Introduction

The City of Toronto provides a long-term disability plan through a contract with an LTD carrier. If an employee has been in receipt of LTD benefits and is then deemed fit to return to work the City will provide a return to work process to reintegrate the employee to his/her own job or undertake a job search to find alternate suitable work.

The City is committed to facilitating the safe return to work of employees who have been off work due to illness or injury. The City has a duty to accommodate employees to the point of undue hardship under the Ontario Human Rights Code as well as the City’s Human Rights and Harassment Policy.

Application

This process applies to all City employees who are enrolled in the Long Term Disability plan.

Definitions

Qualifying Period

An initial period of total disability, starting with the first day of disability, before benefits become payable, as specified in the contract with the insurance carrier

Long Term Disability Income

An income replacement benefit which provides 75% of an employee’s pre-disability earnings and is provided to employees who are deemed by the insurance carrier to be totally disabled based on the definitions within the contract

Definition of Disability

During the Qualifying Period and the succeeding 24 months, an employee is totally disabled when he/she is wholly and continuously disabled due to illness or bodily injury and, as a result, is not physically or mentally fit to perform the essential duties of his/her normal occupation.

Thereafter, an employee is totally disabled provided he/she is wholly and continuously disabled due to illness or bodily injury and, as a result, is not physically or mentally fit to perform the essential duties of:

  1. his/her normal occupation; and
  2. any other occupations, jobs or work
    1. for which he/she is, or becomes, qualified by his/her education or training or experience, considered collectively or separately; and
    2. which the current monthly earnings are 75% or more of the current monthly earnings for the employee’s normal occupation

Rehabilitation Program

A plan of training or work related activity, recommended or approved by the LTD carrier, which is designed to help a disabled employee to re-enter the work force

Human Resources Integrated Disability Management (HR IDM Team)

A team made up of staff of Employee Health and Rehabilitation (EH&R), disability management consultants and ergonomists and occupational hygienists in Occupational Health, Safety and Worker’s Compensation, whose role it is to work with the LTD carrier, managers, employees and unions to return employees to safe and suitable work following illness or injury

Conditions

Qualifying period

An employee who has been absent from work owing to injury or illness for a qualifying period of 26 weeks may be eligible to receive LTD benefits. Should an employee attempt to return to work and then works for more than three weeks during that time, he/she must restart the qualifying period.

During 24 month own occupation period

An employee who is receiving LTD benefits and is deemed medically fit to participate in a rehabilitation program is required to cooperate with the LTD carrier and the City’s HR IDM team. A rehabilitation program may include physiotherapy, a functional abilities evaluation and/or a work trial.

An employee receiving LTD benefits may be employed either by the City or an external employer through a monitored and agreed upon rehabilitation program that involves part-time hours. The amount that an employee is eligible to earn is determined by a formula established by the LTD contract.

When an employee’s LTD benefits are terminated during the first 24 months and the employee is deemed fit to return to his/her original position, divisions are obligated to place the employee back into his/her position.

If an employee’s original position is no longer suitable, the City will actively search for suitable work on his/her behalf, consistent with the appropriate collective agreement (where applicable). The City’s HR IDM team and staffing consultants coordinate these efforts.

The employee may initially require temporary modified duties and the employee’s division is requested to provide work trial opportunities. The modified work opportunity is first sought in the employee’s own division, but if this is not possible opportunities are sought in other divisions in the service area and then in other service areas.

While permanent employees are in receipt of LTD benefits during the first 24 months and unable to perform the duties of their own occupation, divisions are advised to hold their positions for them. Divisions may fill these positions on a temporary basis.

After 24 months (Definition Change)

Employees who pass definition change are totally disabled from any occupation. They continue to receive LTD benefits. The carrier monitors their progress. Employees must continue to provide proof of total disability in the form of updated medical information when requested by the benefit carrier.

When an employee passes definition change the division can fill the vacated position on an over-establishment basis. The HR Disability Management Consultant contacts the manager of EH&R prior to the position being filled. The manager will confirm with the LTD carrier that the employee has passed definition change and is deemed totally disabled until age sixty-five or is not expected to return to work in the foreseeable future.

Employees who have not passed definition change and are no longer in receipt of LTD benefits continue to be responsible for cooperating with all rehabilitation efforts and job placement activities and for providing medical information as necessary as per the collective agreement and related corporate policies.

Implementation

Reintegration and return to work activity

The HR IDM team is responsible for managing the process for seeking accommodations and modified work for employees on LTD. When an employee is no longer deemed eligible to receive LTD benefits, the HR IDM team coordinating his/her case is responsible for clarifying functional abilities and assisting the employee to return to his/her job or initiating a job search for the employee. The search for available work is undertaken in the following order:

  1. If an employee can perform the essential duties of his/her former position with or without accommodation, the employee should be returned to that position. Approach the employee’s home section/unit to determine if the employee can return to his/her own or a similar job (with accommodation if necessary).
  2. If the employee requires alternate work, search for a vacant suitable job in the employee’s home division/service area in accordance with the Modified Work Program for Local 79 and Local 416, where applicable.
  3. If no suitable job is available, broaden the search to the entire corporation
  4. If another suitable job is found, the employee’s right to access that job depends on the Locals 416 and 79 collective agreement provisions, where applicable.

A consistent job search approach must be undertaken for all LTD employees who are deemed available for work. All efforts to find suitable work are to be documented by the HR IDM team. Every position offered whether taken or declined must be documented. The search for position is based on the employee’s equivalent job status, e.g. permanent to permanent, part-time to part-time, temporary to temporary.

If a thorough job search has been done, but no suitable position has been found, consideration for next steps should be taken in consultation with Human Resources, Labour Relations and/or the Legal Divisions.

Questions and Answers

1. When can an employee apply for the OMERS Disability Waiver?

Employees are eligible to apply for an OMERS disability waiver beginning on the 1st day of their 5th month of absence. If approved, the employee continues to accrue pensionable service credits until such time as retirement, death, return to work or when the employee is no longer considered by OMERS to be disabled.

Staff in the Pensions Section will provide notice to OMERS that an employee has been off due to illness and OMERS sends a Disability Election Form directly to the employee. The employee provides the required information directly to OMERS for a decision.

If you require further information, please contact Pensions at 2-8075 or 7-4408.

2. If an employee continues to be disabled and eligible for LTD when do benefits cease?

Employees who pass definition change continue to receive LTD benefits as long as they qualify and continue to adhere to the terms of the contract. LTD benefits cease at the end of the month in which they reach age 65, retire, return to work or become deceased.

3. When an employee is no longer in receipt of LTD benefits how long are health, dental and group life insurance benefits paid by the City?

Employees who are not in receipt of income through the City of Toronto or LTD benefits through the Benefit Carrier, will have their benefits protected with the City paying the premiums in accordance with the benefit protection period outlined in the various collective agreements for unionized employees and City Policy for management and non-unionized employees. If employees are unsure of their entitlements, they should contact their Benefits Representative for information.

4. Who informs the employee that they are responsible for paying these benefits after one year?

The Payroll Processing section of the Finance Division will notify the employee’s division six weeks prior to the expiry of the employee’s benefit protection period. If the employee is still unable to return to work, the division must ensure that Payroll Processing is notified by memo or email from the employee’s supervisor/manager of the extension of the leave of absence after the benefit protection period. Payroll will then process the extension of the leave of absence (with no City-paid benefits) on SAP at the end of the protection period.

Prior to the end of the protection period, the Benefits and Employee Services Section of the Finance Division will write to the employee to advise him/her of the option to continue benefits.

If you require further information please contact Benefits and Employee Services at 2-8121.

5. Can an employee go back on sick leave or use vacation when LTD benefits are terminated if they have not returned to work?

An employee can use sick or vacation credits when LTD benefits are terminated. He/she must also begin providing medical notes to confirm eligibility for absence due to illness in accordance with the collective agreement and related corporate policies.

6. How many times can an employee appeal the LTD decision?

The employee can appeal the LTD decision as often as he/she wishes, but an appeal must provide additional medical information which has not previously been reviewed.

7. How is the City notified that an employee is to be terminated from LTD?

Benefits and Employee Services, Employee Health and Rehabilitation and the HR Disability Management Consultants are notified by the LTD carrier that an employee is to be terminated from LTD. In the majority of cases EH&R has been working with the LTD carrier prior to the termination of benefits as part of the rehabilitation process.

8. Are medical notes required when an employee is on LTD?

Medical notes to the division are not required while an employee is on LTD. Medical information is required by the LTD carrier regularly as part of the ongoing claim. However, before and after an employee is on LTD he/she must submit notes to the division according to the collective agreement and related corporate policies.

9. What happens if an employee is not approved for LTD?

If an employee is not approved for LTD he/she is responsible for continuing to provide medical notes according to the collective agreement and related corporate policies. Human Resources may need to be consulted as further medical/functional information may be required in order to determine fitness to return to work.

10. If an employee uses his/her sick bank or any other available credit beyond six months and applies for LTD later, is the definition change also extended?

If an employee chooses to continue using sick bank rather than applying for LTD at the eligible six month mark, the clock is still ticking for LTD and the definition change date will still be two years after an employee has been out of the work place for six months.

Example:

If an employee leaves work on January 1, 2006, his/her eligibility date for LTD is July 1, 2006. If he/she keeps using his/her sick bank until it runs out on September 1, 2006 and then goes on to LTD, the definition change date is July 1, 2008, not September 1, 2008.

Approved by

Human Resources

Date Approved

March 15, 2006