Proving Eligibility for Disability Benefits
It is your responsibility to provide to the Claims Adjudicator (Manulife) that you are entitled to benefits. Entitlement is shown by establishing that you have an ongoing total disability preventing you from working in your occupation.
Filing Proof of Disability
The process to obtain benefits is commencing by filing a Proof of Claim form which demonstrates that you are Totally Disabled while your were covered under the LTD Plan. Your Proof of Claim form must also clearly show that you have remained Totally Disabled throughout the Elimination Period (150 days), and that there are no exclusions or limitations which would allow for your claim to be denied. The Elimination Period acts to delay the start date for benefits. The clock for the elimination period commencing on the first day of disability, and will only roll while you are under the care of a physician and abiding by treatment recommendations. The Elimination Period will also end if a return to work effort is attempted during the period of disability. If you return to work on modified or restricted duties (often done as a trial to see whether you can work) the Elimination Period clock will continue to run.
Returning to work after Disability
There are circumstances where a worker will be disabled, then be in a position where they can return to work for a period of time before becoming disabled once again. This “Recurrence of Total Disability” is contemplated in the LTD Plan. Where an Employee has returned to work and then leaved work due to Total Disability, the Elimination period will continue to run from when it stopped due to the return to work effort. The Elimination Period will, however, reset if the worker is able to work for 21 days or more. Any subsequent claim for disability benefits after a return to work period lasting 21 days or more will require the Employee to submit a brand new claim. If the Employee attempts a return to work after the elimination period has run and benefits are payable, a subsequent disability claim for the same disabling condition will not be subject to a new Elimination Period so long as it is within the first 12 months following the first Elimination Period. If the new disabling condition prevents the worker from returning to work within the first year after benefits are payable, the elimination period will be waived if the Claims Adjudicator feels that the new disabling condition would have disabled the worker from working in any event for at least 1/3 of the year. If a return to work is made after 12 months on disability, the worker will be required to submit a new claim and wait a new Elimination Period before being entitled to payment.
Disability Benefit Start Date
If the notice of claim is provided to the Claim Adjudicator within seven months from the expiry of the Elimination Period, Benefits will be paid from the end date of the Elimination Period. If the notice of claim is provided to the Claims Adjudicator after the expiry of the Elimination Period, benefits will be payable no earlier than the date on which the notice of claim was given to the Claims Adjudicator. Benefits are not payable if notice of claim is provided over 19 months after the expiry of the Elimination Period. Take home point: Don’t delay to file your file for benefits!
Questions about your LTD Benefits?
We welcome you to contact us with your questions about long-term disability benefits and the Nova Scotia Health Association LTD Plan. To book your free consultation with a reputable lawyer handling long-term disability cases nearby, call toll-free: 1-855-670-1345 or 902-702-3452. Prefer to email? Email Jeff at [email protected].