How to File a Long-Term Disability Claim

Nobody expects to contract an illness or sustain an injury severe enough to affect their ability to work. When people receive a medical diagnosis for a condition that prevents them from performing the duties of their job, it can be difficult to know what to do next, and where to go for financial assistance.

If you cannot work for a long period of time because of a serious illness, physical injury, or mental health condition, long-term disability benefits may provide you with some financial stability. In order to apply, you must pay into an insurance policy that provides coverage for long-term disability. Many people may receive insurance coverage through their employer’s group plan, but they may also have their own private insurance policies with an appropriate level of coverage.

Long-term disability benefits give disabled workers a portion of their normal wages while their medical conditions prevent them from working. In Canada, long-term disability plans usually replace between 60-70% of a recipient’s normal income. If you do not qualify for long-term disability benefits through your insurance plan, but your medical condition prevents you from earning a living, you may be able to receive disability benefits from the Canada Pension Plan (CPP).

To qualify for long-term disability benefits, policyholders will likely be required to use up all other income options available to them, such as paid sick leave, vacation time, and short-term disability benefits. If an employee’s disabling medical condition persists even after exhausting all other sources of income, they can begin the process of filing a long-term disability claim.

In order to apply for long-term disability benefits, you must:

• Obtain a claim form from your employer or private insurance provider
• Compile supporting documents and medical records from your health care providers
• Obtain a medical certificate from your health care provider supporting your application
• Complete all required application forms (which may require additional information from health care providers and your employer)
• Submit the completed application to your insurance company

Your application may be subject to certain deadlines or time limitations. Before you file a claim   for long-term disability benefits, you may consider consulting with a Nova Scotia long-term disability lawyer. A lawyer may be able to review the terms of your insurance policy, advise you of any concerns, and let you know about any potential roadblocks your application may face.

Who  is Eligible to Receive Long-Term Disability Benefits in Nova Scotia?

In order to qualify for long-term disability benefits, you must have been diagnosed with a medical condition that prohibits you from performing the duties of your job for an extended period of time. Since eligibility requirements for long-term disability benefits vary between insurance policies, it may be difficult to determine whether or not your disability qualifies you to receive payments. Typically, your medical condition must prevent you from completing the regular task of your employment.

Some examples of medical conditions that may entitle an employee to collect long-term disability benefits include:

• Heart disease
• Back problems
• Chronic pain or complex regional pain syndrome (CRPS)
• Lupus or Lyme disease
• Psoriatic arthritis or fibromyalgia
• Depression
• Bipolar mood disorder
• Post-traumatic stress disorder (PTSD)
• And possibly more

In your application for long-term disability benefits, you may be required to provide medical evidence proving that you have a disabling condition, and that you’ve been receiving ongoing treatment for it. Evidence you may be required to submit along with your application may include:

• Medical records
• Results of medical examinations
• Statements from your attending physicians
• A detailed description of your job duties
• A statement from your plan sponsor (i.e. your employer)
• Other documentation proving that your medical condition prevents you from performing the duties of your job

If you are having trouble understanding the terms of your policy, or require assistance preparing a thorough and accurate claim for benefits, a Nova Scotia disability lawyer may be able to provide useful advice.

Can Insurance Companies Deny Long-Term Disability Benefits Claims?

For a number of different reasons, insurance providers may deny your claim for long-term disability benefits, even if you believe your condition qualifies you to receive them.

If your claim has been denied, your insurance provider should give you written notice in the form of a letter from of a letter that includes the following information:

• Details about your policy’s eligibility requirements for long-term disability benefits
• The insurance company’s definition of “disability”
• The reason your claim for benefits was denied
• And possibly more

Sometimes, it can be difficult to understand why an insurance company denied a claim for benefits. After reviewing an application, insurance providers may stipulate that the claimant’s medical condition does not fall under the company’s definition of a disability. In those cases, even though you may be unable to work, the company could claim it is not contractually obligated to provide you with benefits.

Additionally, if your claim for long-term disability benefits is related to a pre-existing condition (i.e. a medical diagnosis you received before enrolling in the insurance policy), based on the terms of your insurance plan, you may not be entitled to collect benefits until you have paid insurance premiums for a predetermined length of time. In these cases, if you have not been a policyholder for long enough, your claim for disability benefits can be denied, even though you cannot return work.

If you are unsure why your claim was denied and believe your condition should qualify you to receive benefits payments, a disability benefits lawyer may be able to review your policy and your medical records to advise you on legal options that may be available to you.

If I Am a Union Member Can I Still Sue My Insurance Company For The Denial?

If you are a unionized employee and have been denied long-term disability benefits, it is important to determine whether you can bring a claim in civil court against your insurance company, or whether you are required to grieve the denial and proceed to arbitration.  Sometimes your rights are not clearly set out in your Collective Bargaining Agreement. There are usually timelines in place if you are required to grieve the denial, so it is important to make your decision in a timely manner.  If you are not sure which direction you are required to take, it is important to speak with a disability lawyer and get proper advice.

How Preszler Injury Lawyers May Be Able to Help

Based on the reason provided for a claim’s denial, a lawyer may advise their client which steps to take next.

Oftentimes, benefits claims in Nova Scotia are denied because of missing records, insufficient medical documentation, skipped appointments with physicians, or other technicalities. If this is the case, a lawyer may advise you to file an internal appeal directly through your insurance company. Before doing so, they may be able to help you compile important supporting documentation which may help substantiate your claim, and overturn an insurance company’s decision.

However, the internal appeals process can take a long time. For those who are unable to earn a living because of their illnesses or injuries, waiting for the internal appeal to be processed may not be an option. Furthermore, there is no guarantee the additional information submitted for the internal appeal will convince the insurance company to overturn their initial determination.

With the help of a long-term disability lawyer, you may decide to file a lawsuit against the insurance company for an unfairly denied claim. In these situations, your eligibility for long-term disability benefits would be determined by the courts and not your insurance company.

If the lawsuit is resolved in your favour, you may be awarded payments for:

• Previously denied benefits payments
• Legal fees
• Damages for mental stress experienced
• Punitive damages
• And possibly more

Call Preszler Injury Lawyers Today

If a severe medical condition such as an injury or illness prevents you from earning a living, and you require assistance completing your application for long-term disability benefits, Preszler Injury Lawyers may be able to provide useful help and advice.

If your claim for long-term disability benefits has been unfairly denied, following a review of your case, a Nova Scotia disability lawyer may be able to explain the legal options available to you, and, if eligible, appeal the insurance company’s decision on your behalf.

To review your case in a free, initial consultation, contact Preszler Injury Lawyers today.