If a serious injury, physical illness, or mental condition prohibits an employee from performing their job for a substantial period of time, provided they have the appropriate insurance coverage, they may be eligible to collect long-term disability (LTD) benefits. These monthly payments usually replace between 60-70% of a recipient’s normal income and may be available to people who are insured through their employer’s group plan, or who pay premiums for their own private insurance policy that covers long-term disabilities. This monthly source of income replacement can provide injured or ill employees with some stability during a financially precarious time in their lives.
However, even after eligible recipients begin collecting LTD benefits, for several different reasons, insurance providers may find cause to cease the payments. LTD benefits are often subject to term limits. That means that, depending on the terms of their insurance policy, even if a benefits recipient’s injury, physical illness, or mental health condition continues to prevent them from performing their jobs, their payments may be discontinued once the set term limit has been reached.
Policies may also have fluctuating definitions of “disability.” This means that, after a certain period of time, a medical condition that previously entitled a policyholder to collect LTD benefits may no longer be considered a disabling condition according to the stipulations of the insurance plan.
Insurance companies may also require benefits recipients to undergo frequent health assessments to monitor their medical condition. If an insurance provider determines that a benefits recipient has been making progress and responding well to medical treatments, they may decide that they are now physically able to return to work. If so, based on this determination, insurers may stop making monthly payments to the LTD recipient, even if the patient and their healthcare provider do not believe they are ready to return to the workplace.
If your long-term disability payments were unfairly terminated, a Nova Scotia long-term disability benefits lawyer may be able to help you fight the insurance company’s decision.
Own vs. Any Occupation
If a disabling physical injury, chronic illness, or serious mental health condition prevents a person from performing the duties of their job, they may be able to collect LTD benefits. However, eligibility requirements for LTD benefits vary between insurance policies. Even plans offered by the same insurance provider may be subject to different eligibility requirements for LTD benefits, and different definitions of disability.
An insurance plan’s definition of disability may change after a predetermined length of time. Often, new eligibility criteria must be met after a policyholder has received LTD benefits payments for two years. Policies are often divided into two stages: “own occupation,” and “any occupation.”
Initially, to qualify for LTD benefits, a policyholder with the appropriate level of coverage must be able to prove that their medical condition prohibits them from carrying out tasks required for the job that they had at the time of their diagnosis. This is referred to as the “own occupation” stage, wherein disability is defined in relation to the policyholder’s ability to perform their own job.
This definition is usually adjusted after a claimant receives LTD benefits for two years. In the “any occupation” stage of coverage, benefits recipients must be able to prove that their disability prevents them from working in any profession, if it is unrelated to their current line of work. Insurance providers may, therefore, 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 benefits payments, if an insurance provider believes a policyholder can work in another capacity, they may decide to terminate their benefits payments.
How Social Media Use Could Impact Your Benefits
While everyone should be cautious of what personal information they share on social media, recipients of LTD benefits may wish to take extra precautions. Insurance companies are known to follow benefits recipients on social media. They may misconstrue photos and status updates or take them out of context to justify prematurely terminating LTD benefits.
Facebook posts, Instagram photos, TikTok videos, and tweets rarely characterize the full experience of the person sharing status updates. However, when taken out of context, smiling vacation photos, upbeat status updates, and even motivational quotes can be used by an insurance company to prove that the benefits recipient in question is no longer eligible for payments. This is especially true for policyholders who receive LTD benefits for mental health conditions, such as depression. Insurance companies may dispute and discontinue a recipient’s payments if they look too happy on social media.
The best way to ensure that your social media presence will not negatively impact your LTD benefits is to avoid using social media altogether. However, for those who do not wish to stop using their favourite platforms, some behavioural changes on social media may help them avoid prematurely terminated benefits. These actions include:
- Avoiding discussions about injuries on social media
- Adjusting privacy settings
- Denying friend requests from anyone they do not personally know
- Requesting that friends cease sharing photos or videos of them on their own social media accounts, even if the benefits recipient is not tagged
- No longer posting selfies, videos, or visual representations of their injuries
- And possibly more
Even if LTD recipients have the strictest privacy settings and only intend to share their content with close friends and family, their social media posts can still be presented as evidence in court. It is important to be mindful about what personal information benefits recipients share online and consider how even innocent posts might be misconstrued or used against them by an insurance provider.
Fighting Unfairly Terminated Benefits
If your disability payments have been unfairly and/or prematurely terminated, a Nova Scotia long-term disability lawyer may be able to provide you with assistance.
Depending on why the benefits payments were 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 wrongly discontinuing 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
- And possibly more
Call Preszler Injury Lawyers Today
If a severe medical condition such as an injury or illness continues to prevent you from earning a living, and your claim for long-term disability benefits has been unfairly or prematurely terminated, Preszler Injury Lawyers may be able to help you fight the 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.