What is Bad Faith in an LTD Claim & How Do I Prove It?

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 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. You can count on us to keep you updated and informed about your claim’s progress.

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.

Long term disability 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

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

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.

Evidence 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 to 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. 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, the most convincing evidence will be the opinion of your treating physician.

Your doctor will be asked to fill out paperwork giving their opinion on your disabilty, as well as supporting objective 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. We 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
  • Fibromyalgia

We work with the right medical experts to help you win your LTD claim. We’ll be prepared to present a strong case to your LTD insurer 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 the 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. The long-term disability lawyers of 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.

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 LTD lawyer at Valent Legal can help you dispute the decision and seek the benefits you’re entitled to. Deciding between an appeal or 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.

Long-Term Disability (LTD) Lawyer Halifax, Nova Scotia: How Do We Help

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 of 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 are 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 or contact us online now 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.

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