Long-term Disability Coverage

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.

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

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

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.

Repetitive Strain Injuries: What You Need to Know

When we think about workplace injuries, we often think about slip-and-fall accidents, injuries resulting from falling objects or the various back and neck strains that come with the territory within many workplaces. However, some work-related accidents are often far less dramatic.

A number of injuries occur over time, through constant repetition of daily tasks, which negatively impact the body causing strain to sensitive joints and muscle groups. These repetitive strain injuries, or RSI, can have a long-lasting effect on our health and daily life.

Injuries Resulting From Repetitive Motion

A Repetitive Strain Injury, whether it is temporary or permanent, will need rest or a change in daily habit that provides time to heal. It is crucial to see a medical professional right away to prevent any further damage to the muscles, ligaments, nerves or tendons through continuous, repetitive motion.

Most Common Repetitive Strain Injuries

typingRepetitive Strain Injuries (RSI) can result from a buildup of damage to muscles, tendons, and nerves from repetitive motion or strain on specific parts of the body. Repetitive Strain Injuries are quite common and may be caused by a variety of common work activities, including:

  • Using a computer mouse or trackpad
  • Excessive typing (data entry)
  • Swiping items at a supermarket checkout/cash register use
  • Grasping and manipulating tools
  • Working in an assembly line environment
  • Training for sports or other athletic activities

Some commonly diagnosed Repetitive Strain Injuries are:

  • Tendonitis (inflammation of the tendon)
  • Pertendonitis (inflammation of the sheath of a tendon)
  • Trigger finger (difficulty bending or straightening any of the fingers which is caused by inflammation and thickening of the tendon)
  • Tenosynovitis (inflammation of the fluid-filled sheath that surrounds a tendon causing joint pain and stiffness)
  • Carpal Tunnel Syndrome (numbness, tingling and pain in the hand or arm resulting from compression of the median nerve which is squeezed as it travels through the wrist
  • Epicondylitis (inflammation of tendons surrounding an epicondyle)
  • Bursitis (inflammation of the bursa sac which is common around the elbow, hips, knees and shoulder)

Repetitive Strain Injuries

What Are the Symptoms?

There are many possible causes of repetitive strain injuries and a wide range of symptoms that result. Tenderness or pain the affected muscle or joints are common, a throbbing or pulsating sensation in the affected area and or tingling in the hands or arms. Any other symptoms will depend on which part of the body is affected.

It’s important that you visit a medical professional for a proper diagnosis as soon as you experience symptoms to prevent any further damage over time.

Repetitive Strain Injury Prevention

The primary ways in which you can reduce the risk is to stop or limit the intensity of the activity. If the activity cannot be stopped, tips for reducing the risk may include:

Taking breaks: Taking regular breaks from any repetitive task may help reduce the strain on your body.

Stand up: Standing up, stretching and frequently moving your limbs may reduce the risk. Stretch your back, arms, fingers and legs regularly.

Vision break: Rest your eye muscles by looking up and staring for a moment at objects in the distance or simply looking around the room. The key is to give your eyes a regular break from screen time.

exerciseOverall health: Eat healthy and get regular exercise to keep your body as resilient as possible, and try to avoid smoking, as this reduces blood flow and oxygen in the body.

Posture: Try to keep yourself from slouching. Ensure your desk, chair and computer screen are aligned as much as you can in an ergonomic setting.

Wrists: Avoid bending or overextending your wrists, and keep the arms, wrists and fingers aligned when typing as much as possible.

Typing: Try to touch type as much as possible and avoid hitting your keys too hard.

Keyboard Shortcuts: Try to use keyboard shortcuts whenever possible, as this can reduce the amount of typing needed.

Mouse or Track-pad: Do not grip too tight or press too hard, and try to slow your speed in order to reduce muscle tension in your hand and wrist.

Temperature: Keep an eye on the temperature of your work area and regulate where necessary.

Phone Use: If you need to use a phone while working, try wearing a headset as this will keep you from needed to grip the phone for long periods or needing to clamp the phone between your head and shoulder.

You can trust Tim Louis & Company to ensure the best possible outcome for your personal injury case

These common RSI injuries can have a lasting impact on one’s health and quality of life. If you or a loved one has experienced a serious injury while on the job, contact Tim Louis and his compassionate and experienced legal team today by calling 604-732-7678 or email timlouis@timlouislaw.com.

Sources:
https://www.enjuris.com/workplace-injury/repetitive-strain-injuries-work.html

https://my.clevelandclinic.org/health/diseases/17424-repetitive-stress-injury

https://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/overuse-injury/art-20045875

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