In British Columbia, long-term disability claims are typically governed by the Insurance Act and the specific terms of insurance policies. Teachers often have coverage through their employer’s group insurance plan which outlines the eligibility criteria, the definition of disability, and the process for making a claim. The definition of “disability” can vary significantly between policies and often an insurance plan will require that the individual be unable to perform their own occupation for the first two years of disability and thereafter that they be unable to perform any occupation in order to qualify as “disabled” under the policy.

Common Injuries & Conditions Leading to Teacher Disability

Performing your job as a teacher can have different requirements depending on the age of your students and the subject matter(s) you teach.

As with anyone working a job, teachers can be subject to the same illnesses and conditions that can lead to disability for anyone else, such as a diagnosis of epilepsy or arthritis. However, unlike other employment, teachers (depending on the area in which they work) can be subject to extremely demanding physical and mental duties, whether resulting from trying to keep up with young children and frequently having to bend and lifting heavy weight, or from dealing with a work environment where they have to focus and use their thought process for teaching older students. Due to this, many teacher long-term disability claims have to do with claims relating to orthopedic injuries, soft tissue injuries, concussions, and psychological disability such as anxiety, depression and PTSD.

Why Teacher Long-Term Disability Claims Get Denied

Each denial of long-term disability benefits is specific to the facts of the claim and the wording of the particular insurance policy, however some of the more common reasons teacher long-term disability claims are denied are:

• Policy Exclusions – Insurance policies often contain specific exclusions that can lead to denied claims. For instance, certain pre-existing conditions or mental health issues may not be covered. Teachers should carefully review their policy to understand what type of disability is covered and what might be excluded, as this knowledge will be essential during any claim or appeal process.
• 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 teacher’s condition. Teachers must ensure their healthcare providers document their limitations and the necessity for long-term disability.
• Failure to Follow Treatment Plans – Insurers may deny claims if they believe the claimant has not adhered to prescribed treatment plans. Teachers must ensure they follow all medical recommendations and keep thorough records of their treatments and compliance. Not following your doctor’s advice can lead to a denial of long-term disability benefits.

Teacher Long-Term Disability Denial Lawyer

Being a teacher can already be a challenging profession, and having to challenge a denial of long-term disability benefits you should rightfully be entitled to is something no one wants to have to deal with.

If you or someone you know is a teacher and has been denied their legitimate 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 teachers are part of a union, and it is important to ensure that the specific union collective bargaining agreement allows you to bring a lawsuit to enforce your rights to your long-term disability benefits, as some unions prohibit their members from doing so. The experienced lawyers at Taylor & Blair LLP can review your collective bargaining agreement to help determine if you are able to bring your claim in the Supreme Court of British Columbia.

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. You are entitled to a copy of your file materials from the insurance company 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.