Nursing is one of the most demanding professions, both physically and emotionally. Nurses often face long hours in high-stress environments, and a physical toll of caring for patients. In British Columbia nurses have long lacked the support they deserve, especially since the Covid-19 pandemic, and it has been taking a toll on the profession as a whole. While steps are being taken to address the difficult working conditions nurses in BC are subject to a new nurse-to-patient ratio for many hospital settings.
The reality is that nursing is a difficult job that can result in the need for nurses, despite their dedication, to access their long-term disability benefits for a variety of reasons. Unfortunately, claims for long-term disability benefits are frequently denied, leaving nurses in precarious financial situations. Understanding the reasons for these denials and how to navigate the appeals process is crucial for nurses seeking the support they deserve.
Common Injuries & Conditions Leading to Nurse Disability
There is no “one size fits all” description of the duties and work conditions that a nurse can find themselves in and as such there is no limit to the type of injuries and conditions that can lead to nurse disability.
As with any employed group nurses are subject to the ailments and conditions that can lead to disability in others, such as a diagnosis of cancer or a stroke. However, unlike other employment, nurses (depending on the area in which they work) can be subject to extremely taxing physical and psychological duties, whether resulting from physically manipulating patients and frequently bending and lifting heavy amounts of weight, or from dealing with a psychological toll of dealing with patients with mental health conditions, catastrophic injuries, or in palliative care. Due to this many nurse long-term disability claims have to do with claims relating to soft tissue injuries, fibromyalgia, and psychological disability such as anxiety, depression and PTSD.
Why Nursing Long-Term Disability Claims Get Denied
Each denial of long-term disability benefits is specific to the facts of the case and the wording of the particular insurance policy, however some of the more common reasons nursing long-term disability claims are denied are:
- Insufficient Medical Evidence – One of the primary reasons for denial is a lack of adequate medical documentation. Insurers require comprehensive medical records that clearly demonstrate the severity and impact of the nurse’s condition. Nurses must ensure their healthcare providers document their limitations and the necessity for long-term disability.
- Policy Exclusions – Insurance policies often contain specific exclusions that can lead to denial. For instance, certain pre-existing conditions or mental health issues may not be covered. Nurses should carefully review their policy to understand what is included and excluded, as this knowledge will be essential during any claim or appeal process.
- Failure to Follow Treatment Plans – Insurers may deny claims if they believe the claimant has not adhered to prescribed treatment plans. Nurses must ensure they follow all medical recommendations and keep thorough records of their treatments and compliance. It is not uncommon for health care professionals to be reluctant to admit when they need care themselves, and sometimes even more reluctant to engage in a system they work in to access that care. Oftentimes this can lead to a denial of long-term disability benefits.
Nursing Long-Term Disability Denial Lawyer
If you or someone you know has been denied their legitimate nursing long-term disability claim, the experienced insurance denial lawyers at Taylor & Blair LLP can help make sure the insurance company pays out the benefits that are owed.
Many nurses are part of a union, and it is important to ensure that the specific union rules allow you to bring a lawsuit to enforce your rights to your long-term disability benefits. The experienced lawyers at Taylor & Blair LLP can review your collective bargaining agreement to help determine if you are restricted in bringing forth a lawsuit.
Prepare for the Denial Claim Review
To help expedite a review of your claim, please have a copy of your long-term disability denial letter, a copy of your long-term disability policy and, ideally, a copy of your file with the insurance company. Your file materials with the insurance company belong to you and your insurer will provide you with them if you request a copy. If you haven’t already requested a copy of your file materials after your long-term disability was denied, do so today, as your lawyer will need your insurance file to properly pursue your claim for long-term disability benefits.
There are strict timelines in which you have to bring a lawsuit to enforce your rights to long-term disability benefits. Contact the lawyers at Taylor & Blair LLP today for a free consultation.