A long term disability New Brunswick claim replaces part of your income when illness or injury stops you working. The policy sets the rules, the insurer decides the claim, and the insurer has a financial reason to say no. This page explains how the policies work, why claims are denied, what changes at the two-year mark, and how a denial is challenged in court.
Valid claims are delayed, questioned and denied without good reason. That is common, not exceptional. Knowing how the system works is the strongest tool a claimant has.
A Long Term Disability New Brunswick Policy Is a Contract That Replaces Part of Your Income
It is a contract that pays a portion of your income if you cannot work. Most people in the province have it through an employer’s group benefits plan, usually administered by a national insurer. Business owners and contractors sometimes buy individual policies.
Whichever way it was bought, the policy wording governs. It sets the percentage of income paid, usually a share of pre-disability salary up to a monthly maximum, whether the benefit is taxable, and what other income is deducted. Every policy has an elimination period, the waiting period before benefits start. Its length is in the policy, so read yours.
During that wait, people rely on short-term disability, sick leave banks or Employment Insurance (EI) sickness benefits. Once the elimination period ends, monthly long-term payments are supposed to begin.
Coverage Turns on Function, Not Diagnosis
The test is not the diagnosis but how the condition affects your ability to do your job. Insurers minimise the severity of a condition to avoid paying. The policy covers a wide range of physical and psychological illness.
Physical injury is the leading cause of long absences. Serious trauma leaves chronic pain, mobility limits and an inability to sit or stand for long. Someone with a catastrophic injury usually needs a car accident lawyer and a disability lawyer working the same file.
Physical conditions that commonly succeed:
- Spinal cord injuries and chronic back pain.
- Traumatic brain injury and persistent concussion.
- Advanced cancer and the effects of chemotherapy.
- Autoimmune disease such as multiple sclerosis or rheumatoid arthritis.
- Heart disease, stroke and other cardiovascular conditions.
Mental health conditions qualify equally, but insurers scrutinise them harder because there is no x-ray or blood test, and they call them subjective.
Mental health conditions that commonly succeed:
- Major depressive disorder, including treatment-resistant depression.
- Severe anxiety and panic disorders.
- Post-traumatic stress disorder (PTSD).
- Bipolar disorder and other mood disorders.
- Burnout and chronic psychological stress that removes functional capacity.
Long Term Disability New Brunswick Applications Need Three Forms
The application is three forms, and a missed deadline or an incomplete form triggers a denial.
The Employee Statement is yours. It asks for your job duties, your condition and how the symptoms stop you working. Be honest and be specific about daily limitations.
The Employer Statement is completed by your employer’s HR department. It confirms your employment, salary and the physical and mental demands of the role. Where it contradicts your statement, for example on how much lifting or travel the job involves, the insurer notices and asks why.
The Attending Physician’s Statement is the one the insurer weighs most. Your family doctor or specialist completes it. A note saying you are “unfit for work” is never enough. The doctor must give the diagnosis, the treatment plan and your specific functional limitations, with objective evidence.
Insurers Deny for Lack of Objective Evidence, Exclusions and Surveillance
Insurers are for-profit, and denial is cheaper than payment. The common grounds:
Lack of objective evidence. Insurers want MRI results, CT scans or psychiatric assessments. A condition that is hard to measure, such as chronic fatigue or fibromyalgia, will be fought.
Pre-existing condition exclusions. Many group policies exclude a condition you were treated for shortly before coverage began. Insurers audit past records looking for one.
Surveillance. Insurers hire investigators to film you leaving the house, carrying groceries or driving, and read your social media. A few seconds of footage becomes the argument that you can work.
Denial letters also cite failure to follow recommended treatment, missed form deadlines, disagreement between the insurer’s doctors and yours, an assertion that you could do modified duties or a different job, and vague documentation from your medical team.
The Definition of Disability Changes at the Two-Year Mark
Almost every policy changes its definition of “total disability” after 24 months.
For the first two years the test is “own occupation”: you qualify if you cannot do the essential duties of your own job. A surgeon with damaged hands qualifies even if they could work as a greeter.
After two years the test becomes “any occupation”: benefits continue only if you cannot do any job suited to your education, training and experience.
Insurers begin building the file for the transition months in advance. Around the eighteen-month mark, expect a request for updated medical forms, a functional capacity evaluation and sometimes an independent medical examination. Insurers use the transition to end claims. They hire vocational evaluators to identify lower-paid, less demanding jobs they say you could do. The firm has fought many of those terminations.
A Denial Is Answered with a Lawyer, Not the Internal Appeal
Act quickly. The denial letter will invite you to use the insurer’s internal appeal and submit more medical evidence. That appeal is reviewed by the same insurer that denied you. Reversals without legal pressure are rare, and months spent on it use up the limitation period.
Get a lawyer instead. The lawyer takes over contact with the adjuster, obtains the full claim file, and finds what evidence is missing or misread. Often the gap is a treating specialist who was never asked for a report, or a functional limitation the family doctor described in the chart but not on the insurer’s form.
The Lawsuit Runs From Statement of Claim to Mediation
When the appeal fails, the next step is a lawsuit against the insurer under the provincial court rules.
It begins with a Statement of Claim setting out the disability, the breach of the insurance contract and the general and special damages claimed.
Documentary discovery follows. The insurer must produce its whole internal claim file, which often contains the adjusters’ notes and internal messages that show how the denial was reached.
Then the Examination for Discovery, where the insurer’s lawyer questions you under oath about your health and history. Your lawyer prepares you and sits beside you. The insurer’s representative is examined too, on how the claim was assessed and why it was denied.
Before trial the parties go to mediation with a neutral mediator. Most disability lawsuits in the province settle there.
The Insurance Act, the Rules of Court and the Limitation of Actions Act Govern the Claim
A long term disability New Brunswick claim is governed by the provincial Insurance Act, which sets how insurers must operate and handle claims. The Rules of Court set the timelines and evidence rules for the lawsuit. Both are on the Government of New Brunswick website.
The limitation period is the critical date. Under the Limitation of Actions Act, the general period is two years from the day the claim is discovered, and some policies contain wording that tries to shorten it. Miss the date and the right to sue is gone. Calculating it is not always simple, so get advice at once.
CPP Disability, Section B and Workers’ Compensation Are Deducted or Paid First
Most policies deduct other income. Almost every group policy requires you to apply for Canada Pension Plan Disability (CPP Disability), and if you are approved the insurer deducts that amount from its monthly payment.
If a motor vehicle collision caused the disability, Section B accident benefits, the no-fault medical and income replacement benefits in every provincial auto policy, also apply. The priority between the auto insurer and the disability insurer is a contested question.
Workplace injuries go to Workers’ Compensation first, and the disability policy offsets whatever the workplace safety board pays.
The Case Is Won on Objective Medical and Vocational Evidence
A lawsuit against an insurer is won on medical evidence, not on your own account of pain or fatigue.
The firm obtains your complete medical history and reads it for the objective evidence the adjuster ignored or minimised: clinical notes, surgical reports, prescription histories, specialist referrals.
Where the family doctor’s opinion is not enough, the firm arranges an assessment by an independent specialist. Those independent medical examinations (IMEs) give the court the objective proof it needs, and they answer the insurer’s own IME on equal terms.
Vocational evaluators and occupational therapists run functional capacity evaluations that measure physical and cognitive limits and show whether you can do your own occupation or any occupation.
The Firm Litigates Disability Claims in Every Atlantic Province on a Contingency Fee
The firm litigates disability claims across Atlantic Canada from offices in Moncton, Halifax, Charlottetown, St. John’s and Saint John. Regional details are on the Moncton office page and the locations page. It knows the local medical systems, the provincial courts and the regional adjusters.
Every personal injury and disability claim is on a contingency fee: no win, no fee. No retainer, no hourly bills. The firm funds the medical experts and court filings and is paid only from a settlement or verdict.
A Successful Claim Recovers Arrears, Reinstatement and Sometimes Punitive Damages
A wrongful denial threatens the household’s survival. A successful claim can produce several kinds of payment.
Arrears: every monthly payment withheld since the denial, often with interest.
Reinstatement: ongoing monthly benefits for as long as you remain disabled. In some cases the firm negotiates a lump-sum buyout of the policy’s future value.
Aggravated or punitive damages: where the insurer acted in bad faith or with malice, courts occasionally award them as punishment. They are rare.
Delay Weakens the Case and Shortens the Limitation Period
The longer a denial stands, the harder it is to reverse and the closer the limitation date comes.
If your long term disability New Brunswick claim has been denied, the firm reviews the denial letter and the medical file and sets out your options. It handles the legal work while you handle your recovery, and holds the insurer to the contract it signed.
For the full scope of the practice see the long-term disability lawyer page and the New Brunswick long-term disability lawyers page. The firm takes the case to trial if the insurer will not settle fairly.
FAQ
Can I Be Fired While on Long Term Disability in New Brunswick?
An employer cannot fire you for being disabled; that breaches human rights legislation. But if the condition permanently prevents you from returning to your job, the employment contract may eventually be treated as frustrated. If you are terminated while disabled, get advice at once to protect your insurance rights and whatever the employer owes you on termination.
Do I Have to Apply for CPP Disability If I Am Receiving Private Benefits?
Yes. Almost all group policies require it, and the insurer deducts the CPP amount from its payment. Refuse to apply and the insurer may suspend your benefits.
How Much Does It Cost to Hire a Lawyer to Fight a Denial?
Nothing upfront. The firm works on a contingency fee, a pre-agreed percentage of the settlement or award.
Can the Insurance Company Force Me to See Their Doctor?
Yes. Most policies allow the insurer to request an Independent Medical Examination (IME), and refusing lets it terminate benefits. A lawyer can review the request to confirm the doctor is qualified and the exam is fair.
What Happens If My Benefits Are Cut Off at the Two-Year Mark?
The definition changes from “own occupation” to “any occupation” at 24 months, and insurers use it to end claims by arguing you could do an easier job. You can challenge the termination by proving you cannot perform any suitable occupation.