This consumer guide is intended to educate you about the disability claims and appeals process as it relates to Manulife Financial. It includes a review of Manulife's claim procedures and complaints processes. We also report on relevant news, including public court decisions involving Manulife disability claims. This guide is not endorsed or supported by Manulife. You should not confuse it for any guide or publication Manulife may produce about its short- or long-term disability plans.
Manulife is one of Canada's “big three” life insurance companies alongside Sun Life and Canada Life (formerly Great-West Life). This guide will help you understand how Manulife claims fit within the broader context of disability claims and appeals in Canada. As you will learn, its claims and appeals processes are largely the same as any other insurance companies in Canada. Therefore, we will occasionally provide links for general articles on claims and appeals as they will apply equally to Manulife.
Manulife 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 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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Manulife Financial is one of Canada’s big three insurance companies, along with Sun Life and Canada Life.
Manulife sells and administers a range of insurance and financial products, including short- and long-term disability benefits plans. Manulife sells individual and group disability insurance policies to consumers and employers. It also acts as a third-party administrator for disability plans that are set up and funded by large employers or non-profit groups.
There are no general rules for Manulife short-term or long-term disability benefits. The benefits that you are able to receive, payment amounts, eligibility, and the procedure will all depend on your specific group insurance plan. Each insurance policy is unique, so you will need to obtain the correct one to learn the rules that apply to you.
Your benefits will be summarized in a document called the group benefits booklet or certificate of insurance. If you find that you need to file a short- or long-term disability claim with Manulife, the first thing you’ll want to do is get a copy of the benefits booklet for your policy. The document should be available from your employer, union, or association, and should tell you everything you will need to know to proceed.
Manulife 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 Manulife, usually using an independent insurance broker. If you have an individual insurance policy from Manulife, then the rules for your benefits can be found in the insurance policy and any amendments or riders attached to it.
There are two potential roles that Manulife might play in the payment and administration of benefits. They could be the insurer, administrator, and payor of benefits under a group policy; or, they might act as the third-party administrator of benefits paid by your employer or association.
There are also situations where Manulife will be 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 cases, Manulife acts only as the administrator of the plan and exercises authority given to it by the organization that funds the plan. There might not be an insurance policy document as there would be if Manulife was the insurer; however, the rules for benefits will be set out in a document called the “Plan Text” or something similar.
Whichever role they take — insurer or third-party administrator — usually will not change the claims process in most situations. The only time it will really differ is if you need to appeal a denial of disability benefits. If Manulife 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.
Similarly, if they are a third-party administrator of a non-profit disability plan, you may have restricted rights on appeal. These plans might have strict rules, procedures, and deadlines that don’t apply to regular long-term disability policies. You might not be allowed to appeal by lawsuit, but instead be limited to using the grievance and arbitration process set out in a collective agreement.
For even more in-depth information on disability benefits, you can check out our related Ultimate Guides:
Manulife uses the same general process as many other large insurance companies in Canada. The application process requires you to fill and submit 3 forms:
The process is the same whether you’re applying for short- or long-term disability benefits. You can get the forms from your employer, or find them online through Manulife's plan member portal or on their website.
Once your forms are received, your claim will be assigned to a case manager. That person will let you know if they need any further information. They review and investigate your claim.
Case managers at Manulife are very well-trained and will probably do quite a bit of investigation and information gathering. This might include reaching out to you on the phone to clarify details on an interview call. During this call, they will keep extremely detailed notes; if you ever need to see these notes, they will be kept in your claim file.
They might also write to doctors and other specialists for copies of your medical file and ask very specific questions that could support an approval or denial. Once you've applied, the best thing you can do is cooperate with the claims manager until you get a decision.
If your claim with Manulife gets denied, the first step is to engage in an internal appeal.
You will receive a letter in the mail from Manulife stating their decision. Denial letters from Manulife are usually long and detailed — they will point out the reasons for denial or refer to specific sections of information that you’ve submitted. This actually gives you quite a good place to start.
We typically like to get a copy of the claim file before doing anything else. This file will detail everything that’s going on in your claim. One of the key things to look for is the reports from their independent medical reviewers. These are people who look over the information from your doctor and determine for Manulife how disabled you are, and if your claim should be approved. Once you have this information, you can get it to your doctor to either clarify or dispute what they have said.
If they are missing information, get that to them as soon as you can.
There isn’t really a formal process to do an internal appeal. Usually the denial letter will set out any process or deadline that they have. You do have to submit in writing — a letter or an email — that you want to appeal the decision and that more information will follow.
After one or two denials at this stage, you might want to look into hiring a lawyer to help you through another internal appeal, or move you forward to a legal appeal.
If you’ve been denied after a couple of internal appeals, you might want to take it outside of Manulife. A legal appeal does exactly that. With a legal appeal, the decision-maker is someone outside of Manulife — usually a judge. This is someone from outside with no connection to you or the insurance company who can objectively make a decision.
A legal appeal is technically filing a lawsuit against Manulife. Once you file a lawsuit, Manulife assigns a lawyer and a new claim manager for this appeal. Sometimes, this new team is enough to get an approval simply because they have a fresh set of eyes.
If that doesn’t happen, you’ll get in touch with this new team to trade information. Usually an interview will take place (with your lawyer present) so they can better understand your situation. They might approve or settle at this point. If not, they go before a judge for a final decision, although it’s actually rare for a case to go that far.
The first step in resolving a problem within Manulife is to speak with your claims advisor or call a Manulife customer service representative.
After that, you can escalate your complaint to a customer service manager.
If they fail to resolve your issue, you can escalate further to the Customer Experience Care Team for an additional review. This begins a more formal investigation where the team will contact you to submit documents and information. They will provide you with written responses and information regarding your situation and their decisions.
The numbers to contact the Customer Experience Care Team are as follows:
If you’re still having problems, you can contact the Ombuds Office for a secondary investigation:
Manulife, Ombuds Office
500 King Street North
Waterloo, ON N2J 4C6
Telephone: 519-747-7000 ext.248874
If you absolutely need to pursue a complaint past this point, there are a few external services you can seek out. In the case of a disability claim, at this stage you would have to contact The OmbudService for Life & Health Insurance (OLHI) or another service, depending on what your issue was related to.
If you’re a Manulife plan member, you have two options: fully paper or fully digital. This means that when you need to submit forms, you can print them and send them through the mail, or submit them through the secure group benefits portal.
Manulife has a fairly comprehensive “Find a Form” section on their website. Some forms are accessible directly from the webpage, but it appears that the disability forms are only available if you sign in to the portal. If you’re a plan member, you should be able to easily find the forms you need through the group benefits portal.
Manulife is in the process of shifting to a fully digital experience. Although you can still submit paper forms through the mail, it’s quicker and easier to use the plan member portal or the app.
As stated above, Manulife plan members can only choose one: paper forms, or the online portal.
Since Manulife is transitioning to provide most claims services online and digitally, the best way to stay up-to-date with your claim status is to use their online portal. The portal requires your direct deposit information and an email address when you first sign up. When you submit a claim, they will send updates to that email address.
If you opt out of using the online portal, you can check your letters or other communications from Manulife for the correct phone number to call. Usually, you can contact your case manager if you’re curious about the status of your claim.
Following are answers to some frequently asked questions we receive about Manulife.
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 Manulife 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 Manulife.
While we don’t have access to statistics, we can assure you that Manulife 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 Manulife.
The short answer is yes. Generally, we encourage everyone to engage the internal appeal process before suing Manulife for denial of long-term disability benefits. We have had good success in helping people get Manulife claims approved during the internal appeal process. In our experience, Manulife 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
Manulife 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 Manulife 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 Manulife 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.