Provincial form
New Brunswick long-term disability — medical report
New Brunswick Social Development uses a medical report when someone on social assistance is being considered for long-term disability or extended benefits because of a prolonged impairment. This is not a private insurer’s LTD form, not CPP Disability, and not WorkSafeNB. Use the department PDF in the client’s package.
Provincial LTD is not insurer LTD
A Manulife or Canada Life long-term disability form asks about own-occupation and any-occupation under a policy. Social Development is asking whether this person has a prolonged medically documented impairment that limits the ability to earn a living under provincial rules. Do not paste an insurer restriction table into the provincial form and call it done.
Use the current Social Development medical. Names of streams and forms change. If the client only has a caseworker letter listing questions, answer those questions. Do not invent a form number.
WorkSafeNB is a different file
If the impairment is a work injury, they may still need this provincial medical and a WorkSafeNB report. Complete each. Entitlement at the board does not automatically answer Social Development, or the reverse.
Who completes it
The treating physician or nurse practitioner for the condition that limits work. If psychiatry or a specialist holds the real file, complete your part and name them. Do not certify a condition you have never assessed.
How to complete the medical
- Primary condition that stops or limits work, and secondary conditions that add to it.
- Onset, first treatment, and whether this has already lasted months to years.
- Functional limits: sitting, standing, hours, concentration, public contact, safety-sensitive work — with numbers.
- Treatment and residual restriction on treatment.
- Prognosis for return to any work you actually know about. Do not invent a job in a field you do not understand.
- Investigations that support the limit. A diagnosis of “back pain” with a normal exam and no function is a delay.
Worked example (fictional)
NB provincial LTD medical — recurrent depression
Fictional 46-year-old. Do not copy into a real Social Development form.
Primary: major depressive disorder, recurrent, currently moderate–severe. This episode from Nov 2025. Last competitive work: cashier, Jan 2026. Findings 2026-08-20: slowed, PHQ-9 19, cannot complete a 20-minute form without a break, sleep 4 h. No active plan for self-harm. Tx: bupropion XL 300 mg, counselling every 2 weeks (started April). Psychiatry wait-listed. R/L: cannot sustain a 4-hour customer-facing shift; attendance unreliable most weeks. Could not complete a two-week trial of reduced hours in March. Duration: this episode >8 months; history of two prior year-long episodes. Not a six-week sick note. I am the FP. This is not a WorkSafeNB form and not a private LTD APS.
Why the department asks again
- Using a private insurer LTD PDF instead of the provincial medical.
- No duration, or language that sounds like a one-week flu note.
- Restrictions that do not match the diagnosis.
- Missing practitioner identifiers.
- Copying an ODSP Health Status Report including Ontario program names.
Draft the NB disability medical from the visit
In Scribeberry, open Forms, search for New Brunswick long-term disability medical, or upload Social Development’s current PDF. Generate from the encounter and your notes, then edit every field before you sign. Scribeberry does not pre-map this form. You still review and sign. Scribeberry does not file with the Province of New Brunswick.
Frequently asked questions
Is this the same as a Sun Life or Manulife LTD form?
No. Private LTD follows the policy. This page is the provincial social-assistance medical. Upload the PDF you were actually given.
What about CPP Disability?
Separate application, separate medical report. A person can be on provincial disability and not on CPP-D, or the reverse. Complete the form in front of you.
Can I say they will never work again?
Only if the chart supports that. Prefer function and a review horizon. “Never” from a first visit for a treatable condition will be questioned.
Does Scribeberry submit this to Social Development?
No. Scribeberry helps you complete the PDF. The client or you return it to the caseworker. Keep a copy in the chart.
Forms
