If your workplace is unionized, and you are a member of the union, there are a number of additional concerns to address with respect to how you may dispute a denial or termination of your benefits.



Employer Funded Benefit Plans

Many large employers choose to "self-insure" disability benefits either for short-term disability benefits and/or long-term disability benefits. When they do this, they usually enter into an Administrative Services Only ("ASO") Agreement with a life insurance company who will act as the administrator of the Plan. This means that the insurance company will process the claim and all significant steps in the claim will be handled by the insurance company (including benefit cheques drawn on insurance company accounts). In other words, it will often appear that the benefits are coming from the insurance company, when in fact, the ultimate responsibility for each and every payment rests with the employer.

When benefits are denied or terminated under this type of benefit plan, the Collective Bargaining Agreements ("CBA") usually require any dispute to be the subject of the grievance and arbitration process outlined in the CBA. Such grievances and arbitration hearings MUST go through the union who will provide legal representation if that is required.

Insured Benefit Plans

In some workplaces, a traditional insurance policy or plan is put in place and any denial or termination of disability benefits is the responsibility of the insurance company. Such cases must be disputed through the Court system as the insurance company is not bound by the collective bargaining agreement and therefore they cannot be properly included in a grievance or arbitration arising out of employment. David Share Associates have many clients who fall into this category.

How Can You Determine What Your Options Are?

It is usually very difficult to tell from the correspondence, CBA or benefit booklets provided to you. You may be able to get clarification on this from your union representative or the human resources department at your place of employment. If this doesn't clarify matters, contact David Share Associates and we may be able to tell you over the phone or during a free consultation.