This article discusses everything you need to know about SSQ Insurance long-term disability benefits. That includes a discussion of rules as well as information about applying for benefits and appealing a denial.
Navigating long-term disability insurance benefits can be exhausting, but don’t let complicated policies and legal jargon hold you back. We wrote this guide to help you understand this challenging process; so you have the best chance at winning the benefits you deserve.
Psst. If you are reading this article in 2023, SSQ may now go by Beneva.
About SSQ Insurance
Founded in 1944, SSQ Insurance (SSQ Assurance in French) is a mutualist company that offers insurance and investment products. It is headquartered in Quebec City, but it operates all over Canada. The company sells short and long-term disability coverage through group insurance plans. When we published this article (July 2022), SSQ did not offer disability benefits through individual insurance policies.
However, this may change when SSQ officially joins forces with another Quebec-based insurance company, La Capitale Financial Security. In 2020, SSQ and La Capitale announced they would combine operations to become Beneva. However, for the rest of 2022, SSQ Insurance and La Capitale’s legal entities and contracts will remain separate. They decided to transition one company at a time to ensure the change didn’t affect both companies’ operations. So, in 2022 La Capitale became Beneva, and SSQ is expected to join in 2023.
So, for this article, we will continue to refer to the insurer as SSQ, but keep in mind if you are reading this in 2023, they may go by Beneva. And some rules and contact information, for example, may change.
SSQ Insurance Long-Term Disability Rules
There are no general rules for SSQ long-term disability claims. However, as mentioned earlier, SSQ only offers long-term disability coverage through group insurance plans. Therefore, those who purchased individual insurance plans won’t have disability coverage with SSQ.
If you need to file a long-term disability claim with SSQ, you can find the rules and procedures in your specific group policy or plan document. It will include information on eligibility, payment amounts, and claim procedures. These group policies and plan documents differ. The only way to understand the rules for your situation is to get a copy of the document that applies to you.
Look for a document called the group benefits booklet or certificate of insurance. This booklet will summarize your benefits and explain any rules you must follow. You can request a copy from your employer, union, or association. It contains all the information relevant to your claim.
Although, we can’t provide you with the exact rules for your specific plan, most require you to meet the following criteria.
You must be:
- covered under a disability insurance plan
- ill or injured after an accident
- continually seeing a doctor
- unable to work because of your physical or mental health (“totally disabled,” according to your policy)
To learn more about how long-term disability insurance works in Canada, check out our Ultimate Guide to Long-term Disability.
Short-term disability rules
Same as long-term disability, there are no general rules for all short-term disability claims with SSQ. Check your group policy or plan for information on eligibility criteria, payment amounts, and claim procedures.
Applying for SSQ Long-Term Disability
SSQ’s application process is simple. To apply for long-term disability, you must submit three forms.
These forms include:
- Employee Statement — you fill this one out
- Employer Statement — your plan administrator (usually your employer) fills this out
- Initial Attending Physician’s Statement — your doctor fills this out
You can get these forms from your employer. Or, you can find them by logging into SSQ’s Customer Care Centre.
There are three ways to submit your forms: fax, email, or mail. SSQ has two offices, one in Toronto and one in Quebec. So, check with your employer or the group benefits package to confirm which office you should mail your application to.
Email: [email protected]
SSQ, Life Insurance Company Inc.
2525 Laurier Boulevard
PO Box 10500, Stn Sainte-Foy
Quebec City, QC G1V 4H6
Email: [email protected]
SSQ, Life Insurance Company Inc.
110 Sheppard Avenue East, Suite 500
Toronto, ON M2N 6Y8
What happens after you send your application?
Once your documents are received, a case manager will be assigned to your claim. This person decides if your claim is approved or denied.
When making this decision, the claim manager considers the following information:
- Your specific insurance policy
- Your medical condition (including limitations and restrictions)
- Current treatments
- Your job description
- The coordination of benefits, if benefits are paid by a government agency (e.g., Canada Pension Plan)
Your case manager may also contact you to obtain additional information. They may want to clarify certain aspects of your claim or ask for additional medical documentation.
After the case manager reviews everything, you will receive a decision. If your claim is approved, benefits will get deposited into your account. To receive benefits, you must first apply for direct deposit by providing a void cheque. SSQ pays long-term disability benefits on a monthly basis. You will receive your payment on the third business day before the end of the month.
SSQ Complaints Process
If you are unhappy with SSQ’s service or one of their products you can file a complaint. This process is for service-related complaints. It is not meant for complaints about claim decisions, for example. If SSQ has denied your claim, you should appeal, not complain.
The first step in resolving a problem with SSQ is to speak with your claims advisor or call a SSQ customer service representative.
If your complaint isn’t resolved after this step, you can ask to have your case reviewed by a specialist, team leader or supervisor. This person will review your case and contact you.
If that doesn’t solve your issue, you may send a written complaint to SSQ’s Complaints Officer. You can send it online or by mail.
2525 Laurier Blvd
P.O. Box 10500, Station Sainte-Foy
Quebec City QC G1V 4H6
If you aren’t satisfied with the Complaints Officer’s decision or if the 30-day deadline for receiving a definitive reply from the Complaints Officer has expired, you can also appeal to other financial regulatory organizations and associations.
You may address the OmbudService for Life & Health Insurance, which will be able to propose a voluntary conciliatory process.
If you live in Quebec, you can ask the Complaints Officer at any time to transfer your complaint file to the Autorité des marchés financiers.
If you live in Saskatchewan, you may contact the Financial and Consumer Affairs Authority at the following:
Email: [email protected]
Address: Suite 601 – 1919 Saskatchewan Drive, Regina SK, S4P 4H2
What Happens if my SSQ Long-Term Disability Claim is Denied?
If SSQ denies your long-term disability claim, you can appeal it either internally by requesting a review or you can move forward with an external appeal.
Let’s go over how to do both.
For internal appeals, you have 90 days upon receipt of the decision to request a review. This request must be in writing and should include any new medical information — if you have any. If there are delays in getting the information you need, notify SSQ before the deadline. They will usually extend your time if you let them know in advance.
So, what information do you need to get to them?
Again, your best point of reference is the denial letter, which will state the reasons you were denied and outline the additional information they need to approve your claim. Another thing you can do is request a copy of your claim file; this will give you a clear picture of how they are interpreting your case and reveal some areas where you or your lawyer can make clarifications. In the claim file, you might find out if they are suspicious of you (performing surveillance), the independent medical records they are in possession of, 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.
You can also move forward with a legal appeal. This is a lawsuit that is filed through your province’s court system, and is 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. This is because there is a new team of people who can review your situation with a fresh perspective.
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 prepared to deal with on your own.
At Resolute Legal, we have successfully represented people in short- and long-term disability claims involving SSQ. We have represented people at all claims stages, including applying for benefits, internal 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.
Call us toll-free today at 888-732-0470 or fill out the form below to request a free consultation.