It is surprisingly frequent for claimants to be initially denied disability benefits by their insurer. More surprisingly: insurance companies may not give you a full picture of why they denied your claim.
A disability claim may be denied because the insurer feels you have not proved the severity of your injury. Or it may simply be denied because of small errors in your application. It is crucial that you have a long term disability lawyer to ensure your claim is comprehensive and makes use of all legally relevant details.
Brampton Disability Cases in the News
CLAIMANT AWARDED AGGRAVATED DAMAGES AFTER LONG-TERM DISABILITY DISPUTE
Long-term disability coverage exists to provide Brampton individuals with an income when they become disabled due to an injury or illness and are therefore unable to earn an income and pay their expenses. Unfortunately, people of any age can develop a disability and disabilities often last many months or years. In fact, the Canadian Life and Health Insurance Association tells us that, on average, one in three people suffer a disability of greater than 3 months, before the age of 65.
The following are not uncommon circumstances that result in disability for many Brampton individuals.
A severe injury resulting from a motor vehicle accident requires months of recovery
Cancer patient recovers from chemotherapy and radiation treatments
Back or wrist injury suffered in a fall prevents accident victim from working for months
A worker employed in a physically demanding job requires months to rest after heart surgery
Cycling accident results in broken shoulder preventing the victim from driving and working
Long-term disability plans typically replace 60-85 per cent of a person’s income. Many employers offer long-term disability coverage, but if unavailable through work, Canadians can also get coverage through an individual plan, an association or government plans.
After paying for a long-term disability insurance plan, we assume that we will be covered in the event of a circumstance that prevents us from working. That’s the way it should work, however, unfortunately it is not always the case. Sometimes, the insurance provider for a long-term disability plan disputes a legitimate claim for coverage, which can have a devastating impact on the life of a person who is already struggling physically, emotionally and financially as a result of their disability. These were the circumstances that led a woman to seek aggravated and punitive damages against her disability insurance provider, in Cross v. Canada Life Assurance Co. Ltd., after she was denied deserved benefits for some time.
The Cross case concerns a 57-year-old Vaughan woman who began to experience considerable pain while employed at Canadian Tire, which prevented her from continuing to work. In May 2000, she completed a “Claim for Managed Disability Form” and submitted it to her employer, who requested advice from Canada Life, their group insurance provider. At that time, the plaintiff was diagnosed by two separate doctors; one of whom diagnosed neck and shoulder pain, and arthritis; and the other, her family physician, indicated that she could not do lifting or prolonged sitting and may need a different job. Based on the information from the claimant’s family physician, in August 2000, Canada Life informed the woman that, in their opinion, she is not totally disabled from work duties as the diagnosis indicates she may need a different job. As a result of this assessment, Ms. Cross consulted with a lawyer to represent her in further dealings with the insurer.
In November 2000, the claimant submitted a more extensive “Attending Physician’s Statement for Disability Benefits” which indicated that she was suffering from a herniated cervical spine disk, shoulder and neck pain, and rheumatoid arthritis. The physician’s report also indicated that she was unable to use her fingers and hands on a repetitive basis and he wasn’t sure when she could return to work. Canada Life acknowledged receipt of Ms. Cross’ long-term disability claim in November and indicated that they would need to complete an assessment. They also requested additional medical documents and in mid-December, an X ray was forwarded to the insurer. Finally, in mid-January 2001, after having the plaintiff’s application reviewed by their medical consultant, Canada Life informed Ms. Cross that the limited information they had received did not support a disability.
On January 29th, Ms. Cross commenced a lawsuit against Canada Life. At the Examination for Discovery in April 2001, some additional medical reports were made available to the insurer; however, Ms. Cross’s lawyer did not produce all of the requested reports and clinical notes written by the claimant’s physicians until July, arguing that they were irrelevant. After receiving all the medical documents, a rheumatologist employed by Canada Life assessed the information in late August, and as a result of his report, Canada Life finally approved Ms. Cross’ long-term disability application and paid all her past-due benefits, including interest, on November 2, 2001.
After receiving her owed benefits, Ms. Cross commenced an action for aggravated and punitive damages, which alleged that due to the delay in receiving disability benefits, she had to cash in her RRSPs and experienced other difficulties and damages. In his consideration of the facts of this case, the Ontario Supreme Court judge noted that some of the delay in approving benefits was exacerbated by the adversarial approach taken by the claimant’s lawyer in refusing to produce certain medical information. However, the court concluded that, regardless of this fact, Canada Life did not process her application on a timely basis; they could have requested their own medical information much earlier; and the substantial delays caused by the insurer constituted a breach of duty and lack of good faith in dealings with Ms. Cross.
The standard for awarding punitive damages is quite high and citing Whiten v. Pilot Insurance Co., requires “malicious, oppressive and highhanded behaviour” on the part of a defendant. The actions of Canada Life were deemed to fall short of this standard and therefore, punitive damages were not granted in this case. However, the judge concluded that Ms. Cross was entitled to aggravated damages, based on Clarfield v. Crown Life Insurance Co., wherein it was stated that aggravated damages may be awarded where the plaintiff demonstrates an actionable wrong, such as a breach of the insurer’s duty of good faith. For her financial loss resulting from having to withdraw RRSP funds, the judge awarded the plaintiff $11,000. She was awarded an additional $18,000 for emotional distress and anxiety due to the drawn-out delay in payment of benefits.
If you have been denied owed long-term disability benefits, call a skilled disability insurance lawyer at Kotak Law. We have considerable experience and success in representing Brampton clients whose disability insurance was denied and will work zealously to obtain owed benefits for you.
Source: the Canadian Life and Health Insurance Association Inc. (CLHIA): https://www.clhia.ca/domino/html/clhia/clhia_lp4w_lnd_webstation.nsf/resources/consumer+brochures/$file/brochure_guide_to_disability_eng.pdf
Disclaimer: This article is intended to supply general information to the public. We make every effort to ensure the accuracy of this information. However, as laws change quickly, the reader should always ensure the accuracy and applicability of such information with respect to their particular case. The information contained in this article cannot replace a thorough and complete review of the reader's situation by competent legal counsel who has had an opportunity to review all of the facts.
Kotak Personal Injury Law
80 Maritime Ontario Blvd, Suite 240 BramptonOntarioL6S 0E7
Helping you from the very start Kotak Personal Injury Law is a Mississauga personal injury law firm handling wrongful death and injury cases including car accidents, slip and fall, dog bites, defective products as well as disability insurance, critical illness insurance, mortgage insurance and credit card insurance claims. Serving Peel Region, Halton Region and the Greater Toronto Area, including Mississauga, Brampton, Oakville, Burlington, Caledon and Halton Hills, Ontario