Continuing Disability Claim Form by uhf10081


Continuing Disability Claim Form document sample

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									                     Faculty Common Disability Plan Action Flow Chart -                                                                                       Effective April 1, 2002
                                                                           Days 6
Action [based                                                                                                                                                           at 15 Wks of                       at 21 Wks of
on calendar            Days 1                                             through                      Days 15                                                             Short Term                         Short Term
   days ]:           through 4                    Day 5                      14                      through 20                            Day 31                           Disability                         Disability

Employee              1. Call DDRCP*          4. Call DDRCP re                                    11. Complete STD Claim             14. STD claim begins,               16. Complete LTD                  17. STD claim ends;
                            daily           possible return to work                                Forms; fax directly to                 if approved                   Claim Package; fax                 LTD claim begins, if
                                                 (RTW) date                                       Manulife 1-604-608-0675                                             directly to Manulife 1-                   approved

                                                                                                                                                                                 Note to Employee:
                                                                                                                                  Vancouver Island University stops paying wages to an Employee on the 31st day of absence. If STD claim form
                                                                                                                                   is not forwarded to Manulife on or before the 20th calendar day of absence, Manulife will not have had time to
                                                                                                                                  process claim, and Employee will be without pay until their first disability cheque if claim is approved. STD pay
                                                                                                                                  [from 31st day of absence and continuing for 21 weeks] is 70% of gross insured earnings. Banked sick time (to
                                                                                                                                    receive 100% of pay) cannot be used unless the STD claim has been adjudicated and accepted by Manulife.

DDRCP* or            2. Note absence on     5. Manage lost time in                                12. Work with HR to plan
Designate            On-Line Sick Leave         the workplace                                         return to work if
                           System                                                                       appropriate

                                            6. Stay in touch with                                 13. Monitor RTW with HR                                                                                   18. Monitor RTW, if
                                             Employee; discuss                                                                                                                                              applicable, with HR
                                            RTW as appropriate

Human                3. Monitor the Daily    7. Maintain contact          9. Send Short             13. Monitor RTW with                   15. Maintain                16. Send Long Term                        19. Maintain
Resources (HR)        Sick Leave Report       with Employee &             Term Disability           Manulife and DDRCP                     contact with                Disability (LTD) Claim                    contact with
                                             DDRCP throughout              (STD) Claim                                                      Manulife,                  Package to Employee                         Manulife,
                                                  absence                   Package to                                                     Employee &                   at Week 15 of STD                        Employee &
                                                                            Employee                                                     DDRCP throughout                                                           DDRCP
                                                                                                                                             absence                                                              throughout

                                             8. Notify DDRCP of            10. Contact            12. Work with DDRCP to
                                              plans for a RTW or            DDRCP to              return Employee to work if
                                            rehabilitation program        determine work                  appropriate

*DDRCP = Dean,
Director, Regional
Campus Principal
or Designate

                                                                      C:\Docstoc\Working\pdf\484c5564-385f-4c63-ba67-69d7c07133be.xls Updated January 2009

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