I was out for drinks the other night and had the pleasure of meeting a new friend. She didn’t know what I did for a living and started telling me the story about her husband’s plight with Work Safe. I am not an expert on Work Safe or their disability wording.
What I was surprised about is that Work Safe was trying to push the claim off to the Insurance Company. In all the Employee Benefit contracts that I work with, Work Safe is first payor. What this means is Work Safe pays their disability benefit amount and if there is any topping up, which normally there isn’t, the Insurance Company pays just the top up portion.
This is from Empire Life’s Standard Contract Wording and is standard wording in the industry:
“Amount of Long Term Disability Benefit Payable
Where the Schedule of Benefits indicates Primary Integration, the amount of Long Term Disability Benefit payable in any month to a Totally Disabled Employee under this Provision will be the lesser of:
- the Scheduled Benefit less:
- the initial monthly disability benefit the Insured Employee is entitled to under the Canada/Quebec Pension Plan excluding any Dependent benefits and excluding any cost-of-living index increases that occur after the time of commencement of payment of any disability pension under the Canada/Quebec Pension Plan, and
- any disability benefit the Insured Employee is entitled to under any workplace safety legislation (e.g. Workplace Safety ad Insurance Act, 1997) or similar legislation, and
- any disability benefit the Insured Employee is entitled to under an automobile insurance plan deemed to be first payor of benefits, and”
What upsets me the most about this claim is my perception of the lack of assistance the injured employee and his wife are receiving. He has a brain injury and has a difficult time with anger and depression due to the head injury and their impression is that Work Safe is trying to get him back to work to early. His Spouse is working full time and trying to navigate her way as best she can through the claim and assisting her husband.
I do understand that there are people who take advantage of the system and some people are very good at it. Work Safe and Disability Insurance Companies must do their due diligence. My question is where is the advocate for these people?
There have been a couple times as a broker when I have stepped away from helping a client claim for disability. Once in a blue moon, I get a client who is really efficient and capable of handling the situation without me. Sometimes, with a car accident by the time the person gets to the Long Term Disability portion they already have legal involved. At that point they already have all the support they need.
My concern in this claim is that he is dealing with a brain injury, she is dealing with a husband who’s personality has changed, and they are feeling like they are in over their head. The average person does not have the training to understand the wordings in the contracts. At the end of the day they just need to feel like someone cares about what they are going through and to assist them in making am informed decision.
This is scary stuff folks, it is only his income, no biggie.
If you want a broker who understands what they sold, contact Glendinning Insurance Services, your Resource Specialist.
You never know what life has in store for you, so while you can: