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PEI Long Term Disability Lawyers

When illness or injury prevents you from working, long term disability (LTD) benefits should provide financial stability. For many people in Charlottetown, Summerside, and across Prince Edward Island, however, insurers deny valid claims, delay payments, or terminate benefits unfairly. At NOVA Injury Law, our LTD lawyers fight back against insurance companies to protect your rights and ensure you receive the benefits you deserve.

We are proud to be recognized as The Doctor-Lawyer Law Firm™. With a physician working directly with our legal team, we support every LTD case with medical expertise. This unique advantage allows us to present stronger claims and challenge insurers more effectively.

See this testimonial from one of NOVA’s satisfied clients!

What Sets NOVA Injury Law Apart?

  • We’re one of the only injury firms with our own in-house physician to help you create a bullet-proof case.
  • We offer free consultations with no obligation.
  • Technology allows us to easily communicate with clients anywhere, from small towns to large cities. However, if you prefer in-person consults, we proudly offer complimentary house-calls anywhere in Halifax or Nova Scotia.

Our payment is contingent on winning your case (no win, no fee), so you can focus on recovery.

Graphic: What Makes NOVA Injury Law Different?

What Health Conditions Qualify for LTD Benefits?

If you have been affected by a long-term illness or injury that has left you unable to work, you may qualify for LTD benefits. Although several illnesses or injuries may qualify you to receive benefits, some of the most common include:

Several other medical conditions also qualify for disability, as described on our webpage “Which Medical Conditions Qualify for Disability,” which provides a more detailed description. 

How Do I Apply for LTD Benefits in PEI?

To qualify for LTD benefits, you must first determine if your employer has an LTD insurance policy or if you have your own private policy. You must also assess the policy to determine if you meet the criteria to obtain LTD benefits and be ready to provide extensive medical documentation that supports your claim. It is worth noting that anyone considering filing for LTD benefits must be continuously disabled and unable to return to work during the “elimination period” before benefits can begin. 

Filing for LTD benefits without the help of a lawyer can be time-consuming and cause unnecessary delays. When you hire a lawyer, they can assist you with the application to apply for benefits, ensure all legal paperwork is filled out correctly, and adhere to strict deadlines. 

Complete Claim Forms

You must complete and submit several claim forms, including a claimant, employer, and attending physician’s statement. The claimant statement includes information you share regarding your condition. Your employer must also provide information regarding your job duties and how your disability affects your work. Finally, the physician’s statement attests that your doctor believes your disability prevents you from working. 

After you have submitted your application forms, the insurer will review them and may request additional medical documentation to determine if your case meets eligibility requirements. 

Why is Medical Documentation So Important?

One of the most crucial factors in being approved for LTD benefits is providing comprehensive medical documentation. Medical documentation provides a formal diagnosis of your condition and, even more importantly, how it affects your ability to perform your job duties. For example, if your medical condition involves depression, your doctor must provide documentation that demonstrates how your symptoms interfere with your ability to perform your job.

Comprehensive medical reports, such as diagnostic testing including MRIs, CT scans, and X-rays, provide the insurance company with objective evidence that helps to substantiate your claim. Any documentation you provide should also show that you have actively sought medical treatment for your illness or injury. Many insurers are questioning whether to approve LTD benefits if there are significant gaps in claimants seeking treatment.

Your physician or other specialists working on your case should also include the treatment plan they have developed to address your condition, as it demonstrates your ongoing efforts to recover and that you are complying with all requirements. 

At NOVA Injury Law, our dedicated legal team has significant experience helping clients gather all essential medical documentation and interacting with the insurance company. Contact us today to learn more about filing an LTD application and gathering medical documentation. 

Why Should I Hire a Lawyer to Help Me Obtain LTD Benefits?

Trying to navigate the legal maze of obtaining LTD benefits can be overwhelming. To make matters worse, many insurance companies often deny initial claims, requiring applicants to file an appeal. Having a skilled lawyer on your side can make all the difference in getting your claim approved and avoiding the need to pursue an appeal. 

Ensure Compliance With Legal Procedures

One of the most essential roles of an LTD lawyer is they handle all of the legal issues connected with filing a claim. Filling out the various forms can be confusing, and those that are filled out incorrectly or incompletely may be automatically denied. 

Gather Necessary Medical Documentation

If you are seeking LTD benefits, you must have substantiated medical documentation. After thoroughly assessing your case, your lawyer can determine what medical evidence is needed that demonstrates how your condition prevents you from performing your job duties. Lawyers who help clients seek LTD benefits are familiar with the criteria insurance companies use when determining if applicants should be approved. 

NOVA Injury Law has LTD lawyers who have a long history of successful representation, assisting clients in gathering and presenting comprehensive medical documentation capable of meeting the insurance company’s evidentiary standards.

How Long Will I Have to Wait After I Have Submitted My Application for LTD Benefits?

Once your application is submitted, you will still have to wait for the “elimination period” to conclude before you can receive LTD benefits. Generally, the elimination period takes anywhere from 90 to 180 days, depending on the terms of the policy. 

The purpose of the elimination period is to ensure that you meet the definition of disability. Insurance companies make applicants wait to differentiate between short-term health conditions and those that do qualify for LTD benefits. Suppose you were to recover and be able to return to work before the elimination period is over. In that case, your application for long-term benefits would be denied. 

After the elimination process is over, it can still take an additional 45 to 105 days for the insurer to make an initial decision. 

What Can I Do if My Initial LTD Claim Was Denied?

Insurance companies often deny initial LTD applications even for those who provide comprehensive medical documentation. If your LTD claim was denied, you can file an internal appeal with the insurance company or file a lawsuit to pursue benefits. The most effective approach is to hire a qualified lawyer to assist you. 

An LTD disability lawyer can assist you in navigating the legal intricacies involved in filing an LTD appeal. When you come to NOVA Injury Law for help, our lawyers can review the denial letter to understand better the insurance company’s reasoning for denying the claim. Based on the reasons cited by the insurer, our legal team can gather new evidence and determine what legal options will best suit your needs. 

One of the primary benefits of retaining legal counsel is their ability to identify and obtain new evidence that substantiates your claim more effectively. Our LTD lawyers recognize that going through the appeals process can be stressful, especially if you are facing a financial crisis due to your inability to return to work. 

Our LTD lawyers and legal staff will handle all communications with the insurance company to help alleviate stress and allow you to focus on healing. Depending on the circumstances involved in your case, we can also file a lawsuit against the insurance provider if they are unwilling to negotiate. 

What is the Deadline for Filing a Lawsuit?

If your LTD benefits have been denied, consider the option of filing a lawsuit. In PEI, the limitation period for filing a lawsuit against an insurer is generally two years from the date of the first denial letter or the date benefits should have started. 

Even so, some insurance policies have strict time limits that may be shorter than the standard two years. Therefore, you must seek legal representation and have your lawyer review the policy’s specific time limits to ensure that you do not miss a critical deadline. Often, older policies contain clauses that shorten deadlines to one year from the day the claim was denied. 

The most practical legal solution is to seek immediate assistance from a qualified lawyer immediately after receiving a denial letter. 

Key Deadlines

Under the law, there are strict time limits for individuals to file lawsuits based on the specifics of their cases. Understanding these key deadlines is essential so that you do not inadvertently lose your right to appeal your denial. 

Unequivocal denial

The limitation period begins when the insurer states that they will not approve your claim or when they decide to terminate LTD benefits. Once this occurs, the clock starts ticking on the limitation period. Filing an internal appeal does not pause the limitation period, so understanding critical deadlines is key to ensuring that your claim is not denied.

Any occupation change: Generally, most LTD policies change their definition of disability after an individual receives 24 months of benefits. For example, in the first 24 months, an individual receiving benefits is considered disabled if they cannot perform their specific job, also referred to as their “own occupation.” 

Even so, after 24 months, the definition of disability changes to “any occupation”. At this point, a person is only considered disabled if they cannot reasonably perform other job duties based on their training, education, or experience. Many insurers use the any occupation change rule to terminate benefits after two years. If your benefits have been terminated under the rule, the deadline to file a lawsuit begins from the date of the termination notice. 

What are the Most Common Reasons for an LTD Claim Being Denied?

If you have filed an LTD claim and been denied, you are not alone. Many PEI residents file claims only to have them denied by the insurance company. Some of the most common reasons that insurance companies deny LTD claims include:

  • Insufficient medical evidence: The application lacks comprehensive medical documentation that supports the individual’s claim that they can no longer work due to their condition.
  • Failure to meet definition of disability: The applicant’s condition does not meet the insurance company’s criteria for disability as defined in the policy.
  • Pre-existing conditions: The applicant’s disability is the result of a pre-existing condition not covered under the policy.
  • Failure to follow treatment plan: The applicant failed to follow the recommended treatment plans or regular medical care. When this occurs, insurers question whether the individual’s condition could improve with proper medical treatment.
  • Missed deadlines: The claim was submitted after the required deadline had passed.
  • Misrepresentation or fraud: The insurance company believes that the applicant provided false or misleading information on the application form.

How to Avoid Having Your Claim Denied

There are several steps that you can take to prevent your claim from being denied. Your best course of action is to retain a lawyer who can assist you with your claim. A knowledgeable lawyer will help you complete your application and ensure that you have proper medical documentation. 

Other ways to prevent denial include:

  • File your claim as soon as possible to avoid missing critical deadlines.
  • Ensure all paperwork is filled out correctly and that all requested medical documentation is provided to the insurance company.
  • Attend all medical appointments and follow all recommended treatment plans.
  • Respond to all insurance company requests promptly.

How Long Does an LTD Lawsuit Take to Be Resolved in PEI?

Depending on your situation, you may choose to pursue a lawsuit to try to recover LTD benefits. If you file a lawsuit, your case will most likely take 12 to 18 months before it is scheduled to go to trial.

Other factors can influence how long it takes for your case to proceed to court, including:

  • The complexity of the case
  • The length of time it takes for the discovery process to be completed
  • Negotiations between the plaintiff and the insurance company
  • Court and other legal backlogs can cause substantial delays in a case going to court

Fortunately, many LTD lawsuits are settled out of court, often through mediation. Mediation allows a plaintiff and the insurance company to work out their differences and avoid the costs and time involved in pursuing litigation. 

No one likes the idea of having to pursue a lawsuit, but often it is he most effective way to ensure that the insurer negotiates fairly. NOVA Injury Law has a proven record of helping clients resolve their legal issues without the need to go to trial. Our LTD lawyers have in-depth experience negotiating with insurance companies and their legal teams and are committed to securing the fair outcome you deserve. 

Can I Be Fired From My Job While on Long-Term Disability?

Many PEI workers worry that they could be fired from their jobs while receiving long-term disability benefits. Under the law, a PEI employer can terminate you while you are on long-term disability, but is obligated to follow all specific legal guidelines.

For example, your employer cannot terminate you solely based on your disability, a violation of anti-discrimination laws. Before your employer can legally terminate you, they must first try to accommodate your disability, but not to the point that it causes them undue hardship. 

Even so, if your employer can prove that terminating you is not a discriminatory act and the direct result of a “frustrated contract”, they can end their employment relationship with you. A frustrated contract simply means that the employment relationship between them and you is no longer sustainable. 

If you are terminated, your employer must provide you with proper notice or pay in lieu of notice. Under provincial law, you are entitled to all outstanding wages owed to you.

Suppose you are receiving LTD benefits and feel that you have been terminated from your job unfairly. In that case, you must speak with a qualified lawyer immediately, who will review your case and determine what legal options may apply to your case. 

Should I Agree to Take a Lump-Sum Settlement?

One of the most common methods that insurers use to try to save money is offering claimants lump-sum settlements for their LTD claims. Although it may seem tempting to accept a lump settlement, there are risks involved that could affect your future. 

What is a lump-sum settlement?

A lump sum settlement is a one-time payment made by an insurer to a claimant. Once you accept a lump sum settlement, your case is closed and you forfeit your right to make future claims. 

Even though choosing a lump-sum settlement means you receive all the money at once, you could be putting yourself and your family at financial risk. One of the main reasons that insurance companies offer lump-sum offers is to save money. Lump-sum settlement payouts are far less than if individuals choose to receive regular payments. 

If your condition worsens or your financial resources are exhausted, you cannot request any additional compensation from the insurer. 

Other Risks

Depending on who paid the insurance premiums for your LTD policy, your benefits may be considered as taxable income. If your employer paid any portion of the premiums, your LTD benefits are subject to tax. However, if you paid 100% of the insurance premiums, your LTD benefits are tax-exempt. 

You should never agree to accepting a lump sum without first consulting with an LTD lawyer who will thoroughly assess the factors in your case to help you make an informed decision.

Contact Our PEI Long-Term Disability Lawyers Today So We Can Get Started on Your Case

If you have a medical condition or injury that prevents you from returning to work, you may be eligible to apply for LTD benefits. Trying to navigate the complex maze of applying for benefits can be challenging and is best handled with the help of a PEI LTD lawyer. 

NOVA Injury Law has lawyers who are ready to stand up to the insurance company to help you receive the benefits you deserve. Ready to talk? Call our injury and disability lawyers at NOVA Injury Law today to book your free case evaluation and strategy session!

Contact our law office today to schedule a free initial consultation so we can get started on your case.