In order to have a claim accepted, or an ongoing claim continue, you must be disabled as defined in the Plan Document. In the majority of cases claims are accepted and benefits are paid. However, if it is determined you are not entitled to benefits you will receive a written decision, including reasons and, where appropriate, how to initiate a review of the decision.
This right of review / appeal is your only right of appeal, as appeal through the courts is excluded by the appeal provision in the LTD Plan Document, which states:
Adjudication Right of Review
6.(1) When the Administrator has ruled that an employee is not disabled, said decision may not be challenged by an action in the courts, but may be appealed through the Board of Trustees of the Nova Scotia Public Long Term Disability Plan, who will be responsible to schedule an appeal hearing in accordance with Section 6(3).
6.(2) The decision resulting from the appeal hearing shall be final and not subject to further review.
6.(3) An Appeal System has been established with the following provisions:
(a) The appeal will be limited to determining whether or not the employee is disabled, as defined herein.
(b) The appeal will be heard by an Appeal Board established by the Board of Trustees.
(c) The appeal will be conducted pursuant to Guidelines established by the Board of Trustees pursuant to this Plan.
(d) The employee shall bear his or her own costs of the appeal; however, if the appeal is successful, the employee shall receive costs as permitted by the Appeal Guidelines.
(e) Any appeal is to be initiated no later than 30 days following final denial of the employee's claim by the Administrator.
For additional information please see:
Please see Appeals Process FAQ's for answers to commonly asked questions. Should you have additional questions, please contact our office.