Receiving a serious medical diagnosis is never easy. If the symptoms of your medical condition make it impossible for you to work, receiving the diagnosis can cause even more anxiety and stress. People who have sustained disabling injuries or have developed chronic medical conditions and can no longer perform the duties of their job as a result may face great financial uncertainty.
When Canadian employees can no longer work because of their disabling medical conditions, long-term disability (LTD) benefits may provide them with an essential financial lifeline. Provided employees have the proper insurance coverage through their employer’s group plan or a privately held insurance policy, if eligible, their LTD coverage could replace between 60-70% of their normal wages.
In accordance with the Nova Scotia Human Rights Commission, employers are required to provide accommodations for employees with disabilities to the point of “undue hardship.” An employer cannot legally terminate a worker’s employment solely because of their disability. However, depending on the employee’s medical prognosis, if there is no likelihood of them being able to resume their position at work, their employer may, in fact, be able to end their employment contract.
However, even after a disabled worker’s employment has been terminated, they may continue to collect LTD benefit payments for as long as they are considered eligible. This applies both to workers who pay into their own privately held insurance policy and those who receive LTD coverage through their employer’s group insurance plan.
That said, if an employee collecting disability benefits loses their job, they will likely no longer be able to access their employer’s health insurance coverage. As a result, they may find themselves incurring additional costs for prescription drugs and other medical expenses.
Additionally, even though people may continue to collect LTD benefits after being let go from their jobs, their monthly benefit payments may not last indefinitely.
The Difference Between “Own” and “Any” Occupation
Workers who have sustained disabling physical injuries, chronic illnesses, or severe mental health issues that prevent them from working for a substantial period of time may be eligible to collect LTD benefits, even after their employment has been terminated.
That said, people who collect disability benefits are subject to the terms of their individual insurance policies. Different insurance policies have different eligibility requirements for LTD benefits, as well as different definitions of disability.
Some medical conditions that may qualify a person to collect LTD benefits include:
- Heart disease
- Back problems
- Chronic pain or complex regional pain syndrome (CRPS)
- Lupus or Lyme disease
- Psoriatic arthritis or fibromyalgia
- Bipolar mood disorder
- Post-traumatic stress disorder (PTSD)
- And possibly more
Even though these and other medical conditions may entitle a policyholder to collect LTD benefits according to their insurance plan’s definition of disability, after a predetermined length of time, an insurance plan may impose a stricter set of qualifying criteria on people collecting benefits. Oftentimes, policies are divided into the following two stages:
- Own occupation stage
- Any occupation stage
In the “own occupation stage,” in order to qualify for LTD benefits, a policyholder’s medical condition must prevent them from performing the duties of the job they held at the time of their diagnosis. According to the terms of most insurance plans, this stage lasts for the first two years of LTD coverage.
Once this two-year period has expired, an insurance policy’s eligibility requirements are usually adjusted to meet new criteria. In this new “any occupation stage” of coverage, in order to continue collecting LTD benefits, a policyholder’s medical condition must prohibit them from completing the tasks of any job, even if it is unrelated to their current position.
In the “any occupation stage,” insurance providers may reassess a disabled employee’s eligibility for LTD benefits based on their ability to perform the duties of other jobs. That means, after two years of receiving benefit payments, if an insurance provider believes a policyholder can work in another capacity, they may decide to terminate their benefits payments.
Other Reasons LTD Benefits May Be Terminated
Although people collecting LTD benefits may be able to continue receiving these payments after being fired from their jobs, typically insurance policies are subject to set term limits. Even if a policyholder continues to qualify for LTD benefits during the “any occupation stage” of their insurance plan, their coverage may be discontinued after a predetermined period of years, or until the recipient reaches a certain age.
Insurance providers may also require people collecting benefits to submit to frequent medical examinations. By closely monitoring the recovery process of disabled policyholders, insurers may find evidence to discontinue benefits payments. If an insurance provider determines that someone is physically able to return to work, they may terminate their monthly benefits payments.
Insurance companies have also been known to monitor benefits recipients’ social media accounts in an attempt to find evidence proving that their medical conditions no longer affect their ability to return to work.
If your LTD benefits payments were unfairly terminated, a Nova Scotia long-term disability lawyer may be able to help you appeal the insurance company’s decision.
How A Lawyer May Be Able to Help if Your LTD Benefits Have Been Terminated
Even though a disabled worker’s LTD benefits may extend beyond the date of their employment’s termination, insurance companies may find reason to prematurely terminate their benefits payments. If your disability payments have been unfairly discontinued, a Nova Scotia long-term disability lawyer may be able to provide you with assistance.
Depending on why the benefits payments were prematurely terminated, a lawyer may advise you to file an internal appeal directly through their insurance provider. With this course of action, a lawyer may be able to help you put together crucial medical evidence about your condition, including additional assessments from medical experts. Doing so may help prove the continued severity of your medical condition and illustrate its impact on your ability to perform any kind of occupation.
That said, insurance companies can take a long time to respond to internal appeals. People who rely on LTD benefits payments to pay their bills will most likely not have the time to wait on a new decision. Plus, submitting new medical evidence to your insurer may not alter their initial determination. After all the waiting involved, insurance companies may simply turn down your request for appeal.
That is why your lawyer may advise you to file a lawsuit against the insurance company for prematurely, unfairly terminated benefits payments. In these situations, your ability to continue collecting LTD benefits would be determined by the Courts, and not by your insurance company.
If the lawsuit is resolved in your favour, you may be awarded payments for:
- Previously denied benefits payments
- Legal fees
- Damages for mental stress experienced
- Punitive damages
- Aggravated damages
- And possibly more
Contact Preszler Injury Lawyers with Questions About Your LTD Benefits
If your employment was terminated while you were collecting disability and your benefits payments were unfairly terminated after the fact, Preszler Personal Injury Lawyers may be able to help you overturn your insurance company’s decision.
To review your case in a free, initial consultation, contact Preszler Injury Lawyers today or call us at 902-405-8282.