Exclusions & Limitations
Any treatment that is performed and prescribed by a doctor/ nurse practitioner or, when Sun Life believes it is necessary, by a medical specialist.
What is Appropriate Treatment?
A legally binding document outlining the terms of agreement between Sun Life and the Plan Sponsor.
What is the Contract?
Financial, psychosocial, occupational and medical elements that can impact a person's recovery.
What are influencing factors?
A pot of money available for DCMs on each absence, to fund treatment programs or refer PMs directly to approved/contracted treatment providers.
What is the DCM Funded Treatment program?
Our best source for "functional" information about a PM
Who is the plan member
The standard provision states that "Sun Life will not pay benefits for any period while the Plan Member is absent from Canada for longer than 4 weeks (STD)/4 months (LTD) due to any reason, unless Sun Life agrees in writing in advance to pay benefits during the period"
What is the Out of Country provision?
The system where you can find the full contract and booklets.
What is DARC?
National system for describing an occupation's physical and cognitive demands
What is the Career Handbook?
The maximum timeframe for medical information and an FTI to be on file before making an RC referral
What is 8 weeks for medical and 4 weeks for an FTI?
The person who can help you prepare for a challenging MH FTI
Who is a the SCMH, Nicola Forde?
Benefits are not payable if a Plan Member's condition results from a work injury/accident and makes them eligible to receive benefits under another governing body.
What is the Workers Compensation Board (WCB) provision?
An employee will be considered totally disabled while the employee is continuously unable due to an illness to do the essential duties of the employee's own occupation or any occupation.
What is a definition of disability?
Elements that influence an individual psychologically and/or socially.
What are psychosocial factors?
A functional-medical assessment done by a practitioner qualified in the appropriate specialty. This is a non-biased, non-invasive evaluation/examination of the PM's condition.
What is an IME?
The follow up process for an FTI
What is 3 attempts over 3 consecutive days?
Something we must consider if a PM goes off work within 12 months of their date of coverage
What is a pre-existing condition?
Someone who is licensed to practice medicine where that practice is located.
What is a Medical Doctor?
A condition that reduces normal functioning, interferes with activities, of daily living, can be noticeable to others and can impact social functioning and judgement.
What is Functional Impairment?
This is an alternative plan that we create in the planning stages of a claim in the event that the initial plan is not successful.
What is a Contingency Plan?
What open-ended questions typically start with
What is Why, How, What, Describe, Tell me about..., What do you think about?
Treatment that involves the process of cosmetically modifying a patient’s physical appearance.
What is Aesthetic Treatment?
An absence management service that supports plan sponsors who have LTD with Sun Life but self-insure the short-term disability period.
What is Salary Continuance?
Medical and functional information, restrictions and limitations, as well as occupational information regarding the essential duties of a Plan Member's own occupation are used to determine this.
What is Total Disability?
A referral service aimed at providing the PM with faster access to medical specialist within the provincial health care systems
What is Medical Confidence?
A communication technique that aims to help PMs strengthen their own motivation and commitment to make changes to their daily life and recovery
What is motivational interviewing?