Halifax Long-Term Disability Lawyers

If you or a loved one has suffered a long-term disability (LTD), you may need legal help receiving the benefits that you deserve. In Nova Scotia, workers can access LTD benefits through private insurance policies and trust agreements. Insurers or employers and employment contracts determine the terms of the policies. Under the law, Nova Scotia workers are granted legal rights for LTD benefits under the Workers’ Compensation Act and the Nova Scotia Human Rights Act, which protects workers from discrimination and ensures they are fairly compensated for their injuries. However, employees can only qualify for LTD benefits if their injury prevents them from returning to work for at least a year or longer.

If you have suffered a long-term disability and have questions about obtaining benefits, contact Nova Injury Law today to schedule a consultation.

For more information, please see:

What is the Eligibility and the Claims Process for Long-Term Disability Benefits?

Although LTD benefits are determined through an individual’s or employer’s private insurance plans, injured workers must still meet basic requirements to qualify. In general, an injured worker must be covered under a long-term disability plan and meet the requirements as stated in their policy.

Some of the necessary medical documentation needed to qualify for LTD benefits includes:

A statement from your primary care physician that provides details regarding your medical condition and an explanation of how it impacts your ability to work
A detailed description of your job duties and how your long-term injury affects your ability to perform your obligations
A statement from your employer that verifies your job duties and how your injury impacts your ability to perform assigned tasks
All medical records from your healthcare providers, such as therapists or specialists, detailing your diagnosis, treatment plan, and any progress that has been made
Reports from any specialists who have examined you
Medical records from all diagnostic tests, including CT scans, MRIs, and X-rays

First, you obtain a claim form from your employer or private insurance company to file for LTD benefits. Gather all necessary medical documentation, complete the form, and return it to the insurance provider. Failure to complete the paperwork correctly could result in your claim being denied. Additionally, you must provide comprehensive medical documentation that verifies your long-term disability. You must also communicate regularly with the insurance provider to answer any questions they may have.

Please see What Qualifies as a Long-Term Disability? for more information.

Common Reasons for Disability Denials

Long-term disability claims are often denied for various reasons, with some of the most common being missed deadlines or a lack of sufficient supporting medical documentation. Other factors that may cause an LTD claim to be denied include pre-existing conditions or an employee failing to follow prescribed treatment plans. In other instances, LTD claims may be denied if an employee is terminated while applying for benefits, if the employer does not believe the applicant has a long-term disability, or if the applicant believes they can perform other job-related duties.

In some instances, insurance companies have been known to try to challenge claims for LTD benefits related to mental health conditions, including PTSD or depression, chronic fatigue, or conditions that lack physical symptoms.

How to Appeal a Denied Claim

If your LTD claim is denied, you must follow specific steps to file an appeal. First, review your denial letter to determine why the claim was not approved. Your next step should be to consult a long-term disability lawyer who can assist you with filing an appeal. Due to the legal complexities involved with the appeals process, having a lawyer to assist you can significantly increase your chances of having the denial overturned.

An experienced lawyer can assist you with gathering the necessary medical documentation that supports your claim, and they can help you prepare your written appeal. Your lawyer can ensure that the written appeal adequately addresses all issues detailed in the denial letter. After completing your appeal letter, submit it within the specified time limit so you do not miss any critical deadlines.

What are the Different Types of Long-Term Disabilities?

Long-term disabilities can take many forms, including catastrophic injuries, chronic illness, or mental health issues, and may qualify applicants for LTD benefits. Chronic illnesses that qualify for LTD benefits may include musculoskeletal disorders, cancer, or PTSD.

Sometimes, individuals suffer temporary health conditions that only last a few weeks or months. To qualify for long-term disability benefits, you must have an illness or condition expected to last for at least a year or possibly until retirement age. Individuals who suffer catastrophic or life-changing injuries are no longer able to perform basic activities of daily living unassisted or require extensive ongoing medical care.

Catastrophic conditions are those that result from severe trauma and may include:

Spinal cord injuries
Traumatic brain injuries
Amputations
Organ loss

Mental Health and Invisible Disabilities

Although many long-term disabilities are the result of physical injuries, some mental health and invisible disabilities may still qualify. Some of the mental health conditions that often qualify for LTD include PTSD, anxiety, or depression. Invisible disabilities are those that are not readily apparent but can prohibit individuals from performing their work-related duties and may include chronic pain or autoimmune diseases. It should be noted that anyone who is seeking LTD benefits for mental health or invisible disabilities must be able to provide comprehensive medical documentation that supports their claim.

What Evidence is Needed to Prove and Support a Disability Claim?

If you are seeking long-term disability benefits, you will need to prove that your condition qualifies for compensation. Most insurance providers require that applicants provide extensive medical records to prove they qualify.

Medical reports should always include a doctor’s report that provides details of your condition, limitations that affect your ability to perform your job duties, and your prognosis. One of the most essential pieces of medical documentation includes a copy of any functional capacity evaluations (FCEs) conducted by your therapists that outline your mobility challenges or impairments. You should also include any incident or police reports that provide information regarding how you were injured, so they can also be considered to determine eligibility for accident-based claims. Other evidence supporting your disability claim includes a complete treatment history, progress made, and reports of all diagnostic tests performed.

What are My Rights and Legal Protections Under Nova Scotia Disability Law?

Individuals seeking long-term disability benefits have specific rights and legal protections under Nova Scotia’s Long Term Disability Plan Ratification Act. Under the law, workers seeking LTD benefits can seek fair compensation for injuries that prevent them from returning to work. Some of the significant protections offered to disabled workers seeking compensation include:

The right to a fair and timely claims process: All insurers must provide claimants with clear timelines for processing claims. Any delays or requests for additional information must be dealt with promptly
The right to appeal if your claim is denied: If your LTD claim is denied, you are entitled to file an appeal to challenge the insurer’s decision
The right to file a lawsuit to recover compensation if your disability was caused by negligence or your claim was wrongfully denied
The right to legal representation to assist you with filing a claim or an appeal

When to Consider Filing a Lawsuit

Depending on the circumstances involved, it may be necessary to file a lawsuit to try to recover LTD benefits. For example, an insurer may be liable for an LTD dispute if they fail in their duty to fulfill their legal obligations as defined by the Insurance Act or as outlined in policies. Some common examples that often result in claimants having to file lawsuits include:

Denial or termination of benefits not based on pre-specified contractual terms
Bad faith practices such as unfairly denying a claim, prolonged denial, or delaying payment
Your employer tries to retaliate against you for trying to obtain LTD benefits

Regardless of your situation, it is always best to hire a long-term disability lawyer to assist you with your legal needs. In most cases, insurers are more willing to follow the law and treat claimants fairly if they know they have skilled legal representation.

How Can I Choose the Right Long-Term Disability Lawyer?

Suppose you cannot return to work due to a long-term disability and want to apply for benefits, or have been denied. In that case, you must seek a knowledgeable lawyer with a proven reputation. However, with all the many lawyers in Halifax, it can be challenging to determine which is right for your needs.

Some of the steps you should take when considering what lawyer to choose for your legal needs include:

Read reviews and client testimonials that provide information about the lawyer and their services
Ask how much experience and success the lawyer has in handling long-term disability law and claims
Ask questions about their success rate in handling appeals and litigation
Look for a lawyer who is willing to provide regular updates regarding changes or progress in your case

What a Disability Lawyer Does for You

One of the most significant benefits of hiring a disability lawyer is that they will assist you with the claims or appeals process so you can focus on recovering. The legal process of obtaining LTD benefits can be complex and is best handled by an experienced lawyer. Hiring a lawyer familiar with disability law is the best way to pursue compensation and help you have the peace of mind you deserve after suffering a long-term disability.

Some of the services that a disability lawyer provides to clients include:

An evaluation of your case to determine if you meet the legal requirements to obtain LTD benefits
Assistance in filling out the insurance paperwork to start the claims process. Having a lawyer help you with paperwork will also ensure it is filled out correctly and turned in promptly, so you do not miss critical deadlines
Gathering key evidence to build a robust case
Acting as your legal advocate and negotiating with the insurers to obtain full and fair compensation for your claim
Assisting you with the appeals process, and if necessary, taking the case to court to obtain LTD benefits

What are the Important Financial Considerations to Keep in Mind Regarding LTD Benefits?

If you are seeking LTD benefits, it is also imperative that you consider financial considerations such as taxable income and how these factors can affect you. LTD or replacement income benefits generally pay 60% to 70% of the claimant’s gross income before injury. It is important to note that other factors can also affect how LTD benefits are calculated, such as the severity of the injury and any stipulations outlined in the insurance policy.

You should also know that much can depend on who paid the insurance policy premiums. For example, if your employer paid the premiums, they are generally taxed as employment income. Conversely, if you paid your premiums, any LTD benefits you receive are tax-exempt. If you and your employer shared the cost of premiums, the portion paid by the employer is usually taxable.

It is worth noting that although you are injured and have medical expenses and out-of-pocket costs, they do not play a role in determining LTD benefits. LTD benefits are meant to provide injured workers with income replacement and not cover medical expenses, typically covered through health insurance.

Understanding Lump Sum vs. Monthly Benefits

Injured workers eligible for LTD benefits may receive a lump sum or monthly payments. Each option has advantages and disadvantages.

Lump sum payment: A one-time payment of LTD benefits that effectively ends the injured worker’s relationship with the insurance provider. The lump sum reflects the total value of benefits the individual is eligible to receive. In some instances, employers do not withhold taxes from lump sum payments, so it is essential to keep this information in mind if LTD benefits are accepted immediately. However, many individuals enjoy the flexibility that a lump sum provides without the worry of being subject to an ongoing review from the insurance provider
Monthly payments: Recurring payments that continue for a specified period when you cannot work. One of the downsides of monthly payments is that beneficiaries are typically subject to ongoing reviews to determine eligibility. However, unlike lump sum payments, those who choose monthly payments usually receive a higher total payout

For more info, please see Do I Have To Pay Insurance Premiums While I’m On LTD?.

Call Our Halifax Long-Term Disability Lawyers Today

If you have questions about how you can obtain long-term disability benefits or have been denied benefits, you need a well-qualified lawyer to assist you with your legal needs. Nova Injury Law is a Halifax law firm dedicated to helping clients receive fair benefits. Our disability lawyers take pride in offering Halifax residents guidance with all aspects of their case. Contact Nova Injury Law today by calling (902) 707-3278 to schedule a free consultation. Our team is available 24/7 to provide legal help.