Long-Term Disability Law

Chronic Pain & Long-Term Disability Claims

Chronic Pain and Long-Term Disability Claims

Chronic Pain & Long-Term Disability Claims – Contact Tim Louis

Suffering injuries from an accident or mishap can be a frustrating experience. Ongoing chronic
pain some individuals experience is a general term but is a reality that numerous accident
victims have to learn to cope with even after fulfilling their medical treatments.

If you find it challenging to get through the workday and cannot fulfill your daily work-related
duties or function day-to-day, you are not alone. According to the Canadian Pain Task Force
Report (Sept 2020), an estimated 7.63 million, or 1 in 4 Canadians aged 15 or older, live with
chronic pain.

What is Chronic Pain?

Chronic pain is the result of changes within the nervous system. The nerves continue to fire and signal, leading to pain that remains long after an injury has healed. It may take weeks, months,or even years to completely heal. Lingering chronic pain can take control of your life and causefurther damage, especially to your mental state. Chronic pain can result from a musculoskeletal
injury, nervous system dysfunction, chronic diseases, and autoimmune disorders.

In 2019 chronic pain was recognized by the World Health Organization (WHO) as a disease inits own right for the first time, resulting in updates to the latest (11th) version of the InternationalClassification of Diseases (ICD-11). This distinction is significant as it validates the struggle forthe millions of people around the world who are living with chronic pain.

Chronic pain is classified as chronic primary pain or chronic secondary pain. Acute pain is short-lived and typically lasts no more than 30-60 days, whereas chronic secondary pain can range in intensity and lasts from 6 months or longer.

Chronic Pain Education & Support

For more information, we highly suggest visiting Pain BC, a non-profit, helpful organization that
works to reduce the burden of chronic pain for individuals in BC. They empower people who live
with pain; providing them with a wide variety of helpful, informative resources and the support
required to enhance their well being: https://www.painbc.ca

The Most Common Claims Associated with Chronic Pain

Several injuries are commonly associated with long-term disability claims:

  • Neck pain
  • Lower back pain
  • Shoulder pain
  • Pain stemming from Fibromyalgia
  • Recurring headaches and migraines
  • Cancer pain
  • Arthritic pain
  • Musculoskeletal pain
  • Chronic migraines and headaches
  • Pain associated with Lupus
  • Chest pain
  • Abdominal pain

Symptoms of chronic pain include:

  • Burning sensation
  • Sensitivity to touch, cold, heat, and more
  • Flare-ups
  • Dull Ache
  • Throbbing
  • Soreness
  • Stiffness

What Causes Chronic Pain?

  • Repetitive stress injury, including carpal or cubital tunnel problems
  • Respiratory problems
  • Complex regional pain syndrome (CRPS) and fibromyalgia
  • Neurological problems
  • Loss of hearing and vision
  • Chronic pain after a motor vehicle accident

Filing a Long Term Disability Claim for Chronic Pain

If chronic pain has affected your ability to continue working, you may have the option of
receiving long-term disability benefits if you are covered under such a policy through your
employer. You must however present verification that chronic pain has resulted in the inability to
continue working. The evidence required depends on the nature of your condition and any other
associated ailments.

What You Need to Provide for Filing a Long-Term Disability Claim

To file a disability claim for chronic pain, you must document your symptoms and experiences
and discuss them with a medical professional. Your doctor will assess your medical history and
order x rays, tests, and/or scans to determine if there is joint or tissue damage that may explain
your pain.

Examples of documentation that may be required:

  • Any physician statements and an official diagnosis
  • A journal documenting your pain over time
  • Test results
  • Information about your history of treatment
  • Witness statements from family, friends, and or co-workers who can attest to your
    condition affecting your ability to work and function day-to-day.
  • Any accidental reports

Our Law Firm Provides Results-Oriented Representation for Even the Most Complex Cases.

Do not give up hope if your long-term disability benefits have been denied. If you have been
experiencing chronic pain that has affected your ability to function personally or professionally
and would like to discuss legal options, the compassionate team at Tim Louis Law & Company
will provide you with a free, no-obligation evaluation. We represent clients in a broad range of
injury claims and will take all necessary steps to obtain fair and full compensation for injuries.

Contact us today by calling 604-732-7678 or email us at timlouis@timlouislaw.com

Sources:


https://www.canada.ca/en/health-canada/corporate/about-health-canada/public-engagement/ext
ernal-advisory-bodies/canadian-pain-task-force/report-2020.html

https://www.iasp-pain.org/PublicationsNews/NewsDetail.aspx?ItemNumber=8340

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.
    •  

      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.

Long-Term Disability Coverage: How Long Will Benefits Last?

Long-Term Disability Coverage

Long-Term Disability Coverage

Some insurance policies issue payments for a certain amount of years, while other policies may stop payments after up to a decade. The question, unfortunately, does not have a definitive answer, as every insurance policy is unique.

When you read over your employer’s group benefits package, or even if you purchase your own private insurance, ensure that you read through the policy carefully to ensure that you understand the long-term disability requirements. Understanding the requirements, application deadlines, waiting periods and duration of benefit payouts is important.

While every insurance policy handles long-term disabilitycoverage and benefits differently, there are certain aspects to these policies that are mandated by law – this depends on your ability to return to work before your injury and your ability to work, period. There are certain policies that will stop benefits indefinitely after 2 years if you are able to return to any full-time work (regardless if it pays the same as your pre-injury job), while some insurance policies will continue paying out benefits at a reduced rate if you end up securing a new position that pays less than your previous employer. If however, you are unable to return to work, long-term benefits could last for a number of years.

What is Long-Term Disability Coverage?

If you become disabled during employment, Long-term disability insurance coverage pays benefits. Under most LTD policies, in order to qualify for these benefits, you would need to prove that you are unable to continue working as a result of a medical condition. These medical conditions can include physical, psychological, cognitive, and emotional – or a combination of any of the above. If you qualify for LTD coverage, the payout for benefits ranges between 60%-70% of your pre-disability income. There are certain policies that cover less, but most policies will pay benefits for qualified individuals up to age 65.

When Does Long-Term Disability Start?

Long-term disability payments are never available immediately and considered a last resort after short-term disability options have been exhausted. Before you can be approved for LTD payments, you must go through short-term options first – even if following a serious, catastrophic injury. Short-term options may include sick leave and short-term disability benefits.

How Do I Know If I Have Long-Term Disability Coverage?

If you are fortunate enough to have an employer that has provided you with a group medical benefits package, it is likely that you have insurance for Long Term Disability (LTD) coverage, which may also grant you coverage if you have been laid off or terminated from your job. If you do not have group benefits through your employer, you have the option of purchasing a private LTD plan.

Meeting Important Deadlines

There are strict deadlines that go along with long-term disability claims, so it is important to carefully read through your policy to understand the time limits. Failure to submit a claim on time can result in your claim being denied.

What if My Long-Term Disability Claim is Denied?

If you submitted an LTD application and your claim is denied, you will not receive any payments and will be expected to return to work. Claims can be denied for numerous reasons, such as incomplete information, unclear or improper medical treatment or diagnosis etc. Keep in mind, diagnosing mental health can be complex, but insurers are very specific in their guideline requirements. If your claim is denied, you have the right to appeal the decision – an appeal process will commence, which is why it is important that you contact a trusted lawyer that specializes in such long-term disability cases.

How a Long-Term Disability Lawyer Can Help

When understanding the length of your LTD policy, it is important to understand the language and the integral details you should be aware of. At Tim Louis Law, we are experienced with the process of filing long term disability claims and look forward to discussing your unique situation with you. Contact us today for a free consultation by
calling (604) 732-7678 or email timlouis@timlouislaw.com

Source:
https://www.bclaws.ca/civix/document/id/loo69/loo69/13_409_97

Termination Without Cause While on Long-Term Disability

Termination Without Cause

Termination Without Cause – while on long-term disability

The laws covering whether you can be terminated while recovering from long-term disability are complex.

Ordinarily, in a case in which an employee is absent from work as a result of illness or disability, the employer does not have “just cause” to instantaneously terminate the employment relationship, because a mere absence from work due to illness or disability is not a contractual breach.

Since the medical prognosis for many illnesses and disabilities can be very uncertain, when an employee is absent from work, this uncertainty can create difficulties within the workplace.

As a consequence, there are indeed some instances in which you can legally be terminated whilst on disability leave, but only as long as your employer follows the rules. The question is often asked: “When is an employer justified in terminating employment where an employee is absent from work due to a temporary, but prolonged, illness or disability?”

In fact, this question often arises in matters relating to employees who have been away from work and are receiving long-term disability benefits for protracted periods.

Generally, the fundamental issue for terminating an employee who is on long term disability is whether or not that worker has a reasonable prospect of recovering and returning to work in the foreseeable future.

Frustration of contract

Surely, at the beginning of a contract, it is assumed the employee will be fit and able to report to work. However, where an illness or disability prevents the employee from reporting to work, the contract may be “frustrated”. This means the circumstances, which are not the fault of either party, make it impossible to continue with the employment contract, and therefore the employee is excused from reporting to work, and the employer is excused from continuing to employ the employee.

The employer though will have to establish that the worker is incapable of performing the basic duties associated with his or her post, with or without modifications to accommodate restrictions; is incapable of undertaking any other productive work, and, as noted earlier, has no reasonable prospect of returning to work.

This though is subject to applicable statutory entitlements relating to termination pay and severance, and is also predicated on the type of coverage the employee, has as well as whether or not that employee is unionized.

This is because, within the unionized context, an employer’s right to terminate a disabled employee while on long-term disability will depend on whether the dismissal deprives the worker of continued access to negotiated benefits specifically tied to the illness or disability.

One crucial consideration as it relates to termination is the period of past employment. An employment relationship that is of long-standing is not so easily frustrated. For example, an employee who has been working for an establishment for 30 years and becomes afflicted with an illness, absence for two years would not be considered being away long enough to frustrate the employment contract.

That said, the termination of an employee on long-term disability requires careful deliberation and so, an employer ought to first evaluate an employee’s prospect for recovery and return to work, as well as provisions for accommodating him or her.

When to contact a long-term disability lawyer

If your employment was terminated without cause while you were on long-term disability, you should contact a long-term disability lawyer.

If you are searching for a long-term disability lawyer in Vancouver, contact us at Tim Louis and Company. Our Vancouver long-term disability lawyer has over 25 years of experience and would be pleased to assist with your case.

Call us today to schedule a consultation.

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