Preparing Your Appeal

If you do not agree with a decision made in regard to your claim for life and/or disability benefits, you can request further review. To begin the appeal process, you must inform us in writing of your intent to appeal within 30 days from the date of claim closure or our written claim decision, whichever is later. The Notice of Appeal form is sufficient written notice of your intent to appeal.

Once intent to appeal has been received, you are responsible for providing information to support your appeal within 90 days from the date of claim closure or our written claim decision. On appeal, it is important to provide information for the appeal panel's consideration. Failure to provide new and relevant information will result in the initial decision being upheld. The cost associated with obtaining this information is your responsibility.

Appeal Decision

Upon receipt of all appeal documentation or by the time limit noted above, whichever is earlier, your claim will be reviewed and a written decision will be provided to you within 30 days. In some rare instances additional information is required by the Appeal Panel which may cause delay in the appeal decision. You will be notified in writing of any delay.

Reconsideration

Your Case Manager will first review the information provided on appeal and reconsider the initial decision. If the information does not clearly support a change to the initial decision, your Case Manager will forward your claim to the First Level of Appeal Panel.

First Level of Appeal

A panel consisting of a designated consultant, a Case Manager, and the Supervisor of Case Management Services (or designate) will review your claim and render a decision.

Second Level of Appeal

Should the First Level of Appeal Panel uphold the initial claim decision, you can request a final review by submitting your intent to appeal at the Second Level. The appeal process is the same at both levels (see Preparing Your Appeal). Please note that the Second Level of Appeal will only proceed with the receipt of additional new supporting information. A panel consisting of a designated consultant and at least two Manitoba Blue Cross Managers (or designates) will review your claim and render a decision.

If you have any questions, please contact your Case Manager directly.

Submitting Your Appeal

Submit your Notice of Appeal and supporting information to:

• Mailing Address:
• Manitoba Blue Cross
• Case Management Services
• 599 Empress Street
• PO Box 1046 Stn Main
• Winnipeg MB R3C 2X7

• Email: LDinfo@mb.bluecross.ca
• Fax: 204.788.5591

Samples of information for the Appeal Panel's consideration:

• A written statement of your circumstances including why you feel the wrong decision was made
• Medical information supporting your claim, such as (but not limited to):
  • consultation reports from any specialist(s) you have seen
  • medical chart copies
  • lab results, investigative results

If your claim was denied because you did not meet the definition of disability defined by your policy, you should also provide:

• A written statement of your functional abilities (i.e. what you can and cannot do as a result of your medical condition)
• A letter from your physician(s) and other treatment provider(s) supporting your:
  • diagnosis
  • impairment arising from this diagnosis, including severity and duration
  • level of function
  • restrictions and limitations that have been placed on your level of activity
  • prognosis