If you have become disabled and find yourself unable to work, long-term disability (LTD) insurance could replace a portion of your lost wages and help ensure that you can support yourself and your family.
Employees and/or their employers pay insurance premiums to provide these long-term disability benefits if you’ve become disabled due to injury or illness. Many people across Nova Scotia find them to be a vital source of income during a period of long-term disability.
While it might seem like accessing these benefits should be easy for individuals who’ve become disabled, the unfortunate truth is that the process is not always as simple or straightforward as it should be. Insurance companies often make it difficult for people to get the benefits they need. Eligible claimants might become discouraged when they discover that their initial long-term disability coverage application has been denied.
At Valent Legal, our experienced and compassionate disability lawyers understand the frustration that people feel when their disability application has been denied, or if their benefit payments have been reduced or stopped altogether. If this has happened to you, don’t despair. With a knowledgeable Halifax long-term disability lawyer on your side, you can seek the disability benefits that you are contractually entitled to receive.
Our long-term disability lawyers are passionate about helping people in our community get the benefits they need and are owed. We will be there to walk you through every step of the process. To discuss your situation with our legal team, schedule a free consultation with our Halifax LTD team today.
What Is Long-Term Disability Insurance?
Long-term disability insurance exists to provide benefits to people who have become disabled due to an injury or illness that prevents them from working.
Nova Scotia law requires that employees working more than 28 hours a week enroll in long-term disability insurance plans when available. Nova Scotia also passed an Accessibility Act in 2017 to work towards making the Province completely accessible for those with long-term disabilities by 2030.
LTD insurance policies in Nova Scotia are usually either paid for by your employer or purchased through a broker or professional association if you are self-employed. These policies can vary widely based on the company and specific policy purchased. It is rare for any two policies to be identical, even if the same insurance company issued them.
This means that the very definition of “long-term disability” can vary among insurance companies or even among plans from the same provider. They may have specific exclusions or pre-existing conditions clauses, for example. It is crucial that people examine the details of their plans if possible before buying a long-term disability insurance policy.
People who are covered will generally qualify for long-term disability benefits when other benefits end, which could include:
- Employer-provided sick leave
- Short-term disability benefits
- EI benefits
- And more
Conditions that typically qualify for disability benefits include:
- Fibromyalgia
- Limited upper body mobility
- Slowed walking or limited lower body mobility
- Digestive disorders (Crohn’s/colitis, IBD and IBS, incontinence, etc.)
- Breathing disorders (COPD, tuberculosis, emphysema, chronic asthma)
- Hearing Impairment
- Cognitive impairment
- Degenerative diseases
- Cancer
- Chronic fatigue syndrome
- Heart disease
- Depression
- Anxiety
- And more
Most beneficiaries can expect to receive 60-70% of their usual income from LTD. Depending on the specifics of your plan, you might be eligible to receive benefits for up to two years if your disability prevents you from returning to the job you formerly held. After that two-year period, you might only qualify for benefits if your disability prevents you from doing any type of work.
What Evidence is Needed in Long-Term Disability Claims?
If you need to apply for long-term disability benefits in Nova Scotia, the first thing you should do is review your policy’s summary plan description or consult with your human resources department to understand the precise definition of “disability” under the policy. Each policy could have a different definition of what qualifies as a disability, and you’ll want to be prepared to prove your condition qualifies.
In general, an individual might be considered “totally disabled” if they are entirely unable to perform the duties for the position they once held due to their medical condition. Some policies provide “partial disability” benefits to individuals who are no longer able to perform the duties of their former job but could work full or part-time in a different position.
To prove that your condition qualifies, you’ll need to establish causation between your disability and your inability to work. To do so, the most convincing evidence you can present will be medical evidence, or the opinion of your treating physician.
Your doctor will be asked to fill out paperwork giving their opinion on your disability, as well as supporting objective medical evidence, which could include:
- X-rays
- MRI results
- Surgery records
- Lab results
- Exam results
- Clinic notes
While your claim is pending, you should continue to seek treatment from your physician to show that the condition is ongoing, and it is wise to do so even after you’ve been approved for benefits. If you fail to continue treatment, the insurance company might have grounds to terminate the payment of benefits.
At Valent Legal, we understand that some disabling illnesses will not show up on an X-ray or an MRI. Our Halifax long-term disability lawyers have extensive experience helping people with conditions that the insurance company might reject due to lack of “objective evidence,” including:
- Post-traumatic stress disorder (PTSD)
- Chronic pain
- Depression
- Anxiety
- Fibromyalgia
- And more
We work with trusted medical experts to help you win your LTD claim. We’ll be prepared to present a strong case to your LTD insurance provider to help you pursue the benefits you need and deserve.
How Change of Definition Can Affect You
If you’ve become disabled, you might be able to receive disability benefits from your policy initially, but the payments might stop after a period of time. This usually occurs after two years of receiving benefits, and often means that you are subject to a “change of definition.”
Under most LTD policies, people are eligible to receive long-term disability benefits when they are unable to work at their “own occupation.” Benefits might be cut off, however, if, after two years, the individual is unable to prove that they cannot work in “any occupation.”
Read more about “any occupation” versus “own occupation” here.
This is a complicated issue that can be quite stressful for many individuals who count on these benefits to survive. Fortunately, you do not have to simply accept the insurer’s determination. It could be possible to get your benefits re-established. Our long-term disability lawyers at Valent Legal have successfully advocated for others in your position and have helped them regain the benefits they are entitled to. We’re ready to do the same for you. Schedule your free case review with our team today.
What to Do If You’re Denied Long-Term Disability Benefits
By law, insurers are required to put a denial of benefits in writing. If you’ve received a denial of benefits letter from your long-term disability insurance company, don’t give up hope. There is a process to appeal a denied benefits claim. An experienced disability lawyer at Valent Legal can help you dispute the decision and seek the benefits you’re entitled to. Deciding between an appeal and a lawsuit can be tricky on your own.
The denial letter might include reasons for the company’s decision and will include a deadline for you to appeal. Your disability lawyer can ensure that your appeal is filed on time, so you do not lose your right to pursue further action.
There are typically a few steps in the appeals process. At each stage, it is possible for your claim to be approved. The possible stages include:
- Internal Appeals: Employees at the insurance company will take another look at your application and will reconsider the denial decision. Most companies allow for two or three rounds of internal appeals before the appeal must move on to the next stage.
- Appeal by Lawsuit: If internal appeals prove unsuccessful, you could file a lawsuit to challenge the company’s decision. This will put your disability claim in front of a judge or jury to decide whether you qualify for benefits. The decision will be enforced on both you and your LTD insurer. If your lawsuit is successful, you could also be eligible to collect compensation for additional damages, including mental distress caused by the denied disability benefits and financial losses, like your legal costs.
- Out-of-Court Settlement: At any time during the appeal by lawsuit, the insurer could offer you a one-time, lump-sum settlement. This is usually offered in exchange for dropping the lawsuit and agreeing not to seek benefits under the plan. These lump-sum settlements will usually include payment for past and future benefits, but might be limited to a specific year’s worth of payments, which might not be the actual amount that you’re entitled to.
Limitation Periods in Long-Term Disability Claims
If your disability insurer refuses to pay you long-term disability benefits, you will need to file an objection within 30, 60, or 90 days, according to the specific terms of your policy. If you wish to forego the internal appeals process and file a lawsuit against the insurance company instead, you generally have either one or two years in the province of Nova Scotia, according to the Limitations of Actions Act. The exact time frame to file will be dependent on your policy. It is important to consult with experienced lawyers as soon as you receive a denial letter from your disability insurer to make sure you don’t run out of time to sue.
The limitation period will begin as soon as your benefits are denied and you are notified of the denial. Even if your insurer gives you the opportunity to appeal the decision or submit additional evidence for your case, the limitation period will continue to pass. For this reason, initiating a court action against an insurer as soon as possible will help expedite the legal process.
Why Work With a Halifax Long-Term Disability Lawyer?
When you’re facing a denial of your benefits, having reliable legal representation on your side is crucial. At Valent Legal, our long-term disability lawyers in Halifax are experienced in guiding clients through the process of appealing denied disability applications, contesting reduced benefit payments, and filing lawsuits against insurance companies, when necessary.
When you work with our team, you’ll receive:
- Compassionate Legal Advice: At Valent Legal, our Halifax disability lawyers are committed to assisting clients whose insurance companies are withholding the benefits they need to survive. We understand that dealing with a disability is challenging enough. Let us alleviate the legal burden by navigating the application, appeal, or litigation process for you.
- Appeal Support: Appeals can be expensive and time-consuming. You may need to collect additional medical charts or medical opinions if your benefits have been denied (e.g., an Independent Medical Evaluation (IME) or Functional Capacity Evaluation (FCE)). We’ll help you collect the evidence you need while identifying your best options for financial support.
- Litigation Experience: Sometimes, pursuing an internal appeal just won’t cut it. At our firm, our lawyers will help you file a lawsuit against your insurance provider when it’s necessary to pursue the full amount of benefits you deserve. We’ll provide support throughout the litigation process, from initial filing to representing you in court.
Long-Term Disability: Frequently Asked Questions
Are Long-Term Disability Benefits Taxable in Nova Scotia?
Generally, this will depend on who pays the premiums for the LTD policy. If your employer pays all or part of your long-term disability insurance premiums, the benefits you receive are typically considered taxable income. However, if you pay the full premiums yourself with after-tax dollars, the benefits will usually be tax-free. It’s important to review your policy with a lawyer or speak with your insurer or employer for specific details about your tax obligations.
What’s the Difference Between Group and Individual Disability Insurance?
Group disability insurance is provided through an employer or association and often offers lower premiums and fewer options for customization. Individual disability insurance is purchased personally and paid for by you. Typically, it offers more flexible coverage, benefit amounts, and terms. You may also retain your individual policy if you change jobs, while group LTD coverage will normally end when your employment does.
How is Short-Term Disability Insurance Different From Long-Term Disability Insurance?
Short-term disability (STD) insurance covers temporary injuries or illnesses and will normally provide applicants with up to six months of benefits. Long-term disability (LTD) insurance will pick up after STD benefits end and is intended for more serious or prolonged conditions. LTD can continue for years at a time, or even until you hit retirement age. While it is often easier and quicker to obtain STD benefits, LTD provides extended financial protection for long-term health issues.
How Much Does it Cost to Hire a Long-Term Disability Lawyer?
At Valent Legal, our Halifax long-term disability lawyers offer completely free initial consultations for our clients. In addition, we work based on a contingency fee arrangement for LTD cases. This means that you don’t pay any money at any stage unless we successfully win your case for you. At that point, we will take a pre-specified percentage of the compensation you receive. This way, you can have financial and emotional peace of mind throughout the legal process.
Long-Term Disability (LTD) Lawyer Halifax, Nova Scotia: Contact Valent Legal Today
When an injury or illness has left you unable to work, you deserve the long-term disability benefits that you paid for through your hard work or payments toward your policy. If your insurance company wrongly denies your claim, the Halifax disability lawyers at Valent Legal will be there to answer your questions, help you understand all your legal options, and advocate for you.
Our team of knowledgeable long-term disability lawyers and compassionate support staff is committed to getting you the benefits you need, whether you are applying for the first time, appealing a denied claim, or need help re-establishing benefits that were cut off.
Call us to schedule a consultation at absolutely no cost to you. We take LTD cases on a contingency-fee-basis. If we can’t help you get the benefits you seek, you won’t owe us a thing in legal fees. Contact us online now.