This consumer guide is intended to educate you about the disability claims and appeals process as it relates to The Canada Life Assurance Company, formerly known as Great-West Life. It includes a review of Canada Life’s claim procedures and complaints processes. We also report on relevant news, including public court decisions involving Canada Life disability claims. This guide is not endorsed or supported by Canada Life. You should not confuse it for any guide or publication Canada Life may produce about its short- or long-term disability plans.
Canada Life is the recent amalgamation of three other insurance companies: the Great-West Life Assurance Company, London Life Insurance Company, and the Canada Life Assurance Company. Before the merger, Great West Life was one of Canada's “big three” life insurance companies alongside Sun Life and Manulife. As you will learn, its claims and appeals processes are largely the same as any other life insurance companies in Canada. This guide will help you understand how Canada Life claims fit within the broader context of disability claims and appeals in Canada. Therefore, we will occasionally provide links for general articles on claims and appeals as they will apply equally to Canada Life.
Canada Life manages a variety of short- and long-term disability plans. It also acts as a third-party administrator for self-funded disability plans. This guide is not a substitute for the official Canada Life documents for your particular disability plan or insurance policy. You must read your own plan document or insurance policy to understand your rights and obligations.
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The Canada Life Assurance Company is one of the big three life insurance companies in Canada. It just formed in January, 2020, when 3 insurance companies merged together -- Great-West Life Assurance Company, London Life Insurance Company, and the Canada Life Assurance Company.
Canada Life sells and administers a range of insurance and financial products, including short- and long-term disability benefits plans. Canada Life sells individual and group disability insurance plans to consumers and employers. They also act as a third-party administrator for disability plans set up and funded by large employers or non-profit groups.
At the time of writing, Canada Life is still working on combining these brands, updating their websites and materials. Any reference to the 3 previous insurance companies is to be understood as referring to Canada Life.
There are no general rules for Canada Life short-term disability claims; the benefits and claims process will be unique based on your particular group insurance or income continuation plan.
If you need to file a short-term disability claim with Canada Life, the first step to take is to get a copy of the benefits booklet for your specific policy; this should tell you what you need to know. Your benefits will be summarized in a document called the group benefits booklet or certificate of insurance.You should be able to get this booklet from your employer or association.
There are two potential roles that Canada Life might play in the payment and administration of benefits. They might be the insurer, administrator, and payor of benefits under a group policy; or, they might act only as the third-party administrator of benefits paid by your employer or association.
Whether Canada Life is acting as the insurer or as a third-party administrator will not change the claims process in most situations. However, Canada Life’s role as a third-party administrator does become relevant if you need to file a legal appeal or lawsuit for payment of benefits. If Canada Life is a third-party administrator, you would need to take legal action against the actual payer of benefits, which is usually your employer or association.
To learn more about short-term disability claims in general, check out our Ultimate Guide to Short-term Disability.
There are no general rules applicable to all Canada Life long-term disability claims.
If you need to file a long-term disability claim with Canada Life, you can find the rules for eligibility, payment amounts, and claim procedures in your specific group policy or plan document. These group policies and plan documents are unique, so the only way to know the rules for your situation is to get a copy of the document that applies to you.
Your benefits will be summarized in a document called the group benefits booklet or certificate of insurance. You can request a copy of this booklet or certificate from your employer, union or association. This booklet will include all the information relevant to your claim and you don’t need to get a copy of the original group insurance policy issued to your employer or association.
There are situations where Canada Life will act as the third-party administrator of a disability plan set up and funded by a government, large employer, or other association. We refer to these types of plans as non-profit disability plans. In these situations, Canada Life acts only as the administrator of the plan and exercises authority delegated to it by the organization that funds the plan. While there is no insurance policy per se, the rules for the benefits will be set out in a document called the “Plan Text” or something similar.
With non-profit disability plans, you may have restricted rights on appeal. These plans may have strict procedures and deadlines that don’t follow the rules applicable to regular long-term disability insurance policies. You may be unable to pursue your appeal using the lawsuit process and may be limited to using the grievance and arbitration process set out in a collective agreement.
Canada Life also issues individual insurance policies. These are usually for self-employed professionals, executives, or small-business owners. You have to buy this type of policy from Canada Life, usually using an independent insurance broker. If you have an individual insurance policy from Canada Life, then the rules for your benefits can be found in the insurance policy and any amendments or riders attached to it.
To learn more about long-term disability claims in general, read our Ultimate Guide to Long-term Disability.
The application process is similar to most other insurance companies, and will depend on your specific disability policy or plan. While the application forms are very similar from plan to plan, you’ll need to use the specific forms designated for your plan or policy. There are no “general application forms” you can find and use online.
There are typically three forms: a claim form that you fill out; a medical form your doctor fills out; and a form your employer fills out.
You can usually ask your employer for the forms, or you can find them on GroupNet, which is Canada Life’s secure online portal.
There isn’t one single process for appealing a disability claim denial from Canada Life (or any other insurer); you must follow the appeal rules that apply to your specific disability plan. If you don’t already have one, start by getting a copy of the booklet that describes your specific disability benefits. You can get this from your employer or association.
Generally, your short or long-term disability appeal will involve two or more opportunities to appeal directly to a Canada Life claim representative. This is usually handled by the representative who has already denied you, but is sometimes handed off to a more senior member. This is called an internal appeal.
Once you receive your denial letter, you must notify Canada Life in writing about your intention to appeal before the end of the appeal deadline. Deadlines vary, but can be anywhere from 30 to 90 days, and will be outlined in the letter.
Ideally, you should also get any new medical information to the claim representative before the deadline. If you have delays in getting the information that you need, be sure to notify Canada Life in advance of the deadline; they’ll usually extend your time if they’re made aware.
So, what information do you need to get to them? Again, your best point of reference is the denial letter, which will state exactly the reasons you were denied and outline the additional information that they need in order to approve your claim. Another thing you can do is request a copy of your claim file; this will give you the clearest picture of how they’re interpreting your case and reveal some areas where you and your lawyer will be able to make clarifications. In the claim file, you might find out whether they are suspicious of you or performing surveillance, the independent medical records they have to combat yours, and more.
Once you have more context as to why they denied your disability benefits, you should be able to gather the appropriate information and appeal their decision.
If you’ve been unsuccessful after a couple of internal appeals, you may want to move forward with a legal appeal. This is a lawsuit filed through your province’s court system and ultimately decided by a judge.
The insurance company will usually assign a new lawyer and a new claim representative to your case. Sometimes these get approved right away because there’s a team of new people who can objectively look at the whole situation with fresh eyes.
If you decide to pursue a legal appeal, you’ll probably want to hire a lawyer. There are lots of technicalities that you might not be comfortable or prepared to deal with on your own.
If you’re appealing a long-term disability claim under a group insurance policy, we recommend you follow our 7 steps to appeal a long-term disability denial.
If you’re appealing a long-term disability claim in a situation where Canada Life is acting as a third-party administrator, you’ll need to first determine what the different rules and deadlines are.
Canada Life has an internal complaints process. This is for complaints related to service you have received. The process is as follows:
The Great-West Life Assurance Company
Ombudsman’s Office T 262
255 Dufferin Avenue
There are no general disability claim forms for Canada Life. While many of the forms are similar, each plan or policy has its own unique forms. It’s important that you use the forms Canada Life has designated for your plan or policy; don’t just search for forms online.
At the time of writing (March 2020), Canada Life is developing a “find a form” tool on their website. For the time being, you can sign into your GroupNet account to access the forms you need.
The best way to check the status of your disability claim is to contact the advisor that you’re working with at Canada Life. Alternatively, you may be able to check the status of your claim on GroupNet.
If the advisor doesn’t respond to your inquiries, you can follow Canada Life’s complaint process. Try to work with the claims representative and use the complaint process as a last resort.
Following are answers to some frequently asked questions we receive about Canada Life.
If you were already dealing with one of the insurance companies before they joined, the amalgamation won’t really change anything. Your policy will stay the same, and you’ll be working with the same advisor you had before.
We get this question all the time -- and about every insurance company. When your claim gets denied it can feel like your insurance company is the worst in the world, and just out to get you. In reality, it’s hard to objectively say that one insurance company is better or worse than another. Bad experiences happen everywhere and are typically isolated events due to the claim representative -- not the company as a whole. Sometimes there are legitimate grounds for Canada Life to dispute your claim, even though it doesn't feel that way to you. What may seem like malice is often better explained by a breakdown in systems or an overwhelmed employee. We have spoken with many people who are satisfied or happy with their interactions with Canada Life.
While we don’t have access to statistics, we can assure you that Canada Life approves plenty of long-term disability claims. However, some long-term disability claims aren’t so cut-and-dry — meaning that there can be reasonable disagreement on whether the claim should be approved or denied. If your long-term disability claim was denied, it is likely that you fit into this group of claims.
It can be frustrating when you know for a fact that you’re disabled but your claim gets denied. Often this is simply due to insufficient evidence. Often presenting your case in the right way will lead to approval; this means you need to present evidence that will be convincing to Canada Life.
The short answer is yes. Generally, we encourage everyone to engage the internal appeal process before suing Canada Life for denial of long-term disability benefits. We have had good success in helping people get Canada Life claims approved during the internal appeal process. In our experience, Canada Life takes the internal appeal process seriously and doesn’t "force" people to sue them to win payment of benefits.
There are always exceptions and there are situations where it will not be possible to win approval during internal appeals and a lawsuit will be necessary.
"Spy" is a harsh word — but yes, all insurance companies are allowed to perform surveillance or monitoring of disability claimants. There are rules, however: they aren’t allowed to violate your privacy rights. Any surveillance or monitoring must be done in the public domain, which means they can only monitor you in public spaces or use information that is publicly available online.
To read more about this, check out our article: Surveillance and Long-term Disability Claims
Canada Life disability benefits can be either taxable or non-taxable depending on the specific disability plan. The tax status of long-term disability benefits depends on the percentage of the premium paid by you and the percentage paid by your employer. The only way to know if your disability benefits are taxable is to ask your employer or your Canada Life claim representative.
We know better than most people how stressful it can be to deal with insurance companies. If you're still feeling unsure about your Canada Life disability claim or appeal, sometimes a quick call with us can help you move forward with confidence. Feel free to fill out the form near the top of this page to schedule a free consultation.