Making your first appeal under the Public Service Plan
The First Appeal under the Nova Scotia Public Service Long Term Disability Benefits Plan is assessed by the Claims Administrator, Manulife.
If you are reading this, it is likely that you have received a letter from Manulife rejecting your claim or denying further benefits.
The first appeal is generally needed for two reasons:
- Your benefits were denied upon application
- Your benefits are being cut off
The process is the name whether your benefits are cut off for either of the above reasons or some other reason. The goal is to provide new medical information to convenience Manulife to either accept or reactivate your claim.
What new information should I send to Manulife?
In short, it depends on why your claim was denied. If the decision was based on your eligibility for the plan, you will need to provide that you have a right to advance a claim under the Plan. Most often, however, the denial is due to a lack of objective medical information to support a total disability. The line we read most often in the Manulife denial letters is: “based on our review of the medical documentation, the evidence is not supportive of restrictions and limitations of sufficient severity to preclude you from performing the essential duties of your own occupation”. If the denial occurred after the change of definition date, the denial letter would reference a lack of evidence to “preclude you from performing the essential duties of any occupation for which are suited based on your skills, training, and experience”.
What is “objective medical information”?
Objective medical information is a popular term used by insurance companies. In their view, information that is based on subjective reports (by you or even a doctor) is less valuable or credible. Comments made by your doctor in her chart without tests to support the findings are considered biased or infused with advocacy from the doctor. Comments from a psychologist may be seen as suspect unless there is consistent office testing completed to solidify the opinions.
Objective medical information is also typically harder to acquire. This is especially so for the non-lawyer attempting to gather materials for an appeal. Often, we will send clients to a medical expert for specific testing to support a claim. We will write to the expert to ensure that certain testing is completed and questions are answered. The result is a thorough, comprehensive, and highly valid report which is harder for the insurance company to disregard. Of course, the insurance company also has its own pool of experts at its disposal. A review of the adjudication file will show that your claim may have been sent to an in-house Medical Consultant for an opinion.
When you are considering what information to acquire, ask yourself the following questions:
- What does the insurance company say was not objective about the information I provided?
- What information did the insurance company expect to see?
- Will my doctor/treatment provider write a letter of support?
- Is there further testing that has been recommended that I have not yet done?
In answering the above, you will likely discover that more can be done to prove to the insurer that you are disabled and entitle to benefits.
Many people go above and beyond to gather information to show that they are disabled, and yet the insurance company will continue to deny the claim. Do not be discouraged by the insurance company’s denial letters. It may well be that you are destined to attend the final Board Appeal under the Nova Scotia Public Serice plan to get the fair result.
Be sure to abide by the appeal guidelines set by Manulife in its denial letter. If you are going to gather more information, be sure to find out if it will be provided to you in time to submit it to Manulife. If not, ask Manulife right way for an extension to file additional materials. Manulife should grant a reasonable extension.
Do you need help with your Appeal? Get your free consultation today.
Be sure to contact us right away for a free case review. Ideally, we are providing you with our opinion before the second appeal to Manulife. If this appeal has already happened in your case, please be sure to let us know right away. Time limits apply to your claim and timely notice to complete the final appeal must be made. Jeff Mitchell is an experienced Long Term Disability Benefits Lawyer who has successfully advanced his client’s interests before the Nova Scotia Public Service Trust Fund. To book your free consultation, call toll-free: 1-855-670-1345 or 902-702-3452. Prefer to email? Email Jeff at email@example.com.