FAQ - Disability claims

Filing a claim for disability benefits

How do I file a claim for disability benefits?

For your initial claim, you must send us the Application for short and/or long term Disability Insurance Benefits/Initial Application form.

This form includes three separate sections:

  • The Insured's Declaration section, which you must complete, date and sign;
  • The Attending Physician’s Declaration section, either for a physical or a psychological illness, depending on the case, completed, dated and signed by the physician;
  • The Employer's or Policyholder’s Declaration section, completed, dated and signed by the employer.

The three sections can be sent together or separately. However, the claim will not be processed until all the completed sections have been received.

Important: Attach the Application for direct deposit of benefits form and a cheque specimen to your application, unless stated otherwise in your contract.

How do I return the forms?

All the contact information you need appears on the forms. You can send them to us by email (although it is an unsecured method), fax or mail.

You can also post your forms in the Client Centre to submit a claim: in addition to being secure, you can also speed up the processing of your claim (e.g. avoid mailing delays).

What steps are involved in the claim process?

We will open your file as soon as we receive the form, even if it’s incomplete. Once all the form sections are received, a resource will analyze your claim and contact you as soon as possible. Please note that during the analysis, this person may ask you for additional information.

The decision regarding your claim will be communicated to you by mail and telephone within 5 to 10 business days.

Will I receive a tax receipt for paid benefits?

Tax receipts are provided only if the paid benefits are taxable.

In this case, La Capitale will issue them automatically at the beginning of the year following the previous tax year. You will receive this document by mail. It will also be posted in the Client Centre.


Continuing a claim

What happens at the end of the benefit period that was set if I am still disabled?

If the benefit period that was set ends but you still cannot return to work, consult the decision letter you received after your initial claim. This letter should outline the other documents you would need to provide (consultation notes, medical certificate or file, etc.). If you have questions about the documents to provide or making a change to the initial plan, contact our Customer Service department at 418 644-4200 option 4.

In the event of a disability lasting more than 90 days, send a copy of your medical file since the start of your medical leave. This copy must include test results and specialists’ reports, but not genetic test results, if applicable.

If no documents were requested in your decision letter, you must ask for an extension using the Application for Extension of Short and/or Long-Term Disability Insurance form.

This form includes three separate sections:

  • The Insured's Declaration section, which you must complete, date and sign;
  • The Attending Physician’s Declaration section, either for a physical or a psychological illness, depending on the case, completed, dated and signed by the physician;
  • The Employer's or Policyholder’s Declaration section, completed, dated and signed by the employer.

The three sections can be sent together or separately. However, the claim will not be processed until all the completed sections have been received.

How do I return the forms?

What can I do if my claim is denied?

If, upon receiving the decision, you are not satisfied with how your claim was processed, consult the “Procedure for issues and complaints” document, which is attached to the decision letter. It includes the steps to take if you are not satisfied or wish to file a complaint.

In this event, you may also send medical information that is not yet in our possession. Please note that during the decision review, we may ask you for additional information.


Other types of benefits

Can I integrate other types of long-term disability benefits into my current disability benefits?

Yes, but in accordance with your group insurance contract, any amount received from a public agency or private insurer may cause your benefit amount to be reduced.

How will my La Capitale disability benefits be integrated with Retraite Québec benefits?

If, according to the information received, we notice that you may be eligible for disability benefits from Retraite Québec, you must send them an application.

If not, the (estimated) benefit you would have been eligible for from Retraite Québec will be subtracted from the benefits paid by La Capitale.

Step 1: Documents to send to Retraite Québec

  • Retraite Québec benefits application

Who must complete the form: The physician

Deadline for completing these steps: 4 months

Step 2: Documents to send to La Capitale

  • Reimbursement Agreement
  • Consent and Application for Remittance of Disability Benefits
  • Supplemental Medical Statement

Who must complete forms: You, as the insured

Deadline for completing these steps: 4 months

How will my La Capitale disability benefits be integrated with the Employment and Social Development Canada (ESDC) benefits?

According to your group insurance contract, benefits paid by Employment and Social Development Canada (ESDC) can modify your benefit amount. Here is what you need to do to calculate the gross amount of your disability benefits:

  • Get a copy of your first remittance slip and your statement from your ESDC file.

    Note: If you have trouble accessing your file online, contact an employment insurance agent at the Canada Revenue Agency.

  • Send us a copy of the remittance slip or the statement from your ESDC file. Make sure the gross amount appears on the document you send us.

With this information, we can update your file and establish your benefit amount.


Getting a better understanding of certain terms

What are the differences between the medical documents?

Here are a few definitions to help you distinguish between the various documents that may be required.

Important:When you receive a request for information by mail, make sure you provide the type of documents requested to avoid any delays in the processing of your file.

  • Medical file: Any medical documents, paper or electronic, of a patient that could include clinical notes, laboratory tests, ultrasound examinations, MRIs, test results, etc.
  • Physician’s note or medical certificate: Official certificate provided by a physician which includes the prognosis on the length of an individual’s inability to work, the scheduled return-to-work date, the date of the next appointment, if applicable, and the diagnosis in certain cases.
  • Medical prescription: Any care recommended (prescription drugs or other treatments) in order to treat or improve a patient’s medical condition.
  • Consultation or clinical note: Includes facts noted by a physician during a physical or virtual consultation saved in a patient’s file. The notes may include elements from the medical exam in a patient’s file regarding his or her medical condition or progression.
  • Medical questionnaire: Document addressed to the physician by the insurer which includes a list of questions related to an insured’s disabling medical condition. The answers allow the insurer to complete the analysis of a disability claim file.
  • Gradual Return to Work Protocol: Document provided by an attending physician detailing the parameters for a gradual return to work. These parameters include the number of proposed days or hours of work per week and the maximum period projected before a return to full-time work.

What does waiver of premiums mean and how is it applied?

The waiver of premiums is a period during which you do not have to make insurance premium payments. This waiver applies to certain benefits.

According to your group insurance contract, the entitlement to a waiver of premiums begins at the same time as long-term disability insurance benefits if you are completely disabled.