Long-term disability benefits can provide a form of financial relief to individuals whose serious medical conditions prevent them from working. If a severe injury, physical illness, or mental condition prevents an individual from returning to their workplace for a substantial period of time, long-term disability plans might compensate 60-70% of the recipient’s regular wages. This form of financial compensation often provides crucial support to individuals whose medical conditions prohibit them from earning their salaries while they endure protracted periods of recovery.
Eligible employees covered by their company’s group insurance plan and individuals who hold private insurance policies may be able to collect long-term disability benefits. Typically, long-term disability benefits only become available after policyholders have exhausted all other compensatory options available to them, such as paid sick leave, vacation time, and short-term disability benefits.
Whether or not an individual’s medical condition entitles them to long-term disability benefits depends on the terms of their individual policy. That said, some medical conditions that may qualify individuals to collect long-term disability 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
Insurance companies can deny claims for long-term disability benefits for a variety of reasons. That means that, even if your application for benefits included thorough medical evidence substantiating your claim, an insurance provider may still decide to withhold benefits payments. If your claim for benefits was unfairly denied, a Nova Scotia long-term disability lawyer may be able to review your claim, and explain any options for legal action that may be available to you.
Common Reasons Claims for Long-Term Disability Benefits Are Denied
One of the most common reasons why claims for long-term benefits are denied is missing or insufficient medical documentation. If the medical records provided by claimants to their insurance providers do not adequately illustrate the full extent of their disabilities, or prove that they have been receiving regular, ongoing medical treatment for their conditions, their claims may be denied. Supporting documents like medical records, physician testimonies, and the results of medical examinations may help applicants substantiate their claims for long-term disability benefits.
Oftentimes, benefits claims in Nova Scotia are denied because an applicant’s medical condition does not fall under their policy’s definition of a disability. Eligibility requirements for long-term disability benefits vary between insurance policies. This means that, even though an individual may be unable to perform the duties of their job as a result of their medical condition, if their physical injury, illness, or mental health issue does not meet the policy’s definition of a disability, their claim for benefits could be denied.
Additionally, individuals pursuing long-term disability benefits for mental illnesses often face increased scrutiny from their insurance providers. Unlike physical ailments, it can be difficult to prove mental health conditions with objective evidence. In these cases, insurers may claim that they cannot substantiate an applicant’s subjective emotional experience, and therefore, deny their claim for benefits.
Furthermore, depending on the terms of your policy, if employees are unable to work because of an illness or injury that was caused by a pre-existing condition, they may not be eligible to collect long-term disability benefits. Pre-existing conditions are medical conditions sustained by an individual before enrolling in their current insurance plan. Often, insurance policies exclude disability coverage for illnesses or injuries caused by pre-existing conditions. That being the case, insurance policies with pre-existing condition exclusions may offer an elimination period, meaning that policyholders with pre-existing conditions must be enrolled in their insurance plan for a set period of time before they become eligible to claim long-term disability benefits.
What To Do if Your Claim Has Been Denied
Appealing a denied benefits claim can be a difficult process for seriously ill or injured claimants. Many denied applicants simply walk away from their claims, rather than engage in what could be a long, complicated appeals process. In these circumstances, a Nova Scotia long-term disability lawyer may be able to pursue accountability and financial restitution on their client’s behalf, so they can focus on their recovery.
If your claim for benefits has been unfairly denied, a Nova Scotia disability lawyer may be able to help you appeal the insurance company’s decision.
That internal appeal process can take a very long time, and may not result in the insurance company changing their initial decision. That being the case, if benefits payments were unfairly denied or prematurely terminated, a disability lawyer may be able to file court action in the form of a lawsuit against the insurance company. By pursuing tort action against an insurance provider for an unfairly denied benefits claim, the decision to grant long-term disability benefits would be determined by a judge and not the insurance company.
How a Lawyer Can Help Appeal Denied Claims for Long-Term Disability Benefits
The assistance of a long-term disability lawyer may prove crucial when appealing an insurance company’s decision to deny a claim for benefits.
If your claim for long-term disability benefits was denied because of missing records or insufficient proof of disability, a Nova Scotia disability lawyer may be able to help compile a thorough portfolio of medical evidence to include in your appeal. If your claim was denied because your insurance company believes your disability was caused by a pre-existing condition, a disability lawyer may be able to review your medical history and compile medical evidence to try disproving their determinations.
A long-term disability lawyer may present various forms of evidence in order to try substantiating your claim. If successful, a Nova Scotia disability lawyer may be able to help you recover damages 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 prohibits you from working, and your claim for long-term disability benefits has been unfairly denied, Preszler’s long term disability lawyers may be able to help you appeal 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.