Disability Leaves

A disability leave is governed more by Common Law than by the Employment Standards Act (ESA). The ESA does not address disability leave in excess of the 10 days of permitted leave under the Personal Emergency Leave section (in Ontario refer to sections 50 – 53 under the ESA www.labour.gov.on.ca). Short and Long Term Disability is covered under Common Law.

Conditions for eligibility are personal illness, injury or medical emergency where a medical practitioner deems the employee incapable of working. This could last 1 to 2 years or even more before the employment contract is considered frustrated and at an end. The term is usually either linked to the province's Workers Compensation policy for the continuation of healthcare benefits, e.g. in Ontario it is one year, or it can be linked to a change in the definition of disability under the insured plan, e.g. typically after two years of a continuing disability.

An employee can take unpaid leave under Common Law but must cooperate with their employer. Upon request, the employee is to provide a medical note where the employee has a medical condition and identifying when the employee is expected to return to work. The employer however is not entitled to information regarding the medical condition, i.e. the employer is entitled to the prognosis but not the diagnosis.

If the employee is deemed capable of return to work, they should provide the employer with a medical note outlining any restrictions which could hinder the employee’s ability to perform the job.

Depending on the employer’s benefit coverage, including the definition of a disability under the insured plan, the employee can apply for a benefit under the insured plan or under Employment Insurance

During a disability leave under the ESA, the employee continues to earn credit for length of employment, length of service and seniority. They are also entitled to continue participating in the following employee benefit plans:

• Pension plans,
• Life insurance plans,
• Accidental death plans,
• Extended health plans, and
• Dental plans

If applicable, the employee must continue to pay their share of the premiums in order to participate in the benefit plans.

For more information on Employee Leaves of Absence, please refer to the Ministry of Labour website (www.labour.gc.ca/eng/standards.equity/) for the applicable province or territory.

Metrics for Health & Wellness

Most plan sponsors are faced with the challenge of balancing the quality of benefits being provided with their cost. Understanding how an investment in a benefit can impact on the workplace is often a challenge for an organization but certainly important in establishing a plan that best suits their workplace.

The key to assessing the value of a change in benefit design is to review the plan costs prior to the change and, ideally, for a 3 to 5 year period. The main cost drivers under plans have been extended healthcare (including drugs) and disability plans. To establish a base for the purpose of analyzing future costs, the following need to be recorded by year;

• Paid claims amount,
• Utilization,
• Year-over-year trend, and
• Therapeutic categories

This data will identify not only high claimants but high trends in relatively low claimants – both contribute to increasing exposure to higher costs. These claim types can then be aggregated into groups to not only identify areas where plan design changes can help maintain costs but also those areas where a Wellness initiative can influence outcomes. For example, a cost driver under extended healthcare could be treatment for high blood pressure and/or cholesterol – both of which could benefit from exercise and nutrition programs.

By establishing base lines for benefit costs, a plan sponsor can then identify these opportunities to implement benefit plan changes and also to measure their impact on future costs.

Accessing Special Medical Programs

Health Canada regulates the safety, efficacy and quality of therapeutic products, including drugs and medical devices under the Food and Drugs Act.

Many medical conditions are eligible for coverage under these programs, thereby making the employer sponsored plan the second payor for the treatment and/or product.

To review what drugs and devices are available, please refer to the Health Canada website at www.hc-sc.gc.ca/.