This is general information and is intended as a reference only. It is not a substitute for independent legal advice regarding your situation. Download a printable PDF.
What type of insured benefits does the LCBO provide?
Depending on your employment status with the LCBO, the following benefits may be available to you:
- Supplementary Health and Hospital
- Dental
- Long Term Income Protection (LTIP)
- Life Insurance (including Basic, Supplementary and Dependent Life Insurance)
- Accidental Death & Dismemberment (AD&D)
The LCBO benefit booklet outlines the different benefits that you are eligible for. Benefit coverage differs depending on your employment status.
What if I am denied an insured benefit by the insurer?
If you have submitted a claim to the insurer and were denied a benefit that you believe is covered under your plan, you can dispute the claim.
The first step is to contact the insurer directly and discuss why the claim was denied and what information may need to be submitted to have the claim accepted. Make sure you keep a record of the date, time and the name of the Customer Service Representative you spoke with. If the insurer has suggested some additional information that may help to have your claim paid, submit the extra information. Sometimes, submitting additional information directly to the insurance carrier may resolve the problem.
If the denial remains and you still believe that your benefit claim should have been paid, discuss your complaint with your employer benefits administrator.
OPSEU/SEFPO staff can provide education, guidance and resources to you in an appeal. We can assist by reviewing the claim denial and potentially intervene in attempting to resolve the dispute with the carrier (this includes helping you appeal a Long-Term Disability denial). To do this you will need to send all of the documentation you have regarding your claim denial (copies of receipts, copies of the denial from the insurer, supporting documentation from your doctor, if applicable and any other information related to your claim) along with an explanation of the re
Members receiving a denial decision regarding their LTIP claim are strongly advised to contact our office immediately so that the appeal process can begin without delay. There are strict timelines for filing an appeal.
OPSEU/SEFPO – Pension & Benefits Unit
- Email: [email protected]
- Mail: 5757 Coopers Ave Mississauga ON L4Z 1R9
- Fax: (905) 712-3009, Telephone: (416) 443-8888, Toll Free: 1-800-268-7376
Before incurring any expense greater than $200, it is strongly recommended that you submit a pre-determination. A pre-determination is an estimate of how much of your claim will be paid, prior to the service being completed. This will give you an idea of the amount that will be reimbursed to you thereby avoiding disappointing surprises. To submit a pre-determination, ask for an “estimate” of the cost from your medical provider, then submit the information to the insurer for review.
In any interaction with the insurer, make sure you record who you spoke with, the date and time of the call and the outcome.
If you have questions or concerns regarding your benefit plan, the Pensions & Benefits Committee can provide guidance.
The LBED Pensions and Benefits Committee members are:
- Stephanie Hickman (Chair)
- Lee Hamilton
- Trisha Harrison
- Jacqueline Rigitano (OPSEU/SEFPO Benefits Officer)
If you wish to contact the Pensions and Benefits unit, please email us at [email protected]