Nova Scotia Disability Claims: Why Can they be Denied?

An employee may be eligible for long-term disability benefits if they have a mental disorder, physical condition, or permanent injury that hinders the employee’s work performance. It is highly likely that these employees can collect long-term disability benefits, especially if their employer’s group plan covers them. Employees that have their own private insurance policy with paid current premiums can also be eligible to receive long-term disabilities.

The Canada Pension Plan provides compensation to individuals with a disability that prevents them from successfully earning a living. Policyholders can qualify for long-term disability benefits because of a medical condition that demands a prolonged absence from work. The individual can get these benefits only after all other means of income, such as vacation time, sick leave, and short-term disability benefits have been used. Long-term disability benefits can provide between 60% to 70% of the employee’s monthly income, giving the individual the opportunity to live a financially stable life.

The concern with most workers filing for disability claims is that there is always the possibility that they can deny their claim. Insurance providers can deny disability claims on valid legal grounds. Let’s look at some of the most common reasons for disability claims being denied in Nova Scotia.

Medically Qualifying For Disability Benefits

Every insurance policy has unique eligibility requirements for policyholders that claim long-term disability benefits. In real life, different insurance policies issued by the same insurance company will have a different definition of “disability” in each one of their policies. Not being able to meet the insurance policy’s description of disability is one of the most common reasons for a disability claim denial. The employee might not perform their duties because of a physical or mental handicap, but they cannot claim benefits for the long-term disability.

In most cases, the insurance provider’s precise definition of disability will determine if the employee receives disability benefits. Some of the most common health conditions that can qualify for disability benefits in Nova Scotia are:

• Back problems
• Bipolar mood disorder
• Cardiovascular disease
• Chronic pain or complex regional pain syndrome (CRPS)
• Depression
• Lyme disease
• Post Traumatic Stress Disorder (PTSD)
• Psoriatic Arthritis (affects interphalangeal joints)
• Several other physical conditions

The policyholder can not receive any sort of disability benefits unless they meet the medical description of disability according to the insurance provider. The definition includes any physical or mental conditions that do not allow the employee to perform their employer’s contractual duties. Policyholders receive disability benefits for the first two years after the accident based on this condition. Some insurance providers refer to policyholders in their “own occupation” stage during this time.

According to the insurance provider, the policyholder’s condition after two years takes a turn for the worse. Now the policyholder can NOT complete ANY task, whether it is associated with their work or not. Remember, different insurance providers use different terminology, and sometimes getting a qualified expert opinion is the best option.

Inadequate Documentation To Support Your Disability Claim

All insurance providers require policyholders to submit medical documentation to support their disability claim before they can begin receiving any disability benefits. All the documents must be authorized by the proper medical or legal authorities. Medical records, lab results, and a doctor’s declaration are just some documents that corroborate a claim for long-term disability benefits. Failure to provide all the documents or documentation with the proper verification can result in your disability claim being denied.

Your claim will be denied if the documents you provide do not match the medical description of disability based on your insurance provider or the documents fail to display the full extent of your disability. Insurance providers require claimants to show that they are under constant physical and medical supervision by a qualified general physician to increase the chances of their claim being approved. If your disability claim has been denied due to a lack of supporting documentation, you can reverse the decision by presenting the appropriate documentation.

Pre-Existing Health Conditions & Meeting Insurable Interest Demands

Potential policyholders must meet the insurance provider’s demands before the insurance policy becomes active. A majority of insurance providers require their clients to declare any pre-existing medical conditions before the policy comes into effect. Potential policyholders must supply insurance providers with authorized documentation in support of a new insurance policy to become active. These documents often include the latest health reports to ensure that the would-be policyholder does not already have any of the conditions listed in the policy.

Most insurance providers do not allow their policyholders to file a disability claim for a pre-existing medical condition. Some insurance providers give new policyholders limited coverage during the initial coverage period. The policyholder must hold the policy by regularly paying scheduled premiums for a certain time before they can file a claim.

Disability Claim Denial & The Best Action Strategy

Most insurance companies do not divulge specific information about the status of disability claims to the public. But it is no secret that most claims for long-term disability benefits in Canada are not accepted. According to the legal process, the insurance provider must provide the policyholder with a written rejection of their disability claim.

The rejection contains the exact reason policyholders are denied long-term disability benefits. Policyholders can appeal the insurance company’s decision if they believe their claim was wrongfully denied. Such policyholders must provide additional documentation to support their justification.

How Much Disability Benefits Can You Get In Nova Scotia?

Permanent employees can get monthly disability benefits equal to 70% of their gross monthly salary. The long-term disability benefits continue until any of these stipulations applies:

• You regain your health and recover from the disability. Now you can continue working
• You are 65 years of age
• You are 60 years or older with 30 years of pensionable service in the Nova Scotia Health Employees’ Pension Plan
• You decide to take an early retirement based on the Nova Scotia Health Employees’ Pension Plan
• The policy expires

Always consult your insurance provider to get pertinent information regarding your policy.

Consulting Professional Disability Claims Advisors In Halifax

Policyholders that punctually pay their premiums each month may not be aware of all the intricacies of a long-term disability claim. McIver Insurance has qualified disability claim advisors in Halifax, Nova Scotia to help steer your disability claim in the right direction. With their expertise, you can increase your chances of getting your long-term disability claim approved.