According to the  Government of Canada, coverage under long-term disability policies includes health conditions that leave policy holders unable to work for an extended period of time. Long-term disability benefits are an important way Canadians can protect their income in the event of an injury, accident, or the development of a medical condition.

One major Canadian company offering long-term disability insurance, Great West Life, was recently combined with other insurance companies, London Life Insurance Company and the Canada Life Assurance Company, to form Canada Life Assurance Company. Before the merger, Great West Life was one of the major insurance companies in Canada. After the merger, many Canadians have questions about their Great West Life long-term disability benefits.

Great West Life Long-Term Disability Overview

Great West Life, through its larger company, Canada Life, manages both short and long-term disability plans. Additionally, the company administers self-funded disability plans. Great West Life was founded in Winnipeg 125 years ago.

Those with a Great West long-term disability plan should refer to their policy documents. If you no longer have those documents, you can request this information from Canada Life. Read on to learn more about certain aspects of Great West LTD benefits.

How Does Great West Life Long-Term Disability Work?

Like other insurance companies, policyholders who become disabled must file a claim to access their Great West Life LTD benefits. In order to file a claim, policyholders generally need to submit medical records, as well as documentation related to their work and occupational roles.

Great West Life’s most common operating procedures is to assign one case manager to each LTD claim. The case manager will review the submitted long-term disability claim. Unfortunately, most policyholders are not prepared for the extensive review and scrutiny that will be applied to their Great West Life long-term disability claim, especially larger claims.

What are the Great West Life LTD Benefits?

Specific benefits offered under a Great West Life LTD plan will depend on the policy. Great West Life offers several types of long-term disability plans including:

• High-end “professional” plans for business owners and professionals
• Plan for employees that range from basic benefits to full coverage
• Business plans for companies that want a safety net for cash flow
• Individual plans for those that work from home, seasonal workers, and new business ventures

Great West Life LTD benefits may also depend on riders or additions to policies added by employers or policyholders. Generally, the more you pay in premiums for the policy, the more benefits you receive from a successful LTD claim.

What are the Great West Life Long-Term Disability Rules?

As noted above, the specific processes and procedures that apply to each Great West Life LTD plan will depend on the particular policy purchased. Policies contain definitions and standards for what “disability” means, along with required premium payments to continue coverage.

Plan documents will also contain standards for medical exams, employment documentation, as well as deadlines when making a claim. Fortunately, the LTD claims and appeal process for Great West Life long-term disability insurance claims remain similar to other long-term disability (LTD) claims processes offered by other companies, even though the company has been merged into Canada Life Assurance.

How Do You Fill Out Great West Life Long-Term Disability Forms?

Policyholders should refer to Great West Life LTD plan documents when filling out required forms to make a claim. Experts stress the importance of filling these forms out correctly, in accordance with the company’s standards to avoid a denial based on an error.

Why Would Your Claim Be Denied?

Common reasons insurance companies, including Great West Life, deny long-term disability claims include missed deadlines, errors in the claim documents, evidence of pre-existing medical conditions, skipped premium payments, incomplete or failed medical assessments, failure to meet the definition of “disability,” evidence that the policyholder refused medical treatment, or failed to follow up with a doctor.

Like other insurance companies, Great West Life may do its own investigation. As a result, the company may claim to have evidence that the policyholder is not truly disabled or not as disabled as they claim. Evidence the company uses can include alternate medical records, independent investigations, and may even include pictures from social media of the policyholder doing things that they would not be able to do if they were disabled.

In addition, Great West Life may deny a claim because the claimant’s policy may specifically exclude claims based on health conditions that resulted from certain activities, such as drinking or drug use. The insurance company may also point to information submitted by the policyholder’s employer or even their doctor that they say contradicts the claim.

The insurance company may even use this information to demonstrate that the policyholder can go back to work. The LTD claim may also be denied if the policyholder was institutionalized or incarcerated.

However, Great West Life LTD policyholders have the right to appeal a long-term disability insurance denial.

When Can You File a Long-Term Disability Appeal?

Filing a Great West Life long-term disability appeal may take one of several paths. The process used for each appeal will depend on the details of the policy, the claim, and the reason provided by Great West Life. The general process for an appeal consists of two parts; an internal appeals process and a legal appeal.

If your Great West Life LTD claim is denied, the first step is an internal appeal. The internal appeal will be handled through the company. The first issue to be aware of is the deadline for the appeal to be submitted – usually between 30 and 90 days. Experts recommend getting additional medical evidence and consider hiring legal representation at this point in the appeals process.

Policyholders should review their denial letter and understand why their LTD claim was denied so they can submit the additional clarifications and evidence necessary to establish their claim.

In the event that the internal appeals process is unsuccessful, claimants will need to move on to a legal appeal. The legal appeal will be filed in a provincial court and be heard by an adjudicator or judge. 

A long-term disability lawyer who is knowledgeable about long-term disability rules can help you understand your policy terms and what you can do to appeal your denial.

Both the internal and legal appeals process can seem intimidating; however, policyholders should know that these processes are very common when making an LTD claim.