OTIP, provided through Manulife Insurance, is an insurance entity that Ontario teachers and policyholders rely on in times of need. When an OTIP claimant submits the required OTIP claim forms for insurance coverage, they expect to gain a peace of mind and access to OTIP benefits that can support their medical situation. One seeks OTIP benefits when they are facing a sudden illness or injury, need medication and health care assistance. Furthermore, OTIP provides income replacement in times of short-term disability, long-term disability, and required leave from work to care for a loved one who is facing a medical crisis. If a policyholder is faced with an OTIP denial of any sort, they will endure financial loss or deprivation of the required medical assistance their injury or illness needs for proper health management.
To gain access to OTIP insurance services, a policy holder will have to fill out the required OTIP insurance forms for the specific OTIP claim they wish to submit. The types of OTIP forms vary on the situation at hand, but what is absolutely pivotal to gaining access to OTIP benefits, is the proper completion and adherence to guidelines that surround OTIP forms and the OTIP claim process .
If you do not properly complete an OTIP form, or do not submit an OTIP claim in accordance to the claims process' timelines / deadline, your OTIP claim will be denied.
Ultimately, OTIP is interested in saving and making money, than providing the proper insurance support to policyholders who need assistance. This does not mean they are right or can justly get away with denying claims, but due to many policyholders being unaware of their disability and insurance rights, OTIP has successfully deferred many OTIP claimants and regularly wrongfully denies OTIP claims.
In this article, we will focus on the:
- OTIP Health Form
- OTIP LTD Form
- OTIP Beneficiary Form
- OTIP claims process
We will also discuss what to do if you receive an OTIP RAEO denial, how to handle an OTIP appeal, and when to contact a disability lawyer if faced with a denied OTIP claim. If you have properly filled out your OTIP forms and meet all the requirements of OTIP's claim process, then there should be no reason for you to receive an OTIP RAEO denial of benefits. If OTIP has wrongfully denied your claim, it is best to speak to a disability insurance lawyer as soon as possible.
There are number of OTIP Forms required to be filled out when you wish to submit an OTIP claim or gain access to any of your OTIP benefits. Something all of these forms will ask for is your personal information ("Plan Member Basic Personal Information"), including your OTIP Identification Number and Plan Number. They will all require you to sign and date the forms as well.
It is important that these forms are filled out properly, completed in a timely manner and sent to the appropriate OTIP representative or department. Like with any insurance company, OTIP / OTIP RAEO (which is owned by Manulife Insurance) will highly scrutinize any submitted OTIP forms or OTIP claim you submit. OTIP wants to avoid paying out what is due. Incomplete claims/forms or missed deadlines allows OTIP to easily deny you access to benefits.
OTIP Health Forms
OTIP Health Forms have two different classes: 1. Claim Forms 2. Administrative Forms
OTIP's Claims Forms include:
Extended Health Benefits Claims: These OTIP health forms are to be completed and submitted when you seek coverage for prescription drugs, paramedical services (ex. massage therapist or physiotherapist), vision care, and medical aids / equipment or supplies.
Standard Dental Claims: OTIP health forms for any dental claim you may have.
Out-of-Province/Out-Of-Country Claims: OTIP health forms to be completed for when you have acquired an injury or illness while abroad. This claim should be completed when your claim is under $200.00 .
The Administrative OTIP Health Forms that can influence one's health management include:
Drug Prior Authorization Form: This form should be completed and provide all the necessary medical information to asses your request for a medication on the Prior Authorization List, as indicated under your drug benefit coverage.
Request for Approval of Brand-Name Drug Form: This OTIP Health form will need to be completed by the physician prescribing the brand-name drug. When a medication is prescribed instead of a generic brand, your medical provider needs to explain why this drug needs to be used vs. the lesser expensive generic brand. Reasons for the need of Brand-Name drugs include things such as adverse reactions (allergies) or therapeutic failure.
OTIP Beneficiary Forms
If you have a spouse or child you wish to be beneficiary for your OTIP policy, then you will need to go through an application process for their designation. When a beneficiary is designated, you will be submitting legal documents that need to be completed in accordance to OTIP's rules and regulations. As a group benefits member, you must first complete your benefits enrollment, via the OTIP online portal (the forms must be filled out and mailed to OTIP by the expiry date indicated on your "transition enrollment event"), before you can submit a beneficiary designation form. Once the benefits enrollment is completed online, under "My Benefits", you will have access to a link for the Beneficiary Designation Form.
OTIP beneficiary process will not be completed until you return a signed Beneficiary Designation Form to OTIP Benefits Services. If your OTIP beneficiary form is not received with a signature and proper designation from you, the following may result:
- Your OTIP policy proceeds may not be allocated to the "desired up-to-date beneficiary", such as your spouse or newborn child
- Your OTIP payments will be delayed as a result of "the proceeds becoming part of your estate and subject to probate laws"
- Legal costs and added probate will be incurred and "there will be income tax implications depending on your relationship with the beneficiary"
As you can see, it is very important that you fill out the proper OTIP Beneficiary Forms and fully complete your beneficiary designation process (including a change of beneficiary).
OTIP LTD Forms
If you are suffering from an injury or illness that has caused you to miss an extended amount of time, beyond your sick leave, then you are qualified to submit an OTIP LTD claim (long-term disability claim).
There are 3 different OTIP LTD forms that are required when you wish to submit an OTIP LTD claim:
- OTIP Member's Statement Form
- OTIP Plan Administrator's Statement Form
- Attending Physician Statement Form
You can get these forms directly through your school board, federation, association, or an OTIP representative. It is important that you have the support of your doctors when submitting an OTIP long-term disability claim. When you submit the three required OTIP LTD forms, you should also include any medical documentation that is relevant to your claim. Such documents include:
- physician/specialist/practitioner consultation reports
- surgical reports
- laboratory test results
- medical imaging (ex. x-rays, CT Scans, MRI results)
- medication list
When you have acquired an injury as a result of an accident, such as a car accident, you should also submit a full copy of your car insurance claim, accident report, and any police reports that may have been filed.
If you have become ill or injured due to a workplace hazard or incident, and have submitted a Workplace Safety & Insurance Board (WSIB) claim, you should also include this with your OTIP LTD Forms for your long term disability claim. Along with your WSIB claim, be sure to include your WSIB claim correspondence, present status of your claim, and an incident report of what happened.
- It is very important that you submit all the required OTIP LTD Forms, completed with your signature, in accordance to the OTIP LTD claim filing process. If your OTIP LTD Forms are missing information, are not fully completed, or are not submitted in according to deadlines, your OTIP LTD claim will be denied.
Denied OTIP LTD Claim?
If you have submitted all the required and completed OTIP LTD Forms, along with all the supporting documentation essential to your claim, and in accordance to the OTIP claims process' timelines and deadlines, and have still received a denied OTIP LTD claim, contact a disability lawyer as soon as possible. You have a limited period to address a denied OTIP LTD claim, and unfortunately OTIP is known for prolonging their appeal process, without resolution, till the end date of your limitation period. Our disability lawyers are well aware of the administrative tactics and imposed "technicalities" that OTIP assumes when trying to further deny your OTIP LTD claim. Before initiating an OTIP appeal on your own, speak to a disability insurance lawyer as soon as possible.
If you are facing an OTIP LTD termination, denied OTIP LTD claim, an OTIP RAEO denial, you must fight for your disability rights and appeal OTIP's decision. Properly appealing an OTIP denial requires a very strict adherence to timelines, proper confrontation of all technicalities, and thorough collection of evidence. A disability lawyer should be immediately contacted when you are considering to initiate an OTIP LTD appeal, or are stuck in the midst of an OTIP LTD appeal.
Contact a Disability Lawyer Who Specializes in OTIP:
We highly suggest you contact a disability lawyer who specializes in insurance law and has a thorough understanding of the inner workings of OTIP. Our lawyers can help you if you are facing a :
- OTIP RAEO Denial / Denied OTIP claim
- Denied OTIP LTD claim
- OTIP LTD Termination
- OTIP appeal
PW Lawyers can help quicken the process to get you access to the benefits you need in a timely manner; OTIP is known for prolonging appeals until your limitation period has expired, leaving many policyholders without any support in a time of injury or illness. If you are already in the midst of an OTIP appeal process, we urge you to speak to a disability lawyer about your case and go over what options you have at this time.
Our team of disability insurance specialists, and disability rights advocates are ready to address any questions or concerns you may have. We offer free legal consultations over the phone or in person, no matter where you are located in Ontario. We provide full legal support to all Ontario teachers, and OTIP policyholders who have been mistreated by OTIP during a time of injury or illness.
PW Lawyers is always there for you; fill out an online contact form or call our firm today.