If your claim for disability benefits has been denied or terminated, you can appeal the decision — and we can help. An OTIP Disability Service Representative (DSR) can help you navigate the appeals process. This service is provided to you at no additional cost.
Your DSR can:
- Provide you with details related to the claim or appeal decision
- Conduct visits with you and your federation or association representative to review your individual situation, your options and correspondence
- Communicate with your treatment provider
- Provide information regarding other disability benefit plans, such as the Canada Pension Plan (CPP) and Employment Insurance Sickness Benefits
How the appeals process works
You have limited time from the date of the claims decision to send an Appeal Member's Statement and submit any new or additional medical information supporting your claim. This date will be outlined to you in your decision letter. You can also find this timeframe information outlined in your group plan provisions. Note that any costs associated with the appeal are your responsibility. Your information will be reviewed by a Disability Specialist, who may request additional information, such as:
- Clarification from your attending practitioner(s)
- An independent medical evaluation
- A functional abilities evaluation
- A medical consultant review
Appeal decision
The Disability Specialist may approve your appeal or send it to the Appeals Committee. This committee makes an independent review of your claim and appeal. They may:
- Approve your appeal
- Request additional information
- Maintain the initial decision to deny or terminate your claim
If the Appeals Committee maintains the denial or termination of your claim, and you still wish to pursue your claim, you should discuss your options for binding arbitration or litigation with your federation or association representative or legal counsel.