ASEBP APPEAL PROCESSES

​Members who disagree with an Alberta School Employee Benefit Plan (ASEBP) decision have access to two formal but distinct appeal processes: Total Disability and Policy Appeals. Each applies in different circumstances and has specific procedural limits. An infographic of the processes is attached at the end of this Worth Knowing for your reference and is also available here.

Total Disability Appeals

These appeals involve decisions on Extended Disability Benefits (EDB) concerning whether a member is considered totally disabled. They are often based on different interpretations of existing medical information. While the appeal primarily concerns the member, teachers may, if they wish, access support from Teacher Employment Membership Support (TEMS) to prepare for and present their appeal.

You may appeal if your EDB application is denied or your claim is terminated. The appeal involves reviewing your claim file (which will be shared with you), and you have the right to attend the hearing and bring a representative.

Appeals must be filed within 60 calendar days of the decision. While extensions may be granted in certain limited cases, timelines are important.

A key limitation is that new medical information cannot be directly added to an appeal. Any new evidence must first be reviewed by your adjudicator or case manager. If the decision stays the same, the appeal continues with the updated file.

Decisions are final. ASEBP does not provide reasons for appeal outcomes.

Policy Appeals

Policy appeals concern coverage and claims unrelated to Total Disability. Only the covered member is allowed to appeal, even if the issue concerns one of their dependants. Appeals are typically considered when there is disagreement with how evidence was interpreted (eg, medical information or eligibility criteria), or when a member can demonstrate both medical necessity and extenuating circumstances that lead to hardship.

Requests must be submitted within 60 calendar days. ASEBP will decide if the situation qualifies as a Policy Appeal and what information is needed.

Important Consideration

ASEBP appeals are structured and limited. They are not forums for introducing entirely new arguments at the appeal stage and outcomes are not accompanied by detailed explanations. Members considering an appeal should act promptly, ensure their documentation is complete and seek advice if needed. TEMS can assist with understanding the process and next steps.

Worth Sharing

ASEBP offers two appeal pathways—Total Disability and Policy Appeals—that must be initiated within 60 days and are mostly based on existing information. Members can participate and provide representation, but new evidence must be reviewed before an appeal can proceed, and decisions are final without detailed explanations. Acting promptly and understanding these limits is crucial. An infographic summarising the appeal processes is available here and can be shared as needed. If you have questions, contact Teacher Employment Membership Support and speak with one of our duty officers at 1-800-232-7208.

Read the full Worth Knowing.

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