Appeal (SISIP) (Assorted Topics)

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Re: Appeal (SISIP) (Assorted Topics)

Post by 1993firebird on Mon 20 May 2013, 15:30

Thanks , I have documentation from a social worker , psychiatrist and psychologist all stating my psychological symptoms and physical conditions , just thought that I would have my family Doctor fill out the SISIP physician form. I am unable to be in the work environment due to violent outbursts from stress and an inability to deal with people in general. I would cause great harm and even death to someone if I had to work.

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Is "Adjudication" a lengthy process?

Post by TripleT on Wed 05 Jun 2013, 08:14

Approximately 6-8 weeks ago, I sent a letter to MC informing them of my intent to appeal Manual Life's decision to close my file after 24 month's. My letter included proof of my eligibility for continued LTD benefits beyond the 24 month's but because I "failed to comply with multiple requests for Physician Statement and Financial information...Anyway, I received a phone call from MC (Dan Wallace) about 2 or three weeks ago acknowledging my letter and he indicated to me that he would be handling my case for adjudication. So yesterday I received a letter sent by courier from Manual Life that reads...

"Following the Federal Court's ruling of May 1, 2012, blah, blah...and upon review of your file, it was noted that updated medical and financial info was not provided from the time my claim was reduced to zero to the date of closure of my file(24 month's)"

In the absence of updated blah, blah...unable to determine entitlement beyond initial 24 month's blah, blah...file was closed.

At this time we invite you to provide us with updated medical blah, blah...in order to assess entitlement beyond initial 24 month's blah, blah...must meet definition of "Total Disability".

Manual Life is requesting the Physicians Statement supporting eligibility, they want copies of any "Notice of Entitlement" from CPP or QPP agencies, and they want statement of earnings from time my file was closed (Jan '05) until present..

"You must return this information no later than August 31, 2013. Upon receipt of this info, we will proceed with assessment of your claim".

I had anticipated a request for this information month's ago and I already had everything they asked for so I mailed it all back to Manual Life, and MC, via signature service the same day. They should have it tomorrow latest.

And then I wait for a decision...

1 week?...2 weeks?...2 month's? I'm not being pessimistic, I've already resolved myself to having an extra nice Christmas. No, I thought for the others in the same boat, it would be nice to have an idea of approximately how long the adjudication process will take. Perhaps there is someone who has already gone through this that could enlighten ME as to the time frame involved?

I'll keep you posted!

TTT

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Re: Appeal (SISIP) (Assorted Topics)

Post by georges dumont on Wed 05 Jun 2013, 09:10

well in one way you are Lucky, admin is much fast than leagle procédures. I asked for ccpd about 6 months ago and they are still waiting info to take a decision. 6 months would sound normal in a case like yours if ALL the paper work is done.

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Re: Appeal (SISIP) (Assorted Topics)

Post by bigrex on Wed 05 Jun 2013, 10:02

I agree George. That is why I believe SISIP has the paperwork for continued benefits completed at the 18 month mark. That gives them 6 months to read and make a decision on whether or not someone is totally disabled. Unfortunately in the context of a 2 year plan, 6 months is an extremely long time and a medical condition can grow quite severe within those 6 months, and never be recognized by SISIP.

That is why I always believed that there should have been a clause in the SISIP policy, (and maybe one the opposition parties could pick up on) that if any medical condition that was present during the initial 24 month time period, worsens to the point of being unable to work, within say 5 years (or early enough that age cannot be blamed for the worsening condition), then SISIP could be reinstated. There would be no retro, just reinstated monthly benefits, so the Veteran would not be penalized for any interim employment.
I just think that soldiers need the peace of mind knowing that if medically released, that if three or four years down the road, they are no longer able to work due to a service injury, that there will be support from our government through the insurance policy we have all paid into.
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Re: Appeal (SISIP) (Assorted Topics)

Post by Will's Ridge on Wed 05 Jun 2013, 10:07

TTT...Good luck. Nice to see that you were proactive and had your shit together. Hopefully you'll get a quick and affirmative response

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Re: Appeal (SISIP) (Assorted Topics)

Post by tiger660 on Wed 05 Jun 2013, 12:37

Triple T, my friend was in the same situation as you. He send in the required paperework in November. He got a letter last month from SISIP saying he was approved for LTD, he is now happy happy happy. So I figure you should hear something within 6 months, be patient and good luck my friend.

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Update From MC Reference Adjudication and Sisip Applications For Reinstatement

Post by Guest on Fri 05 Jul 2013, 15:42

In response to an inquiry on behalf of my spouse who is not a  zero sum client ~ I approached Dan Wallace to determine whether  or not to go through adjudication in an effort to have my spouse deemed TPI by Sisip although  is not zero sum but rather a two year client. Initially Sisip's response to Dan Wallace was NO.
 
I have now received  an amended update email from Dan Wallace indicating the following today ~ important for my spouse and many other veterans in the same scenerio ~ Dan Wallace had been exceptional and forthright on this matter on our behalf's  in my opinion:
 
As an update, Manulife has changed its position.

They will now reconsider Bxxxx (and other non-zero sum’s) appeals before sending it to the adjudicator.

We will need to amend the Court Order so it will require a brief meeting with the judge.

If they find that Bxxxxx is not “totally disabled”, he can still appeal to the independent adjudicator.



So, you should assemble any medical documents or opinions regarding Bxxxx dsability and why he was not able to take any jobs after his release and cannot today.

Also, you should inform any class member in a similar situation, i.e. they did not appeal a finding of non-disabled because of the offset that they can appeal now if they sign that declaration
.

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Re: Appeal (SISIP) (Assorted Topics)

Post by Guest on Fri 05 Jul 2013, 16:31

great info sparrow thanks a lot.

propat

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Re: Appeal (SISIP) (Assorted Topics)

Post by bigrex on Fri 05 Jul 2013, 16:36

Sounds good Sparrow, It might be something to consider for myself. Hopefully this happens sooner, rather than later.
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Re: Appeal (SISIP) (Assorted Topics)

Post by Guest on Fri 05 Jul 2013, 22:13

I think it is very promising for the class that Manulife is reconsidering the LTD and/or TPI cases versus going straight to arbitration. I am waiting for direction from Dan Wallace as to what we need to do next and will advise csat when I hear word.
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Re: Appeal (SISIP) (Assorted Topics)

Post by BoltAction308 on Sat 06 Jul 2013, 06:18

Excellent Sparrow! Thank you! Sounds like you and your husband are in the same situation as my wife and I.

I'll get ahold of Dan Wallace first thing Monday as I fall under those guidelines. Glad I kept all my med docs and then some!
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Independent Adjudicator

Post by 1993firebird on Wed 17 Jul 2013, 15:35

The appeal process through the independent adjudicator , Bruneau Group , hired by McInnes Cooper is currently on hold until all parties involved decide how appeals will be dealt with.

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Re: Appeal (SISIP) (Assorted Topics)

Post by zero sum on Wed 17 Jul 2013, 17:07

Until all summer vacations are over? lol
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Re: Appeal (SISIP) (Assorted Topics)

Post by 1993firebird on Thu 18 Jul 2013, 03:14

Could be.

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Re: Appeal (SISIP) (Assorted Topics)

Post by Greatfoot on Thu 18 Jul 2013, 09:23

Does that affect the period of time we have for adjudication?

I mean, if we have ninety days, does it start from when we get our cheque, or from when they decide they will start adjudicating?

Because if it is only ninety days, and they don't decide to start until the end of October, then someone who needs/wants adjudication that got their money in May is totally screwed because they are already 'too late' due to no fault of their own.

Note, I could be off on how long we have to apply for adjudication, but I think you get the point.
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