You must be totally disabled as defined in our Plan document in order to have an LTD application accepted, or an ongoing claim continue.
However, if your application or ongoing claim is declined, our claims administrator Manulife will write to you with their decision, including the reasons.
You have the right to appeal the decline decision and/or initiate a review of the decision.
This right of appeal/review 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
3.(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 3(3).
3.(2) The decision resulting from the appeal hearing shall be final and not subject to further review.
3.(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. (Amended July 18, 2007)
(b) The appeal will be heard by an Appeal Board established by the Board of Trustees. (Amended July 18, 2007)
(c) The appeal will be conducted pursuant to Guidelines established by the Board of Trustees pursuant to this Plan.(Amended July 18, 2007)
(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. (Amended July 18, 2007)
(e) Any appeal is to be initiated no later than 30 days following final denial of the employee's claim by the Administrator. (Amended July 18, 2007)
Please see Appeals Process FAQ's, or should you have additional questions, please contact our Director, Claims Management, Theresa Williams.