You can’t predict the future,
but you can plan for it.
Worth of claims will be made in 2016
LOAN PROTECTION COVERAGE
Where you are unable to work for 5 consecutive days.
50% Upon proof you are still unable to work at 30 days*
Layoff (without cause)
If you have been employed for at least 90 days and eligible for EI benefits.
Client is diagnosed with life-threatening cancer; suffers a stroke; heart attack, kidney failure, or first time major organ transplant.
(Max Benefit: $1,800)
Client passes away.
- Determine what benefit the client should be claiming for:
- Injury/Illness/Fracture/Critical Illness
- Involuntary Unemployment
- Get claim documents to client in-person (preferred) or by email.
- Thoroughly explain the claim documents and checklist on the first page with the client.
- Emphasize thorough completion of every section, and strongly encourage them to bring the documents into the branch for review and submission to IWS via the portal, as soon as possible.
- Go over ‘What Happens Now’ on the last page of the claims form to illustrate the client’s obligations for approved or declined claims. Please have the client endorse this page to confirm details are understood.
- Inform them they have 5 days to get completed claims form back. If the client cannot meet this timeline, ask why and when they will be returned; mark it in your calendar to note if they have been returned. If not, contact the client and ask why?
- Review documents to ensure every field is completed.
- If a field is missing, be sure to ask the client for a reason why or ask them to complete it.
- Please ensure that the client’s email is entered on the claimant’s statement. This is how we communicate claims status/outcome to them.
- Most delays in initial claims processing occur because of missing information.
- Once claims package is ready to submit, scan and upload through the ‘LPP Claims Portal’: https://www.iwsinc.ca/ccreporting/Pages/Login.aspx
- Please be sure to print off confirmation that claim has been received.
- Keep a copy of the claims package and confirmation in the client’s file.
- If the customer would like a copy of their claim documents, please provide them with a copy of the package.
- If a submitted claim has missing information, or additional non-medical information is needed, IWS will email both the CC branch and the client immediately, with a reminder email three and six days later, outlining what information is needed.
- Branch must also follow up with the client to notify what is needed to complete the claim!
- If the information needed is not provided after 10 days, IWS will email the branch and the client notifying them the claim is closed, and no other communication will be sent.
- If additional employment/medical information is needed, IWS will contact the employer/physician directly.
- All ‘Missing/Additional Information Needed’ is also noted on the LPP Claims Portal.
Contact us Immediately!
Claims Decision Explanation, Claims Appeal Request & Customer Concerns:
Claims Processing & Claims Payment Inquiry:
1.866.766.4566 ext. 4061
Kent Taylor, Program Manager
P: 1.877.319.7151 | F: 1.877.838.2125 | E: email@example.com
- IWS will send an email to both the branch and the client of the APPROVAL noting:
- Amount of Benefit being paid.
- What ‘Next Steps’ are required to qualify for the next benefit payment.
- Branch must also follow up with the client to notify them what is needed to qualify for the next payment as well!
- IWS will notify the branch and client by email once the client has reached maximum benefit payable.
- All approvals and claims benefit payment details will be listed on LPP Claims Portal.
- IWS will email the branch stating the claim has been declined.
- IWS will send a letter to the client outlining the details of why the claim was declined.
- If the branch or the client has any concerns or wish to appeal the decision, please contact an IWS Claims Support Specialist listed to discuss your appeal and we will review the file immediately.
- LPP Claims Portal will show claim status as declined.