The MTS Disability Benefits Plan, formerly called the long term disability plan, is an insurance plan owned and operated by the Manitoba Teachers’ Society. The plan has been in existence since the 1970s under arrangements with various insurance companies. In 1989 the Society brought the plan in-house with administration handled by a local insurance company. In 1994 MTS took over management and operation of the plan.
The Long Term Disability Plan is a self-insured plan under the Manitoba Teachers’ Society. As such, the benefits are not underwritten by an insurer regulated under the Manitoba Insurance Act but are an unsecured financial obligation of the Manitoba Teachers’ Society. The most recent independent valuations for the Long term plan show it to be in a well-funded financial position. The financial viability of the Plan is independently assessed on an annual basis with a report on its financial health at the Annual General Meeting of the Manitoba Teachers Society.
When covered members experience illness or injury on or off the job the plan is designed to assist with medical and vocational rehabilitation to ensure the earliest possible return to maximum functionality. Where an absence extends beyond 80 working days or meets the qualifying criteria, the plan provides a reasonable level of income replacement during the period of disability while continuing to assist the claimant with rehabilitation.
Plan participation is mandatory for all eligible employee groups. The premiums paid by covered members provide for the cost of rehabilitation expenses, income replacement, programs, other benefit payments and administration. Investments provide for future costs.
The MTS Disability Benefits Plan operates under the following Mission Statement:
The Plan is dedicated to assisting members through periods of disability in a manner that will attempt to assure, in a consultative approach, maximum rehabilitation both medically and vocationally to assist the members, when possible, to return to work, while providing the disabled member with financial security at a cost that is reasonable to the premium-paying member.
The Claims Process
The Benefits Process
A claim is opened when a covered member applies for disability benefits. This section explains the stages that a claimant will normally follow as he/she is supported by the plan.
Members are asked to notify the plan if they are absent on sick leave for more than 10 consecutive workdays. As well employers are asked to notify the plan of any plan member who is absent on sick leave for more than 10 consecutive workdays. At the notification stage, a case manager or other plan employee will contact the member to provide information, review options and discuss whether a claim application should be initiated.
Employee application forms collect information about medical and vocational history and contain authorizations to enable the plan to gather medical information to substantiate a claim. When you submit an application, provide copies of any recent medical certificates or reports you already have.
Employer Information Forms
Employers will be asked to provide specific information on salary and benefit levels and job history and requirements.
The plan has strict confidentiality and security measures in place. The only information shared with the employer is whether and when you qualify for disability benefits and details of return to work plans. Other information will be provided only if the claimant so authorizes.
The plan directly requests any required medical reports and pays the practitioner a standard fee amount. Some practitioners may request their patient pay an additional amount for reports.
Independent Medical Examinations
An examination by an independent specialist is sometimes required. Your case manager will discuss this with you in advance.
There is a waiting period before income replacement benefits begin of 80 working days or the end of sick leave, whichever is later. If you have insufficient sick leave to carry through the waiting period, your case manager will assist you to explore other options.
Your case manager will gather all pertinent personal, vocational and medical information to facilitate a timely decision on whether or not income replacement benefits are warranted. Where a member feels unable to return to work and a case manager does not have sufficient grounds to justify payment of income replacement, the circumstances are presented to an appointed committee of teachers (Case Management Committee) for decision.
Income Replacement Benefits
Income replacement benefits are not taxable and are paid based on a percentage of your monthly net income. You will be provided with details of how your benefit was calculated at the time of acceptance. Payments are made monthly by direct deposit on the last banking day of each month. Explanation of benefits statements are mailed to you each month.
Generally, even though you may exhaust sick leave benefits, you remain an employee of your division with the right to return to work when you are well. You have an obligation to advise your employer periodically of your status and to make direct arrangements with your payroll office regarding continuation of other employee benefits. It is important not to let your group benefits lapse as future access may be limited or denied. You may also be eligible for disability waiver of premiums on group life insurance coverage. Waiver application forms are available through your payroll office. If there are employment issues surrounding your absence (e.g., work conflict, grievance issues), they can be discussed in confidence with your case manager and/or MTS staff officer/union representative.
Your case manager will coordinate with your caregivers to assist with access to adequate and appropriate health care services. Sometimes other rehabilitation professionals are engaged to assist individuals with improving their level of functioning.
Return to Work/Vocational Rehabilitation
When your care team decides that you are ready to work towards a resumption of work activities, your case manager will help you develop a return to work plan and help you and your employer develop a re-entry plan. Each plan is customized to individual circumstances and may include volunteer activity in or outside the workplace, employer accommodation details and part-time or gradual re-entry plans. Earnings from a part-time return to work are an offset to the income replacement benefits.
There is no minimum duration for a claim under this plan. During the initial 24-month period of disability, continuation of benefits will be based on your ability or inability to sustain regular employment in your current job. Continuation beyond 24-months is based on whether you are able to sustain any type of gainful employment in any job that meets specific minimum requirements. There are regular review requirements for all claims.
Notification, Rehabilitation and Income Replacement
Members are asked to notify the plan if they are absent on sick leave for more than 10 consecutive workdays. As well employers are asked to notify the plan of any plan member who is absent on sick leave for more than 10 consecutive workdays. At the notification stage a case manager or other plan employee will contact the member to provide information, review options and discuss whether a claim application should be initiated.
Notification allows us to make early contact with members and initiate supports if required. This also allows us to explain the qualifying criteria and initiate the Disability Claim process if necessary, explore your financial options and provide any other information or required forms.
DBP provides claimants with a wide scope of services to assist the claimant to regain full functioning. These services are offered by the case manager or through a network of service providers and medical professionals to support the rehabilitation of claimants. Services can include rehabilitation consulting, medical consulting, physical and occupational therapy, equipment required for rehabilitation, psychiatric counseling, human resource support services, career counseling and re-training.
Income Replacement Program
The Income Replacement Program is a core component of the benefits available to covered members. It provides income for claimants while they are away from work and not earning income. To be eligible for income replacement a claimant’s claim must be accepted and must meet the qualifying criteria.
Eligible claimants who have been absent from work due to a disability for more than 80 consecutive working days or who have expired there sick leave credits whichever is longer may receive income replacement.
The level of Income Replacement is a tiered income replacement based on Gross income as follows
60.5% on first $24,000.00
51% on next $18,000.00
47.5% on next $42,000.00
42.5% in excess of $84,000.00
Claimants approved for Income Replacement will receive monthly income replacement payments at the end of each month. These income replacement payments are not taxable.
There are times when members who make application for disability benefits under the Plan do not have 80 sick leave days credit. These members should discuss their situation with their case manager. There may be other options available to these members such as short term disability insurance or short term employment insurance coverage which could bridge this income gap.
The Plan never shares claimant’s medical or employment information, even among different departments of the Teachers’ Society without express consent. Enrolment data is located on a secure data-base accessible only by staff working directly with claims.
The only information passed to the Employer by the Plan is whether and when members qualify for Disability Benefits and particulars of return to work plans. Confidentiality is our pledge.