This article discusses everything you need to know about Manulife’s long-term disability benefits. This guide covers the rules and information about applying for Manulife disability insurance and appealing a denial.
If you need to win disability benefits from Manulife Insurance — it’s crucial to learn as much about them as you can. We wrote this guide to help you put your best foot forward when dealing with a Manulife long-term disability claim.
- About Manulife
- Manulife Long-Term Disability Rules
- Manulife Short-Term Disability Rules
- Complaints Process for Manulife Insurance
- Manulife Insurance Disability Claim Forms
- Appealing a Manulife Long-Term Disability Denial
- Long-Term Disability Lawyers for Manulife
- Manulife Insurance Disability FAQs
- Take the Next Step – Get Your Free Books
For a broader review of long-term disability benefits in Canada, explore our Ultimate Guide to Long-term Disability in Canada.
Manulife Insurance is one of Canada’s largest insurance and financial services companies. Manulife is apart of Canada’s big three disability insurance companies, along with Sun Life and Canada Life. You may have heard them go by the name of Manulife Financial or Manufacturers Life Insurance Company.
Manulife offers a range of insurance products, including short-term disability, long-term disability, illness and life insurance. It sells both individual and group disability insurance policies. It also acts as a third-party administrator for organizations that have their own disability benefits plans.
Manulife Long-Term Disability Rules
Manulife offers both group and individual long-term disability insurance policies. Generally, long-term disability refers to situations where you will be off work for 17 weeks or more.
There are no general rules for Manulife long-term disability benefits. The benefits you can receive, payment amounts, eligibility, and the procedure will depend on your insurance plan. Each insurance policy is unique, so you will need to get the correct one to learn the rules that apply to you.
For group insurance plans, your long-term disability benefits are summarized in a document called the group benefits booklet or certificate of insurance. You should always get a copy of the group benefits booklet or certificate of insurance before applying for benefits. The document should be available from your employer, union, or association.
Manulife also issues individual insurance policies. These are usually for self-employed professionals, executives, or small-business owners. You are responsible for buying this type of policy from Manulife using an 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 long-term disability. 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 disability 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 were the insurer. However, the rules for benefits are in a document called the “Plan Text” or something similar.
Regardless of Manulife’s role — insurer or third-party administrator — this will usually not change the claims process in most situations. The only time it will 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. This 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 appeals. 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 through a lawsuit but instead be limited to using the grievance and arbitration process set out in a collective agreement
Manulife Short-Term Disability Rules
You may have Manulife’s short-term disability as part of your workplace group benefits plan. However, there is no general short-term disability plan. Short-term disability refers to situations where you are off work for a limited time, usually up to 17 weeks (but sometimes longer). Manulife offers a range of possibilities, durations, and amounts. So, the specifics of your short-term disability benefits depend on your employer and what package they selected. You need to review your workplace group benefits booklet to know the specifics of your short-term disability benefits.
You apply for Manulife short-term disability benefits by filling out forms. These include an application form, a medical report and a report from your employer. Then, Manulife reviews your application and will decide to approve or deny your claim. If your short-term disability claim gets denied, you have the right to appeal.
The rules for how you appeal will depend on your work situation. If you are in a union, your appeal may have to go through them. But, this is not always the case.
Complaints Process for Manulife Insurance
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
E-mail: [email protected]
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.
Manulife Insurance Disability Claim Forms
If you’re a Manulife plan member, you have two options for forms. You can either go fully paper or fully digital. So, when you need to submit forms, you can print them and send them through the mail, or submit them through the secure 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.
Checking your Manulife disability claim status
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, 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.
Appealing a Manulife Long-Term Disability Denial
You can appeal a long-term disability denial through an internal or external appeal. I’ll discuss them both in detail below.
If your long-term disability 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 the information you provided. So, this gives you a good place to start.
We typically like getting 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. They determine how disabled you are and if your claim should be approved. Once you have this information, you can get it to your doctor to clarify certain things or dispute what they said.
If they are missing information, get it to them as soon as possible.
There isn’t a formal process for an internal appeal. Usually, the denial letter will set out any process or deadline you need to follow. You have to submit in writing that you want to appeal the decision. And more information will follow through a letters or emails.
After one or two denials at this stage, you might want to hire a lawyer. A lawyer can help you through another internal appeal or move you forward to a legal appeal.
Legal Appeal (or lawsuit)
If you got denied after a couple rounds 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 who has no connection to you or the insurance company. So they can make a decision objectively.
In other words, you are filing a lawsuit against Manulife. Once you file a lawsuit, Manulife assigns a lawyer and a new claim manager for this appeal. Sometimes, the new team will approve your claim simply because they have a fresh perspective.
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. However, it’s rare for a case to go that far.
Long-Term Disability Lawyers for Manulife
Many people can win long-term disability with Manulife on their own. Or with help from a friend or family member. However, sometimes it is hard to win on your own. Even if you are legitimately disabled. And should qualify. This can be very frustrating. In difficult cases, it is common for people to work with a representative. This can be a long-term disability lawyer. Or another person experienced with the process. Many representatives will work on a no-win, no-fee basis. Do your research before hiring any lawyer or advocate.
At Resolute Legal, we have successfully represented people in short- and long-term disability claims involving Manulife Insurance. We have represented people at all claims stages, including applying for benefits, internal appeals, legal appeals, and lawsuits. If you’re dealing with an appeal, we can review your situation and offer suggestions to improve your chances of success. This is part of our free claim review.
Manulife Insurance Disability FAQs
The following are answers to some frequently asked questions about Manulife disability claims.