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APPEAL PROCESS (Representative's role)

Representing a Plan member in an Appeal Hearing

If Manulife declines or terminates a Plan member's claim for disability, that decision cannot be challenged in a court of law.

If the Plan member wishes to appeal, they must inform Manulife of their intent within 30 days of the decision.

We require this completed Authorization to Release Information Form in order to release your client's file.

Ways to appeal

  • The Plan member can present new information to Manulife (such as medical reports, job information, etc.) to support their claim.

  • If Manulife maintains their decision after this new submission, the Plan member can submit new information a second time.

  • If Manulife still maintains their decision after this second submission, the Plan member can request an appeal hearing.

  • The Plan member also has the option of going straight to an appeal hearing without submitting any new information.

Important note

No new information can be submitted after a Plan member requests an appeal hearing.  The Appeal Board will only consider the information on file at the time the hearing is requested.

Who attends the hearing:

  • the chair of the Appeal Board (a qualified doctor chosen by the Board of Trustees)

  • a representative from the Plan

  • a representative from Manulife

  • the Plan member

  • a friend or family member the Plan member wants for support (this is optional)

  • the Plan member's representative (lawyer, union representative, also optional)

The hearing format

The appeal hearing is informal, but all questions and  comments can be directed only to the chair.

First, Manulife will give a summary of the case and their reason for denying or terminating the claim.

Next, the Plan member and/or you present your case.

The parties involved can present their case in writing, either before or during the hearing.

Any written submissions for the appeal hearing must:

  • not contain new information or evidence

  • be written in lay terms if it includes references to case law.  The Appeal Board are medical doctors and if they require legal assistance to interpret the case law presented, they will postpone making a decision and consult with the Plan's legal counsel

If the Appeal Board has any questions, they will ask after both sides have presented their cases.

The Appeal Board's decision

The Appeal Board's decision is final and cannot be challenged in court. However, a Plan member can request a judicial review of the process.  If the court agrees, that the Appeal Board chair made an error in how they reached their decision, a new hearing will be conducted.  The request for a judicial review must be made within 1 year of the Appeal Board's original decision.

Questions?

Refer to the Plan's Appeal Guidelines or contact:

Theresa Williams, Director Claims Management

902-461-0421 Ext. 223