehabilitation Programs: SISIP may suggest or require participation in a vocational rehabilitation program designed to help you return to the workforce. These programs assess whether you can be trained or retrained for a new job.
• Surveillance or Investigations: In some cases, SISIP may conduct surveillance or other investigations to verify your condition and ensure you are unable to work.
• Independent Medical Examinations (IMEs): SISIP may also require you to attend an IME to further assess your disability. Although these are presented as independent evaluations, they are often used by insurers to dispute or deny claims. If SISIP has requested an IME, it’s crucial to get a free consultation with our team to understand your rights and the potential consequences. Learn more about IMEs and long-term disability.

What to Expect If Your Benefits Are Cut Off

Unfortunately, many legitimate claims are incorrectly denied or benefits cut off after the two-year mark due to the stricter “any occupation” standard. If SISIP determines that you can perform any type of job, your LTD benefits may be terminated.

Common Reasons for Denial After Two Years:

• You no longer meet the “any occupation” definition of disability.
• Insufficient medical evidence to prove your inability to work in any capacity.
• Surveillance or vocational assessments that suggest you are capable of working.
• Failure to participate in rehabilitation programs if required.

What to Do If SISIP Cuts Off Your Benefits

If your benefits are cut off after two years, it’s important not to accept the denial as the final decision. You have the right to challenge this through appeals or legal action. The appeal process will be discussed in detail in the next section, but key steps include:

• Gathering additional medical evidence to support your case.
• Seeking free legal advice from a disability lawyer at Samfiru Tumarkin LLP to ensure your rights are protected.

If SISIP/Manulife is wrongfully denying your benefits, you may still qualify for financial support. It’s crucial to act quickly, as waiting too long could affect your ability to appeal or pursue effective legal action.

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Appealing a SISIP Long-Term Disability Denial

If SISIP denies your long-term disability claim or cuts off your benefits, it’s important to understand that you have the right to appeal their decision. The appeal process can be complex, but with the right approach, you can increase your chances of securing the benefits you deserve.

Why Was Your LTD Claim Denied?

Before starting the appeal process, it’s crucial to understand why your claim was denied or cut off. Common reasons for denial include:

• Insufficient Medical Evidence: SISIP may claim that your medical documentation does not clearly show that you are “totally disabled.” Here’s what to know about health reports and how they affect your LTD claim.
• Definition Change After Two Years: As discussed earlier, after two years, the definition of disability changes from your ability to perform your “own occupation” to “any occupation.” If SISIP believes you can perform another job, they may stop your benefits.
• Surveillance or Investigations: If SISIP conducts surveillance and believes you are capable of working, your benefits may be denied.
• Failure to Comply: In some cases, SISIP may claim that you didn’t follow their guidelines for rehabilitation programs or medical treatments.
• Pre-existing Conditions: Your claim may be denied if SISIP determines your disability is related to a pre-existing condition that wasn’t covered by your policy. Learn more about how pre-existing conditions impact LTD claims.
• Policy Age Limit: Most LTD policies have an age limit, often at 65, at which point benefits typically stop regardless of your situation.

The Internal Appeal Process

When SISIP (through Manulife) denies your LTD claim, the first step is to file an internal appeal. This involves requesting a review of your claim by the insurance company. While this may seem like a straightforward process, there are key points to keep in mind:

• Request a Copy of Your Claim File: You should ask for a complete copy of your claim file from SISIP. This file contains the evidence they used to deny your claim, including medical reports and any other relevant documentation.
• Submit Additional Medical Evidence: If your claim was denied due to insufficient medical evidence, ask your doctor to provide more detailed information. Ensure all documentation clearly explains your condition and its impact on your ability to work.
• Clarify Misunderstandings: In some cases, SISIP’s internal review may have missed important details or misinterpreted information. You can use your appeal to clarify these misunderstandings.

While internal appeals can be successful in some cases, they are often not the best long-term solution. Since you’re asking the same company that denied your claim to change its decision, many claimants find that their appeal is denied again.

Should You Appeal or File a Legal Claim?

Although SISIP (through Manulife) offers an internal appeal process, it’s important to consider whether this is the best path forward. Internal appeals are often a drawn-out process with limited success. Instead, you may have better results by filing a legal claim against SISIP/Manulife.

Filing a Legal Appeal

If your internal appeal fails, or if you choose to bypass it, the next step is to file a claim. This challenges SISIP’s denial of your benefits. Here’s what the process looks like:

1. Hire a Disability Lawyer

Working with a lawyer at Samfiru Tumarkin LLP who specializes in long-term disability claims is critical to your success. We will handle communication with SISIP and build a strong case based on medical evidence, legal precedents, and your individual circumstances.

2. SISIP’s Response

Once we file a claim, SISIP must respond and may introduce a new claim manager to review your case. In some situations, they may reverse their decision (as in the case of our client, Sandra Bullock) and provide compensation.

3. Negotiations and Resolution

In nearly all cases, these matters are settled before they ever go near a courtroom. This means you may receive your benefits without a lengthy trial. However, in the rare event the case does go to court, a judge will review all the evidence and make a final decision.

How to Strengthen Your Appeal or Lawsuit

• Comprehensive Medical Evidence: Detailed and updated reports from your healthcare provider are crucial to proving your disability. Be sure your doctors provide thorough documentation of your condition and explain why you are unable to perform any occupation.
• Vocational Assessments: If your claim was denied due to the “any occupation” clause, obtaining a vocational assessment that shows why you cannot work in any capacity can be valuable.
• Legal Expertise: Disability claims can be legally complex. An experienced disability lawyer at Samfiru Tumarkin LLP can handle the complexities and advocate for your rights.

What Not to Do During the Appeal Process

• Do Not Delay: The longer you wait to file an appeal or legal claim, the more difficult it may become to win your case. Be aware of deadlines and start the process as soon as possible. You have two years from the time your claim is denied or cut off to file a claim against the insurance company.
• Do Not Rely Solely on Internal Appeals: While it’s tempting to hope that an internal appeal will resolve the issue, insurers often stand by their initial decision. Get a free consultation with our team before relying entirely on this process.

If your SISIP long-term disability claim has been denied or cut off, it’s critical to take action quickly. Whether through an internal appeal or by filing a legal claim, we can help you obtain the benefits you are rightfully owed during this difficult time.

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SISIP LTD Denial: Legal Alternatives

If your SISIP long-term disability claim has been denied or your benefits have been cut off, you are not out of options. In fact, legal action is often the most effective way to secure compensation you’re entitled to when dealing with a large insurance company. While an internal appeal may seem like the easiest route, a legal claim can provide you with stronger leverage and a more impartial review of your case.

Why Consider Legal Action?

Many people find that their internal appeals with SISIP (via Manulife) are repeatedly denied, even when they submit additional medical documentation. Since the insurer is reviewing its own decision, it’s in their financial interest to maintain the denial. However, by filing a legal claim, you bring your case before an impartial decision-maker who is not influenced by SISIP’s internal policies.

Key Reasons to Pursue Legal Action:

• Impartial Judgment: A legal claim means your case is reviewed by an outside party, ensuring fairness and objectivity.
• Stronger Leverage: Insurance companies are more willing to settle or approve your benefits once they realize Samfiru Tumarkin LLP is on your side.
• Potential for a Larger Settlement: In some cases, a legal claim can lead to compensation that goes beyond LTD benefits, especially if the denial was wrongful or in bad faith.

Steps to Filing a Legal Claim

Filing a legal claim against SISIP (or Manulife, which handles the insurance policy) can seem daunting, but with legal representation from Samfiru Tumarkin LLP, the process becomes much more manageable. Here’s what to expect:

1. Consult a Disability Lawyer

The first step in pursuing legal action is to speak with a disability lawyer who has experience dealing with SISIP LTD claims. At Samfiru Tumarkin LLP, our team has successfully handled numerous cases involving SISIP and other major insurance providers. A lawyer will assess your situation for free and determine if you have a strong case. They will also work with you to try and resolve the matter with SISIP before taking legal action.

2. File a Statement of Claim

Your lawyer will draft and file a Statement of Claim, which outlines the details of your case and why you are entitled to LTD benefits. This document is served to the insurer, officially notifying them that you are pursuing legal action.

3. SISIP’s Response

Once the Statement of Claim is filed, SISIP (or Manulife) will assign their own legal team to review your case. Often, this leads to a reassessment of your claim. In some cases, they may offer a settlement or approve your benefits to avoid the costs associated with a trial.

4. Discovery Process

If the case proceeds, both parties will engage in discovery, where they exchange evidence and information. During this phase, you will have the opportunity to provide further documentation supporting your disability, and SISIP will share the reasons for their denial.

5. Negotiation or Settlement

Nearly all LTD legal claims are resolved through negotiation or settlement before they go to trial. Your lawyer at Samfiru Tumarkin LLP will negotiate on your behalf to secure the best possible outcome. If a settlement is reached, you will typically receive your benefits or a lump-sum payment to resolve the dispute.

In extremely rare cases where a settlement can’t be reached, the claim may go to court. During the trial, a judge will review the evidence from both sides and make a final decision.

What to Expect During the Legal Process

While the legal process can take time, it’s important to remain patient and trust in the strategy laid out by your legal team. Here’s what to expect:

• Ongoing Communication: Your lawyer at Samfiru Tumarkin LLP will handle all communication with SISIP/Manulife, taking the stress off you so you can focus on your health.
• Medical Documentation: Provide updated medical records throughout the process. The more comprehensive your evidence, the stronger your case will be.
• Potential Delays: Legal claims can take a few months to resolve. However, a successful legal claim often results in much better compensation than an internal appeal.

Common Outcomes of Legal Claims

• Settlement: In most cases, SISIP will offer a settlement during the negotiation phase. This could involve a reinstatement of your LTD benefits or a lump-sum payment.
• Benefit Approval: Sometimes, SISIP may approve your benefits after a legal claim is started, especially if they recognize the strength of your case that Samfiru Tumarkin LLP has presented.

Should You File a Legal Claim?

Yes. If your LTD benefits have been denied or cut off, filing a legal claim is often your best option. SISIP/Manulife has a track record of denying claims that are later resolved through legal channels. At Samfiru Tumarkin LLP, we have helped thousands of clients recover their LTD benefits and secure settlements from major insurers.

Insurance companies know our track record. They will likely choose to pay you what you are owed instead of getting into a legal dispute, which costs them more money in the long run.

No Win, No Fee

At Samfiru Tumarkin LLP, we work on a contingency fee basis for LTD cases. This means you don’t pay unless we win. Our goal is to make sure that pursuing legal action is accessible, with no upfront costs, allowing you to focus on your health while we focus on winning your case.

Negotiation or Settlement

Most LTD legal claims are resolved through negotiation or settlement before they ever go to trial. Your lawyer will negotiate on your behalf to secure the best possible outcome. If a settlement is reached, you will typically receive your benefits or a lump-sum payment to resolve the dispute.

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FAQs About SISIP Long-term Disability Claims

When dealing with SISIP long-term disability claims, there are often a lot of questions regarding the process, eligibility, and what to do if your claim is denied. Below are some frequently asked questions to help guide you through your claim journey. Find more answers in our full LTD FAQ section.

1. Who qualifies for SISIP LTD benefits?

CAF members, including Regular and Reserve Forces, are eligible for SISIP LTD benefits, whether they are still serving or retired.

2. When do I apply for SISIP LTD benefits?

You should apply for LTD benefits as soon as it becomes clear that you will not be able to return to work due to illness or injury. You can apply for SISIP LTD benefits by submitting your Employee Statement and Attending Physician’s Statement through Manulife, which administers SISIP claims.

You must wait for a particular period of time before you can switch to LTD. This is called the “elimination period.” If you are still disabled and unable to work after the elimination period, SISIP should approve you for LTD benefits.

3. How do I submit a SISIP LTD claim?

To submit an LTD claim, follow these steps:

• Log into your SISIP account online or submit paper forms via mail.
• Complete the required documents: Employee Statement and Initial Attending Physician’s Statement.
• Ensure all medical evidence is complete and accurate.
• Submit the forms online or mail them directly to SISIP.

4. How long does it take for a SISIP LTD claim to be approved?

SISIP (via Manulife) typically processes LTD claims within 5 to 20 business days. However, it could take longer if additional medical documentation is required or if the claim is particularly complex.

5. What Happens if SISIP Doesn’t Respond to New Medical Documentation?

After submitting additional medical documentation, it’s critical that SISIP (via Manulife) reviews your claim promptly. However, if they fail to respond within a reasonable time frame, this may be treated as an effective denial of your claim. In such cases, you have the right to challenge their inaction and pursue your benefits. Don’t wait too long—if you’re not hearing back, get a free consultation with Samfiru Tumarkin LLP to ensure your claim is properly handled.

6. What happens after 2 years on SISIP LTD?

After two years, SISIP (via Manulife) will reassess your eligibility for benefits. The definition of disability changes from being unable to perform your own occupation to being unable to perform any occupation that you are reasonably suited for by education, training, or experience. This stricter standard often results in benefits being denied or cut off, but you have the right to appeal if your claim is denied at this stage.

7. Can I appeal a SISIP LTD denial?

Yes, if your SISIP LTD claim is denied, you can appeal the decision. The internal appeal process involves providing additional medical evidence or addressing the reasons for denial. However, it’s often more effective to work with a disability lawyer to file a legal claim against the insurance company, as internal appeals can be denied repeatedly.

9. What should I do if my LTD benefits are cut off?

If your LTD benefits are cut off, especially after the two-year mark, you should act quickly. Start by getting a free consultation with a disability lawyer. Gather updated medical evidence that supports your inability to work in any occupation. You can file an internal appeal, but working with a disability lawyer is often the best course of action to challenge SISIP’s decision and secure your benefits.

10. Can SISIP monitor or investigate my disability claim?

Yes, insurance companies, including SISIP, may conduct surveillance or investigate your claim to verify your disability. This could involve monitoring your activities or reviewing your social media presence. If SISIP believes you are capable of working based on this evidence, they may deny your claim or cut off your benefits. It’s important to be honest and consistent in your claim.

For more detailed information on how surveillance works in long-term disability cases, you can explore our guide on LTD surveillance.

Surveillance doesn’t always lead to a denied claim, however. In a notable case, Julie Austin, a teacher whose claim was initially denied, successfully won her LTD benefits after our team demonstrated that the insurer’s surveillance photos didn’t disprove her disability but, in fact, reinforced it. You can read more about Austin’s legal victory here.

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Get Expert Help with Your SISIP Long-Term Disability Claim

If your SISIP long-term disability claim has been denied or your benefits have been cut off, don’t face the challenge alone. Our experienced disability lawyers at Samfiru Tumarkin LLP have successfully represented CAF members and veterans, ensuring they receive the compensation they deserve.

Whether you’re struggling to get approved for benefits, appealing a denial, or dealing with a claim cut-off after two years, we can help. Contact us today for a free consultation and find out how we can support you through the process and protect your rights. Our services extend across all Canadian provinces, excluding Quebec.

Don’t wait – Explore how our experts can help secure your disability claim today.