Insurance Claims

Undercompensation of Mental Distress Damages in Disability Insurance

disability insurance - mental distress undercompensation

Disability Insurance: Undercompensation of Mental Distress Damages

Insights into Disability Insurance undercompensation by Long-Term Disability Lawyer Tim Louis

Introduction

Disability insurance is contractual in nature. When a disability insurer denies benefits to a disabled claimant, the claimant may sue for breach of contract to recover the benefits. Additionally, the claimant may seek mental distress damages, punitive damages, and special costs. Mental distress damages are intended as compensation for the claimant’s psychological injury; punitive damages are intended to punish the insurer’s misconduct; and special costs are awarded only in unique circumstances.

This article focuses on mental distress damages. As these damages are compensatory, they are comparable in nature to damages for psychological injuries in tort; yet, mental injuries have given rise to substantially higher quantum awards in tort claims than in disability insurance cases. This disparity is only partially explained by disability insurance claimants’ pre-existing conditions. In this article, we examine this disparity and the case law through which it has arisen, and propose that this disparity has no principled basis.

Contract and Tort Law: Similar Compensatory Principles

Hadley v. Baxendale (1854), 9 Ex. 341 [Hadley], a decision of the Court of Exchequer Chamber, provided that where one party had breached a contract, the other party could claim compensatory damages arising “from such breach of contract itself, or such as may reasonably be supposed to have been in the contemplation of both parties, at the time they made the contract, as the probable result of the breach of it.”

In Fidler v. Sun Life Assurance Co. of Canada, 2006 SCC 30 [Fidler], the court applied the principles of Hadley to a disability insurance contract. The court reasoned that disability insurance contracts are “peace of mind” contracts: the insured party has entered the contract for the tangible benefit of financial payments if disabled, but also for the intangible psychological benefit of having a reasonable expectation of income security. Both parties would have reasonably contemplated these benefits at the time they made the contract. As such, if an insurer wrongfully withheld disability benefit payments, the insured’s mental distress arising from their loss of income security would be compensable, following the principle set out in Hadley.

Psychological injuries are compensable in tort claims through non-pecuniary damages. The courts have implied that the mental distress damages arising from breach of contract should be the same as those arising through a tort claim. In Mustapha v. Culligan of Canada Ltd., 2008 SCC 27 [Mustapha], the court stated with respect to damages that “[w]ith regards to Mr. Mustapha’s psychiatric injury, there is no inconsistency in principle or in outcome between negligence law and contract law.” This was followed in Lau v. Royal Bank of Canada, 2017 BCCA 253 [Lau], with the court stating “[t]he test for mental distress damages is, in principle, the same in contract and in tort.”

In Saadati v. Moorhead, 2017 SCC 28 [Saadati], the court determined that a psychiatric diagnosis was not a prerequisite for compensation for psychological injuries in tort law. The court reasoned that the damages awarded for mental injury are not based on the injured party’s diagnosis, but rather on that party’s symptoms and their effects (para 31). While Saadati was based on a tort claim, its reasoning was adopted and applied in Lau for mental distress arising from a breach of contract.

Contract and Tort Law: Similar Tests for Psychological Damages

Where an insurer has wrongfully denied disability benefits, the test for whether to award mental distress damages is provided in Fidler at paragraph 47:

The court must be satisfied: (1) that an object of the contract was to secure a psychological benefit that brings mental distress upon breach within the reasonable contemplation of the parties; and (2) that the degree of mental suffering caused by the breach was of a degree sufficient to warrant compensation

The test for whether to award damages in negligence is set out in Mustapha at paragraph 3:

A successful action in negligence requires that the plaintiff demonstrate (1) that the defendant owed him a duty of care; (2) that the defendant’s behaviour breached the standard of care; (3) that the plaintiff sustained damage; and (4) that the damage was caused, in fact and in law, by the defendant’s breach.

These are very similar tests. Firstly, there must be a breach, whether of a contractual duty to pay disability benefits, or of a common law duty.

Secondly, there must be sufficient damage sustained to warrant compensation. In the tort claim in Mustapha, the court set stated that for psychological injury to be compensable, it must be “serious and prolonged and rise above the ordinary annoyances, anxieties and fears that people living in society routinely, if sometimes reluctantly, accept” (para 9). Similarly, the court in Fidler stated it must be “of a degree sufficient to warrant compensation” (para 47). As noted in Saadati and Lau, this will not necessarily require expert medical evidence.

Finally, the damages must be caused in fact and in law by the breach. In Mustapha, the court found that the plaintiff’s psychological injuries must be a reasonably foreseeable result of the defendant’s breach of its duty of care in order to meet the test for legal causation. The court in Fidler, applying the principles of Hadley, applied a test of whether damages arising would have been in the reasonable contemplation of the parties; this is quite similar to the reasonable foreseeability test in Mustapha.

Contract and Tort Law: Different Quantum Ranges

In Asselstine v. Manufacturers Life Insurance Co., 2005 BCCA 292 [Asselstine], the court reviewed previous awards for mental distress damages in disability insurance, and found they typically ranged between $10,000 – $20,000. The court upheld the trial judge’s award of $35,000, finding this amount to be at the upper end of the range for mental distress damages.

In contrast to Asselstine, tort cases in BC have provided a significantly wider range of damages for psychological injuries. In Hans v. Volvo Trucks North America Inc., 2016 BCSC 1155, the plaintiff in a motor vehicle accident claim suffered debilitating and long-lasting PTSD and Major Depressive Disorder, though he did not sustain any physical injuries. He was awarded $265,000 in his tort claim. In Saadati, the plaintiff in a motor vehicle accident was awarded $100,000 in non-pecuniary damages for his tort claim for psychological injuries alone, despite having significant pre-existing chronic pain and minimal pre-accident income.

In claims for mental distress damages in disability insurance cases, there is the obvious hurdle that the plaintiff will have significant pre-existing conditions – enough to be disabled from working. However, even accounting for this, the courts in BC have awarded quite conservative damages.

In Gascoigne v Desjardins Financial Security Life Assurance Company (Desjardins Insurance), 2019 BCSC 1241, aff’d on other grounds 2020 BCCA 316, the plaintiff initially developed a physical disability. The insurer denied her disability benefit payments. The plaintiff eventually developed depression and anxiety, largely “related to the financial pressures she and her family felt when the plaintiff stopped bringing home an income” (para 36). As a result of the denial of disability benefits, the plaintiff went from being happy and optimistic to withdrawn and distressed about finances. She became less able to cope with the demands of daily life. She separated from her husband and was expecting to divorce. Despite these significant impacts on her life, largely brought about by the insurer’s breach of contract, she was awarded only $30,000 for mental distress.

In Tanious v. The Empire Life Insurance Company, 2016 BCSC 110, aff’d on other grounds 2019 BCCA 329, leave to appeal to SCC refused, the plaintiff was denied disability benefit payments. She had significant disabling conditions, including multiple sclerosis, depression, and anxiety, and she had used illicit methamphetamines to try to cope with her disabling conditions. The insurer’s denial of her disability benefits made her living situation substantially worse. She could not afford good housing or food, and at times could not even have her soiled clothes washed. She had worked hard and paid for her insurance, and she felt she was being looked upon as a liar and a criminal when the insurer rejected her claim. She was awarded a mere $15,000 in mental distress damages.

There may be room to expand the range of mental distress damages in disability insurance claims. The court in Godwin v Desjardins Financial Security Investments Inc., 2018 BCSC 99 stated at paragraph 169:

Had the defendant been responsible for the entirety of the plaintiff’s psychiatric symptoms, an appropriate award may have been in an amount somewhat higher than the $70,000 to $80,000 contended for by the plaintiff. In the present case, the award must reflect the fact that Desjardins’ conduct only marginally aggravated Ms. Godwin’s illness. I award damages for mental distress in the amount of $30,000.

This judgment reflects that future awards for mental distress in disability insurance may come closer to those in personal injury torts. Additionally, in Greig v Desjardins Financial Security Life Assurance Company, 2019 BCSC 1758 the court awarded $50,000 in mental distress damages, though the case is currently under appeal. The majority of cases, however, continue to assess damages within the range set out in Asselstine, despite acknowledging that this range is “modest” (C.P. v. RBC Life Insurance Company, 2015 BCCA 30 at para 65).

Conclusion

The gap in psychological damage awards between disability insurance claims and tort claims is worthy of further examination in the courts. Both areas of law aim to provide compensation for the same types of injury, and the courts have recognized that damages in contract and tort should be similar. To prevent arbitrary distinctions, previous case law setting out a “modest” range of damages in disability insurance cases should not be given undue weight. Instead, case law on psychological damages in both disability insurance and in tort should be considered of equal precedential value with respect to future awards of damages for mental distress.

Why You Should Hire a Long-Term Disability Lawyer

Long-Term Disability Lawyer

Why You Should Hire a Long-Term Disability Lawyer

Disability insurance is an affordable option to protect you financially if you have an accident at work and become injured or ill. If you cannot perform your job due to injury, you should receive a monthly benefit resulting from a psychological or disabling physical condition. Sadly, employees are often denied or cut off from receiving benefits before they are able to continue employment. Every insurance policy is unique and outlines conditions that must be met. Although these conditions are outlined, sometimes satisfying these conditions can be challenging.

 

An experienced Long-Term Disability lawyer can help.

If you have applied for long-term disability benefits and your claim has been wrongfully denied, we strongly advise that you hire an experienced Long-term disability lawyer.

 

Why You Should Hire a Lawyer for Long-Term Disability Benefits

  • Communicating with insurance companies can be challenging and stressful. Your lawyer will reduce your stress by handling all the details; so you can focus on your health and well-being.
  • Insurance companies commonly use wording in their policies that can be confusing and may lead to the possibility of damaging your case. A long-term disability lawyer will take charge and will ensure you avoid any pitfalls.
  • Some insurance companies hire Private Investigators to build a case against you by conducting surveillance; documenting your activities and capabilities. They may also edit this footage to discredit you. These are all ways insurance companies can prove to a judge that you are capable of more significant activities than your claim indicates. Your long-term disability lawyer has seen it all before and will guide you through the process and gather evidence to support your claim accurately.
  • Your lawyer will know the information required and the specific questions that need to be asked of your doctor — ensuring that all possible evidence is presented to support your appeal.
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      When You Should File a Claim

      There are statutes of limitations in British Columbia, meaning that there are strict deadlines you must adhere to when you file a disability claim. An experienced lawyer in this area of expertise will ensure that your doctor(s) have provided an adequate amount of information or anything else required to support your appeal. You will want to contact your lawyer as soon as possible to ensure you do not miss any crucial deadlines during the process.

       

      What You Should Do If Your Claim Has Been Denied

      There are several reasons why an insurance company would deny disability benefits:

      • The medical condition does not fall under the definition of ‘disability.’
      • An inadequate amount of evidence to support the injury.
      • The claim was not filed on time.

       

      We highly suggest that you contact your disability lawyer as soon as you find out that your claim has been denied. Even though your claim was denied, this does not necessarily mean your case is closed. A trusted disability lawyer will review your policy and ensure that all information required is submitted to help prove that your condition meets the definition of ‘disability’ according to your insurance policy.

       

      Talk to a Long-Term Disability Lawyer for a No-Obligation, Free Consultation

      You do not have to handle this alone. If your long-term disability claim has been denied, speak with Tim Louis & his compassionate, trusted team of experts by calling 604-732-7678 or email timlouis@timlouislaw.com for a free consultation, and we will provide you with the best possible options.

       

Addiction & Long-Term Disability: Are You Covered for Benefits?

long-term disability and addiction

Addiction & Long-Term Disability: Are You Covered for Benefits?

Addiction resulting from prescription medication, gambling, or other substances, can be mentally and physically debilitating. While some individuals can walk into a casino and gamble a few times a year, others can become chronically addicted. According to the Centre for Addiction and Mental health, 1 in 5 Canadians experience a mental illness or addiction problem in any given year.

Now More Widely Understood, Addiction is No Longer Considered a Choice

Unlike the United States, Canada views addiction as a disease. Human rights legislation protects individuals on the grounds of disability and includes those who suffer from drug and alcohol dependency.

If You Struggle With Addiction, You May Qualify for Long-Term Disability Benefits

Whether or not you qualify for long-term disability benefits from an insurance carrier depends on your employer’s group insurance policy. Specific requirements must be adhered to concerning rehabilitation and or treatment programs to qualify. It is important to distinguish between addiction regarding legal substances (alcohol, cannabis, prescribed medication) and illegal substances (cocaine, meth, heroin).

You can count on the team at Tim Louis Law to thoroughly review your private or group insurance policy to ensure that your rights are protected — providing you with peace of mind that in turn allows you to focus on treatment.

Insurance Companies Routinely Deny Claimants with Substance Abuse Issues

Insurers do not always make it easy to claim disability benefits since many companies do not consider addiction a disability. A qualified long-term disability lawyer can help. Your lawyer will challenge the insurer’s decision on your behalf, as many individuals do not realize that substance abuse is considered a disability in Canada.

Medical Evidence is Integral

Medical documentation as evidence is integral for any disability claim. The claimant must show that their addiction has inhibited their ability to function. The medical evidence must also meet private or group policy standards that dictate the criteria for eligibility.

Treatment Options

Addiction treatment is almost always long-term as relapse is common if undergoing short-term treatment.

Typical treatment options are as follows:

  • Detox
  • Counseling
  • Medication if required
  • Mental health evaluation
  • Treatment for any mental health conditions if necessary
  • Follow-up care for relapse prevention

Gambling as an Addiction

Just as serious of a condition as other more common addictions, compulsive gambling is on the rise in Canada and just as destructive. Gambling addiction leads to a range of personal and social harms such as depression, bankruptcy, anxiety, suicide, and abuse. Unfortunately, in Canada, compulsive gambling may not qualify as a disability.

Compliance Is Key

Compliance is key with regards to disability benefit eligibility. The individual seeking insurance benefits must proactively participate in treatment and/or rehabilitation programs to continue to receive compensation. Failure to do so will result in being disqualified or denied the claim.

Most policies have time limitations that can be difficult to interpret. If your application for disability benefits has been denied by an insurer, do not give up hope. We strongly encourage you to obtain legal advice from a trusted and experienced long term disability lawyer to discuss your dispute case to help navigate your way to a fair and equitable resolution of your claim.

Contact an Experienced & Empathetic Long-Term Disability Lawyer

If you are suffering from an addiction and unsure if you qualify for long-term disability benefits through an insurer, our trusted and compassionate team at Tim Louis and Company will protect your rights so you can focus on treatment and recovery. Reach out to us by calling 604-732-7678 or email timlouis@timlouislaw.com for a free consultation, and we will provide you with the best possible options.

Source: https://www.camh.ca/en/Driving-Change/The-Crisis-is-Real/Mental-Health-Statistics

Disability Claims for Self-Employed Professionals

Disability Claims for Self-Employed Professionals

disability claim for self-employed
If you are self-employed and have purchased a disability insurance policy, you have assumed that this policy serves as income replacement if you are unable to run your business for a period of time due to injury or illness.

Private disability insurance is commonly more expensive than group insurance, and generally, the type of coverage it provides is usually more valuable as it often provides benefits in the event you are unable to work in your regular occupation. Unfortunately, just because you have purchased an insurance policy, this does not necessarily mean that the insurer will not make it challenging for you to receive benefits after you have submitted a claim. Insurers often heavily scrutinize claims submitted by independent, self-employed individuals – this is because of the sometimes-large benefit amounts provided by some of these policies.

Know the Terms & Conditions of Your Insurance Policy

To protect your rights, it is integral that you understand the limitations and restrictions outlined in your disability insurance policy. The definitions of certain disabilities can change over time, so it is important to keep up to date and understand these changes that may apply to you.

Know Your Rights about Disability Claims

Once you have purchased your insurance policy, be sure you are aware that although you have coverage, this does not mean you should “rest easy.” In reality, what you are really buying are rights that you can enforce against your insurer if they fail to provide the protection that was sold to you.

Know the Strict Time Limitations

 Many people do not realize that there are strict limitations with regards to filing a lawsuit against insurers, and oftentimes they are missed. If you do miss a limitation period, the insurance company is not required to pay your claim, and therefore your right to sue them is null in void.

Here some common red flags you should be aware of:

  • The claim is taking an unusually long time to resolve
  • Irrelevant information is asked of you
  • A claim has been denied

Hire An Experienced Disability Lawyer

In many cases, filing a lawsuit is not necessary. The first step involves a demand letter, outlining any discrepancies, pointing out the facts, and the law – with the demand that an insurer complies with the terms and conditions of the insurance policy. Insurance companies are often fully aware when they are not in full compliance, and take advantage of policyholders because most people do not know the law in-depth, and are privy to any red flags before signing off on their policy.

Contact Tim Louis & Company

Insurance companies may deny legitimate disability claims, as the majority of individuals will give up instead of fighting for the monetary compensation they deserve. If you are self-employed and an insurance company has denied your long-term disability claim, the team at Tim Louis and Company is on your side and will fight in your corner.

For a free, no-obligation appointment, contact us today by calling 604-732-7678 or email timlouis@timlouislaw.com

Surveillance: How You Can Lose Your Long Term Disability Compensation

long term disability surveillanceHow You Can Lose Your Long Term Disability Compensation

Have you applied for Long Term Disability coverage and have the feeling you are being followed while out in public?

If you have submitted an application for disability or are collecting disability compensation, your intuition may be accurate, as there is a good chance an insurer has hired a professional private investigator to conduct surveillance on you, seeking an excuse to save money and attempt to deny your claim.

Insurance companies, like all businesses, are profit-based and lose money if they approve too many claims — so it is in their best interest to prove that you can work without the need to receive compensation for your reported medical condition.

Disability claims are on the rise, and surveillance is an efficient way for insurance companies to gather evidence against you – intending to prove that you are fully capable of fulfilling your job duties and do not require financial support.

Surveillance May Work Against You

Insurance companies may hire a private Investigator, follow you, or set up surveillance in front of your home to observe your daily activities.

Suppose you applied for Long Term Disability due to back pain and then observed via surveillance moving or twisting your body in a way that contradicts what you detailed in your claim. In that case, your credibility may be diminished and lead to a denial of your Long Term Disability insurance benefits claim.

Be Specific On Your Application for Long Term Disability Compensation

Detailing your injuries and being specific about your abilities on your Long Term Disability application is essential. Provide context and be mindful about anything observed via surveillance that may be used against you.

Such that if you are observed merely walking down the street for a more extended period than you mentioned you were able to in your claim, you could be at risk of losing your Long Term Disability insurance coverage.

The same goes for mental health disability claims. For instance, if you claim that you are chronically depressed and unable to leave your home and then observed via surveillance leaving your home on a daily basis, you may be questioned and risk losing your coverage.

Why Surveillance is Not Reliable

Context is everything when it comes to surveillance with regards to Long Term Disability insurance claims. As mentioned in the example above, surveillance is not a reliable measure to understand one’s abilities.

Video evidence does not present the aftermath of the activity, such as the stiffness and pain you may experience immediately after or the next day resulting from specific activities such as reaching, carrying grocery bags, or shovelling snow.

Fighting Against Surveillance Evidence

  • Ensure that you are truthful regarding your disabilities and injuries from the start. Do not stretch the truth because you think it will be more believable.
  • Take extreme caution when posting on any social media channels. Any comments, videos, or images involving events, activities, sports, or vacations, can be used as evidence to affect your disability claim. Be mindful before you post.

Denied Long Term Disability Coverage? Hire an Experienced Lawyer

If you have Long Term Disability coverage, and if you’re suffering from a debilitating illness or injury, then you deserve compensation, and that’s where Tim Louis and Company can help.

When dealing with a Long Term Disability claim, it is essential that you have an experienced, reputable lawyer on your side that specializes in Long Term Disability cases.

Long Term Disability Lawyer Tim Louis has been representing those who suffer from LTD for over 25 years and has successfully sued some of the world’s largest insurance companies on behalf of deserving clients.

Contact Tim Louis and His Team Today

You owe it to yourself to explore your options. Contact Tim Louis and his compassionate and experienced legal team today by calling 604-732-7678 or email timlouis@timlouislaw.com for a no-obligation consultation. We will make sure to evaluate your situation and advise the best possible options for your unique situation.

Disability Insurance: Expansion of Special Costs

Disability Insurance: Expansion of Special Costs

disability insurance
 

Introduction

A recent BC Court of Appeal case, Tanious v. The Empire Life Insurance Company, 2019 BCCA 329 [Tanious], gives disability insurance claimants who take their insurers to court greater prospects of obtaining special costs against their insurer, even absent malicious conduct. However, the specific details of the case are very important. This article analyses Tanious with a view to determining the key requirements that will need to be met in future cases to obtain awards of special costs. Leave to appeal Tanious to the Supreme Court of Canada was denied.

Background

Ms. Tanious was diagnosed with multiple sclerosis shortly before beginning a new job. She nonetheless worked at that job for seven years before ceasing work and claiming disability benefits that she was entitled to through her employment. Following her diagnosis, she developed depression and anxiety, and about a year before ceasing work she started using illicit methamphetamines to cope with her deteriorating cognitive capabilities. The insurer, Empire Life, denied that she became disabled during her employment, and further argued that her substance use disentitled her to benefits. At trial, Mr. Justice N. Brown found that she was entitled to disability benefits, and further awarded her $15,000 for aggravated damages for mental distress, loss of peace of mind and of dignity as a person from Empire Life’s refusal to pay benefits.

At the subsequent costs hearing, Brown J. awarded special costs even though the plaintiff conceded that Empire Life did not commit any litigation misconduct. It is this award that was subject to appeal.

The Appeal of Special Costs

The costs scheme in British Columbia is statutory; Rule 14-1 of the Supreme Court Civil Rules sets out the framework for cost awards. It provides that the court may award special costs, but does not set out the circumstances in which they may be awarded. Generally, special costs are only awarded in cases where there has been litigation misconduct. However, there are exceptions, though these are rarely applied. The Tanious case is an example of one such exception.

Overarching Principles

In order to justify a special costs award, the Court of Appeal stated that it is insufficient to simply have a large discrepancy between taxable costs and actual legal costs. There must be some other “unusual feature” in the case, such as “special importance, difficulty or complexity associated with the litigation” (para. 54). The Court cited a handful of examples where special costs had been awarded despite the lack of evidence of misconduct, and explicitly reiterated that in these cases any award of special costs must be made on a principled basis.

Typically, the objectives of costs awards are to provide the winning party with some degree of indemnity for the costs it has incurred during the litigation. However, the Court of Appeal also recognized that costs awards “encourage settlement, deter frivolous actions or defences and sanction unreasonable conduct committed in the course of litigation” (para. 36). Significantly, the Court also indicated that in some instances, “costs may be awarded to enhance access to justice, mitigate severe inequality between litigants and encourage socially desirable conduct” (para. 36).

The Court cited the leading case of Asselstine v. Manufacturers Life Insurance Co., 2005 BCCA 465, which provides that in the context of these objectives, “the application of ordinary costs rules usually produces a just result,” but goes on to say that this does not mean “that the personal and financial circumstances of a litigant can never be relevant on a costs application” (para. 60). The Court acknowledged that such circumstances may come in to play in exceptional cases.

The Court went on to discuss other cases where special costs were “justified in the interests of justice” (para. 65). Given the circular nature of this proposal – that special costs awards are justified by justice – it is challenging to elucidate principled reasons for these awards when they are not related to reprehensible conduct. Instead, these cases are fact-specific and must be considered based on their own merits.

The Court included in its analysis two analogous cases out of the Court of Queen’s Bench in Alberta where special costs were awarded: Hennessy v. Horse Racing Alberta, 2007 ABQB 178, where a judicial review was required to defend the appellant’s livelihood and restore his reputation; and Meleshko v. Alberta, 2013 ABQB 468, where the appellant sought judicial review to reinstate long-term disability benefits, and punitive damages were not available. As well, the Court cited FIC Real Estate Fund Ltd. v. Phoenix Land Ventures Ltd., 2016 ABCA 303 for the proposition that special costs could be awarded if success in the litigation would otherwise “amount to a strictly pyrrhic victory” (para. 65).

The final significant case referenced in the appeal was Carter v. Canada (Attorney General), 2015 SCC 5, wherein the test for awarding special costs was refined by the Supreme Court of Canada, stating that “the plaintiffs must show that it would not have been possible to pursue the litigation with private funding” (para. 63). In these instances, it is not just to ask the individual litigants or their counsel to bear the cost of pursuing the claim.

Factors in Tanious in support of special costs

On its face, the trial judge in Tanious made the decision to award special costs on the basis of very few factors, none of which are unusual in a long term disability insurance case: the purpose of the insurance contract is to provide subsistence level income, and when the insurer failed to pay these benefits, the plaintiff had to bring a lawsuit, which cost money. However, the Court of Appeal recognized that when the trial judge’s reasons were read as a whole, it was apparent that he also considered “the nature of the case, including its unique characteristics and related litigation challenges, complexities and costs, together with Ms. Tanious’ personal and financial circumstances and her need for counsel as established by the evidence” (para. 21).

The particular litigation challenges of this case included several factors that added to the effort required by counsel. Ms. Tanious was a difficult client to represent. She could not meet at counsel’s office; counsel had to drive to her. Similarly, she could not review documents to prepare for an examination for discovery as it was too stressful, and she likely would not be able to remember what she had reviewed. Additionally, she attended hospital 33 times over the course of the case, and often called her counsel from hospital to ask for help with various other issues. Ms. Tanious attempted suicide more than once as her disease progressed; if she had died, her claim for benefits would have ended. In preparing for this case, it was difficult for counsel to predict what Ms. Tanious would say at trial.

Though the insurer did not commit misconduct, it could have acted better. The trial judge noted that the insurer made only a cursory response to Ms. Tanious’ initial application for disability benefits, but once in litigation, mounted a vigorous defence. In combination with Ms. Tanious’ poor mental health and declining cognitive abilities, the actions taken by the insurer necessitated that she obtain legal representation in order to pursue the benefits to which she was entitled.

Notably, Ms. Tanious had separate counsel for the costs hearing. This was perhaps because her original counsel had to testify at the hearing via affidavit as to the many special circumstances in Ms. Tanious’ case; s. 5.2-1 of the Code of Professional Conduct precludes counsel from testifying to controversial matters. Though it was not mentioned by the Court, as a practical matter, this ethical rule adds to the challenges of obtaining special costs.

Future Implications

The courts now recognize that in matters of insurance disputes and also in other exceptional situations, many people do not have access to justice unless they are able to retain counsel. Access to justice is recognized as being one of the policy objectives of the courts that thus far is not adequately being met (para. 81). As the consequences of these shortcomings become clearer, it may be possible to seek special costs as a means of ensuring adequate access to justice for members of otherwise underrepresented and vulnerable populations.

It can be difficult to make a financially viable practice taking long term disability cases to trial. While aggravated damages are sometimes awarded, they are typically small awards that are woefully insufficient in comparison to the costs of litigation. Punitive damages require misconduct on the part of the insurer. The risk of a special cost award, absent litigation misconduct, provides the plaintiff with more leverage in negotiations with an insurer, and may allow a plaintiff to recuperate the full benefits to which they are entitled, while also appropriately compensating their counsel.

Anxiety and Long Term Disability Claims

Anxiety and Long Term Disability Claims

Anxiety has become a far more common challenge for many in recent years. While the severity of symptoms may vary, many of us have experienced a certain level of anxiety at some point in our lives. For some people, anxiety and panic levels can interfere with daily activities — requiring professional help to cope and help manage the symptoms.

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Below are the 5 most common types of anxiety disorders:

Panic Disorder

People who suffer from panic disorder experience sudden and ongoing intense feelings of terror and emotional control loss. Many symptoms are unique to each individual and can include a racing heartbeat, shortness of breath, dizziness, nausea, chest pain, and numbness, to name a few. According to the National Institute of Mental Health, women are twice as likely to suffer from the condition.

Obsessive-Compulsive Disorder (OCD)

A mental health disorder that affects individuals of all ages, OCD occurs when a person gets caught up in a pattern of sudden compulsions and obsessions. These obsessions (thoughts/images/behaviours are not welcomed by the person and can severely disrupt important daily activities.

Generalized Anxiety Disorder (GAD)

GAD can be characterized by persistent, uncontrollable, ongoing worry about a wide variety of things and events. People who suffer from this disorder excessively worry and anticipate disaster — even if there is no reason to warrant this type of worry. Symptoms can include irritability, having a constant sense of danger, difficulty concentrating, disrupted sleep, fatigue, and increased rapid heartbeat, to name a few.

Post-Traumatic Stress Disorder (PTSD)

PTSD can develop after being exposed to a traumatic event such as a motor vehicle accident, natural disaster, war, assault, a threat with death, or witnesses who have experienced these traumatic events. People with PTSD feel a heightened sense of danger, causing them to feel fearful even when, in reality, they are safe. This is due to the natural fight-or-flight response, which is altered with those who suffer from the disorder.

Social Anxiety Disorder (SAD)

Social Anxiety Disorder, also known as social phobia, is a type of anxiety disorder that causes extreme distress in social settings. Social anxiety is different from shyness, as it is more extreme, persistent, and debilitating. Symptoms can include nausea, rapid heartbeat, trembling, excessive sweating, worrying for days before a social event, excessive worry about embarrassment, missing school, or work because of anxiety. These are just a few symptoms that can take over someone’s life in a negative way.

Why Long-Term Disability Claims are Denied

Long-term disability claims may be denied because of the lack of regular medical care or treatment. Ensuring that you attend all medical appointments and any necessary prescribed medication from a professional specializing in mental health is essential if you want to reduce your chances of having a long-term disability claim denied.

Documentation is Important

Having all of the correct documentation in order and submitted on time is a must for any long-term disability claim submission. Hiring an experienced lawyer specializing in long-term disability claims can ensure that you have all of the correct documents submitted within the specified time frame and any other necessary details that must be sent with your long-term disability application.

Contact Tim Louis & Company Today

An anxiety disorder can have a lasting impact on one’s quality of life. If you or a loved one is experiencing anxiety and has been unable to work because of the condition, contact Tim Louis and his compassionate and experienced legal team today by calling 604-732-7678 or email timlouis@timlouislaw.com. We will make sure to evaluate your situation and advise the best options.

Mental Health and Long-Term Disability: Are You Covered?

Mental Health Issues | Tim Louis & Company Law in Vancouver
In the not so distant past, employers viewed mental health issues as temporary and less serious than other physical injuries. At the time, having a mental health disability resulting from a traumatic event was not seen as a legitimate reason to be approved for disability — only physical injuries were considered to be applicable for disability claims. Sadly, psychological or emotional related claims were not seen as harmful to the quality of life.

Today, with more awareness and education about the damaging effects mental health issues can have on individuals and their ability to work and lead a normal, healthy life, mental health is now discussed more and has been proven to be a frequent and substantial issue among Canadians. Each year, thousands of British Columbians miss work due to a mental health-related disability.

Long-term Disability & Mental Health Through Your Employer

As an employee who is covered by a disability insurance policy at work, you as a policyholder/employee have the right to submit a claim for benefits following a lengthy injury or illness. This claim submission will also include diagnosed with mental health conditions. Depending on the type of policy, you may have additional resources available to you where you can receive further assistance on steps to access mental health services, counsellors, and or educational materials where employees can have access to preventative measure guidance.

Time Limits on Recovering

It is important to note that you are not entitled to long-term disability benefits when you begin to experience mental health issues. Just like any other injuries, you must have experienced your disability for 2 years in which you were unable to sustain employment. However, there are some insurance policies that cover claimants under short-disability insurance, so it is important to clearly understand your policy.

No two policies are alike. Be warned that there are numerous insurers that will do all they can to avoid paying out to the applicant. In some cases, even when there is a valid policy in place, insurers will still do what they can to keep from paying out. This is when you need a qualified, trusted long-term disability lawyer who can represent you to fight back. Below are the most common reasons why mental health disability claims can be denied:

  • You have not completed the required details or have not been responsive to the insurer to ensure applications or documentation is updated to fulfill your policy.
  • Failing to seek treatment for mental illness can have numerous consequences for your disability claim. The insurance company may conclude that you refused to take the steps necessary to support your mental illness claim.
  • Your chosen medical professional has not documented your treatment. Insurance companies can deny an application even if your doctor has provided you with a thorough physical examination – if there is not thorough documentation, it is highly likely that your application could be denied.
  • Your doctor may not be providing you with the adequate care you require. An insurance company may deny a claim if they feel you need to see another professional who can provide you with better care for your needs.

Contact Your Trusted Long Term Disability Lawyer

A mental health disability can have a lasting impact on one’s quality of life. If you or a loved one has experienced a mental health issue, contact Tim Louis and his compassionate and experienced legal team today by calling 604-732-7678 or email timlouis@timlouislaw.com.

Long-Term Disability Lawsuits: Know the Steps

Long-Term Disability Lawsuits: Know the Steps

Long-Term Disability Lawsuits: Know the Steps

A long-term disability lawsuit can be an intensive, lengthy process. The time it takes depends on the type of disability plan and can be a complex undertaking. The best option is to contact an experienced and knowledgeable long-term disability personal injury lawyer for trusted advice.

Which Disability Plan Do You Qualify For?

First, your lawyer must determine which disability plan you qualify for:

  • Short-term disability
  • Employer sick pay
  • Employer insurance sickness benefits
  • Canadian pension plan (CPP)
  • Long-term disability
  • Canadian pension plan

Professional Medical Support

Secondly, in order to begin the process, you must have medical evidence supporting your disability claim. Without support from a medical professional, a long-term disability lawsuit claim cannot move forward.

When You Apply for Disability

Ensure that you collect and accurately fill out all related paperwork and/or applications for disability coverage and submit them. If you have any questions, contact your trusted lawyer for clarification – it’s essential that applications for disability are filled out completely before submission, and of course, turned in by the deadline.

Right After You Apply for Disability

Once you have submitted your application for disability, it’s important to know that you may harm your benefits during the transmission period from an employee, to someone on sick leave. For instance, if your employer requests that you accept a severance package, or encourages you to resign from the company, do not agree under any circumstances. If you agree with any of the aforementioned, ruining your chances of receiving disability will be likely (resigning from the company revokes your ability to receive disability benefits).

Waiting for a Decision

In some cases, you may have to be patient when it comes to waiting for a decision to be made on your disability lawsuit. However, generally, it takes roughly 30 days after you have submitted your application. If you have waited longer than 30 days, ensure that you follow up with your lawyer.

When Do I File a Long-Term Lawsuit?

If your disability claim is denied or the amount you sued for is less than you require, your lawyer will assist and collect all of the required documentation to present as evidence for your long-term disability lawsuit. Additional medical examinations may be required to show that you have a disability and are unable to commence work – this filing is called a Statement of Claim.

The Discovery Process

During the discovery process, both parties meet and are interviewed under oath. Your lawyer will spend the time required to prepare you for the questions and explain the entire procedure. Your lawyer will also request all applicable documentation and a detailed explanation as to why their decision was met. Once all information has been reviewed, your lawyer will discuss your options as to whether negotiating a settlement is recommended or whether proceeding to trial is a risk worth pursuing.

Negotiation VS. Trial

Negotiation:

Usually negotiating a fair settlement is a logical alternative than moving forward to trial. If both parties are satisfied with the settlement compensation amount, there is obviously no reason to go to trial and the lawsuit will be dismissed. However, if the insurance company does not agree to a fair settlement, the case can go to trial where an actual judge makes the decision.

Trial:

Trials require substantial preparation and unfortunately may take 2 years or more for the case to even enter the courtroom. A trial, of course, can go two ways: the insurance company can agree to pay you back benefits — plus your current benefits, OR if the decision goes against you, you receive no benefits. Note that a judge may require you to pay part or all of the insurer’s legal fees – one reason why it’s better to reach a settlement over taking a risk by going to trial.

“Oftentimes it’s a relief just to turn the case over to a lawyer so it can be fought vigorously on their behalf…just knowing that someone is fighting the battle so they can concentrate on the quality of life issues can be a huge benefit.” – Tim Louis
http://timlouislaw.ca/bctimlouislaw/long-term-disability-attorney-vancouver-bc/

Tim Louis & Co has been representing those who suffer from long-term disability for over 2 decades. He has successfully sued some of the largest insurance companies in the world on behalf of deserving clients and has appealed the decisions of the Federal government in CPP disability claims on behalf of clients. Tim Louis and his compassionate, experienced team can give you the reliable and trusted advice you deserve. Contact 604-732-7678 or email timlouis@timlouislaw.com for a free consultation.

Leading Accidents that Result in Concussion

A concussion is a mild form of Traumatic brain injury (TBI) that affects brain function and usually caused by a blow to the head, bump, violent shake or any blunt force to the area. Concussions are usually temporary but are a common result of motor vehicle accidents or any other form of personal injury. It’s important to note that even a violent shake of the upper body can cause a concussion.

Neck Massage on Patient After Concussion | Tim Louis and Company
Most of those who suffer from a concussion, recover quickly and fully. However, in more serious cases, symptoms can last for weeks or longer.

Symptoms of a Concussion

It’s important to know that concussions don’t always present symptoms. If symptoms do show up, they may not present themselves right away and can last for days, weeks or longer. The most common symptoms of a concussive traumatic brain injury are amnesia (memory loss), headaches and disorientation.

Physical Symptoms of Concussion:

  • Ears ringing
  • Headaches
  • Nausea
  • Vomiting
  • Fatigue
  • Blurry vision
  • Fluid or blood draining from the nose or ears

Other symptoms may include:

  • The inability to remember the traumatic event that caused the concussion
  • Confusion
  • Feeling of dizziness / Confusion
  • Problems with speech
  • Sleep disturbances
  • Feelings of depression, nervousness and/or anxiety
  • Feeling isolated or alone

When to Seek Medical Attention

Seek medical attention immediately if you or your child has suffered from a head injury – even if emergency care isn’t required.

Leading Accidents that Result in Concussion:

Motor Vehicle Related Injury

Motor vehicle accidents are a common cause of mild or severe TBIs or concussions. These head injuries can occur from any head injury such as hitting the dashboard, driver window or another passenger.

Slip & Falls

When you think about a slip and fall injury, you probably imagine sprains, broken bones, bad bruises or pulled tendons. Head injuries though are very common – so common in fact that they are one of the leading causes of mild to very severe, life-changing forms of concussion.

Any of these slip and fall accidents can result in a mild to severe concussion:

  • Slipping on the wet floor
  • Falling in a store and knocking your head on the floor or against a shelf
  • Tripping over an obstacle or crack on the sidewalk resulting in a blow to the head
  • Falling in around someone’s residence and knocking your head

Assaults

It’s obvious that victims of any type of physical assault are at risk for having a concussion. Any blow to the head, twist and or fall can result in a mild to serious head injury.

Playing Sports

The Public Health Agency of Canada Reports that for females, approximately 20,000 (45%) of brain injuries result from sports and recreation. For males, approximately 26,000 (54%) of brain injuries result from sports or recreational injuries.

According to the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP), Ice Hockey, Rugby and Ringette are the most common sports with the highest the proportion of brain injuries among children and youth 5-19 years of age, ranging from 27% to 44% of all injuries that happened while playing these sports.

According to the government of Canada, 1 in 2 Canadians has little to no knowledge about concussions. Since only 4 in 10 Canadians are aware of available concussion tools and resources, we have added some reliable and trusted sources below to learn more about the causes and treatment of mild or severe concussions.

Contact A Trusted Personal Injury Lawyer

If you or a loved one has suffered from a mild or severe concussion resulting from a motor vehicle collision, or slip and fall, Tim Louis and his compassionate and talented legal team can give you the reliable, trusted advice you require. Contact us today for a free consultation at 604-732-7678 or TimLouis@TimLouisLaw.com

Sources:

https://www.canada.ca/en/public-health/services/diseases/concussion-sign-symptoms/concussion-sport-infographic.html

https://my.clevelandclinic.org/health/diseases/15038-concussion

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