The Disability Board of Management is responsible for the overall administrative and financial management of the Disability Insurance Plan, including the review of the contract of insurance, review of any financial or service agreement, the financial status of the Plan, the services of the Insurer, the administrative fees and charges, the adequacy of reserves, the premium levels, the disposition of disputed claims, and other matters referred to it by the National Joint Council on the overall operation of the Plan, and for making appropriate recommendations to the National Joint Council.
Committee Advisor: Laura Mackenzie
Quarterly Report to the National Joint Council (March 2025)
Regular activities:
- The Board of Management has met two (2) times since the last Council meeting and considered four (4) appeals over the reporting period. The Board agreed with Sun Life’s (SL) decision to decline to provide disability benefits for all four (4) appeals.
- In the four (4) appeal cases reviewed, SL declined to provide disability benefits as it was of the view that the medical information on file does not support a finding of continuous total disability that would prevent the claimant from performing the essential duties of their regular occupation for two (2) appeals and that the medical information on file demonstrated that the claimant had a pre-existing condition for two (2) appeals.
- The Board received a presentation from SL on the claims adjudication and management process. Based on a question from last Council’s meeting, the Board asked SL if they had data related to the ratio of claims received by SL to appeals received by the Board. The Board will share this information with Council once received.
- The Board continues to receive monthly financial updates from SL.
- The Board discussed the appeals backlog and drafted a memo to be presented at the Executive Committee’s March meeting outlining short- and long-term solutions for consideration.
Outstanding item(s):
- Forty-seven (47) appeals. Of these, thirty-seven (37) appeals have been received by the NJC Secretariat from SL and are scheduled for review, and ten (10) are still under review with SL.
Next meetings: June 10, 2025; September 9, 2025; November 7, 2025