Have you applied for long-term disability (LTD), but your claim was denied? If you have been rejected but feel like your LTD benefits have been wrongly denied or terminated, taking legal action might be the only course you can take to get the benefits you deserve. If you decide to go this route, it’s essential to know that you have limited time to begin your lawsuit. If you do not file your lawsuit within the limitation period, you could lose your right to sue for LTD benefits.
Figuring out your limitation period is not as simple as one might think. Different conditions factor into your deadlines for long-term disability claims.
Limitation Period for LTD Claims in Nova Scotia
The provincial government of Nova Scotia has set out legislature that defines the limitation period as two years for most LTD claims. It would keep things simple if this legislation were the be all end all, but the two-year limitation period in Nova Scotia does not apply to all claims.
Your time limit for an LTD lawsuit may differ from the legislation because of your LTD contract. Often, an LTD contract has a limitation period of its own, which is typically one year. It can be challenging to decipher precisely how long you have to fight your long-term disability denial because of the different limitation periods applicable to various insurance policies and claims.
When comparing the outlined two-year limitation period to the period defined by your LTD contract, you may be wondering which time limit takes priority. In a recent case of Nova Scotia resident Angela Cameron v. Nova Scotia Association of Health Organizations Long Term Disability Plan, it was decided that the two-year limitation period was superseded by the one-year period defined in the LTD contract. In other words, a court of law decided that Angela Cameron’s limitation period was only one year, not two, because of the LTD contract she signed.
It’s essential to understand the rights you have to sue for LTD benefits. If you are unsure of the length of your limitation period, contacting a legal counsel might be your best chance at getting the clear and defined answer you’re looking for.
What we want you to take away here is that, even though the Nova Scotia provincial government has set out legislature that defines the limitation period as two years for most LTD claims, this may not be true for you because of the terms of your LTD contract. Every LTD contract is different, and the terms can be confusing, but a long-term disability lawyer can help make sense of your contract.
When Should I Start a Lawsuit for an LTD Denial?
Because a limitation period exists for suing for LTD Benefits denial, we highly recommend you begin your case right away.
You may be wondering what event marks the beginning of your limitation period. Your limitation period does not wait until after you’ve had a chance to speak with your disability insurer or with a lawyer. Count down begins the moment you receive an “unequivocal denial” of your claim from your insurer.
Even if you are perusing an internal appeal with the insurance company after denial, the clock is likely already ticking and will not be restarted because of the internal appeal. Do not assume your right to sue will be prolonged because you are making an internal appeal, because the opposite is likely true.
Once you receive a clear denial of your claim, the two-year timeframe as set out by the Nova Scotian government or the limitation period, as seen in your LTD contract, starts. A time limit does not make the already stressful task of starting a lawsuit for LTD benefit denial or termination any easier. The best choice is to stay ahead of the ticking clock and begin your case immediately after receiving the denial.
4 Reasons Why Insurance Companies Deny Long Term Disability Claims
1. Insufficient Medical Documentation
One of the most common reasons an insurance company will deny an LTD claim is because they will state you have insufficient medical documentation to support your claim. We have seen that this reason is often used more as an intimidation tactic by an insurance company to make the person applying for LTD benefits second guess their application and discourage them from moving forward.
An insurance company’s interpretation of the documentation generally does not align with how the claimant views the same facts. They will often overlook or discount the seriousness of the documentation to avoid paying LTD benefits for the insured person. There have been cases where the insurance company has claimed insufficient medical documentation, but when challenged on their claim, they came back to settle the case, even without additional medical documentation.
2. Meeting “Total Disability” Criteria
The term “total disability” is not a legislated term, which means that it can be interpreted from both the claimant and the insurance company differently. “Total disability” is not intended to be taken literally. A person does not have to be completely paralyzed and unable to do anything to be considered totally disabled. If this were the case, virtually no one would be eligible for LTD benefits.
Your disability insurer may look for ways to argue that you do not meet the criteria of totally disabled, even if you and your doctor thinks that you do. If your claim is denied because of this, you may feel that hope is lost and that you will not be eligible for your LTD benefits. Many people fear taking on an insurance company, but seeking legal representation can help level the playing field.
In November 2018, Sandra Bullock of Georgetown, Ontario had her LTD benefits denied. Her doctors had determined her unable to work, citing major depressive disorder, anxiety, and recurring migraines as the cause of her total disability. Even so, Bullock’s insurance company claimed that she must be well enough to work again because she was caring for her son, who is severely developmentally delayed. Eventually, after the case went public, the insurance company reversed their decision and put back in her claim and acknowledged that she did meet the criteria of totally disabled.
3. Surveillance Disproving your Claim
Although it may seem like something that only happens in movies, private investigators are used by the insurance company to survey claimants in their everyday lives more often than you might think. They may use this surveillance footage as the reason for your long-term disability denial.
While the use of surveillance in a denial is quite ineffective in a court of law, the concept of being surveyed can be quite intimidating for a claimant to know that they’re being watched. This can be enough for some LTD benefit applications to cease to pursue their case any further and not receive the benefits they should be entitled to. However, the footage is often ruled to be unhelpful and is obviously edited or skewed to make the footage seem more damaging than it is. More often than not, surveillance video does not help the insurance company’s case in court but is used merely as a scare tactic to motivate a claimant to back down.
4. Hired Experts Disputing your Disability
If your application for LTD benefits has been denied, it could be because the hired or in-house expert or doctor of the insurance company has decided they think you are not disabled. Even though your doctor, who may have been treating you for years or even a lifetime, has said you are disabled, the insurance company’s expert’s decision can be used to deny your claim.
This decision from the hired expert is another common scare tactic used to dissuade a claimant from continuing to pursue their case. When presented with both sides in court, however, it is far more usual that the judge will side with your doctor who has known you and your medical history for years, rather than the expert who spent maybe an hour with you.
Contact the Disability Lawyers at Valent Legal for Free Legal Advice
If your application for LTD benefits is denied, it does not have to end there. It is in every insurance company’s best interest to deny claims at every chance they get. Every claim usually follows the same story: A claim is made, that claim is denied, and you are forced to prove why it should not have been denied.
Taking on the insurance company that denied your claim could feel like an unwinnable challenge. With a team of long-term disability lawyers at Valent Legal behind you and fighting for your rights, getting the benefits you deserve can become far more obtainable. It is also wise to start your lawsuit as soon as possible so you do not miss out on your right to sue after your limitation period has passed.
Once a legal claim is made, the insurance company now has to weigh the economic and public appearance consequences that will be faced by taking this disagreement to an open court of law. With the help of our disability lawyers who are experts in situations like LTD benefits denial, you can get your claim approved and receive the benefits you were entitled to since day one. Contact the disability lawyers at Valent Legal for free legal advice.
