Lawyers: JOIN NOW

OCA Ruling Extends LTD Coverage Years After Job Ended

The Advocate Files: Personal Injury | Long Term Disability (LTD) Coverage

 

Toronto Personal Injury Paul Cahill - Serving Toronto, Oakville and GTA`

OCA Ruling Extends LTD Coverage Years After Job Ended

Comment by: Paul Cahill – Toronto Personal Injury Lawyer at Will Davidson LLP.

A recent Ontario Court of Appeal ruling makes it possible for a person who was injured at work to claim long-term disability (LTD) even after leaving the job, says Toronto personal injury lawyer Paul Cahill.

Cahill, a partner with Will Davidson LLP, says the court found the former employee was entitled to LTD payments even though he applied for benefits five years after the injury occurred and two years after leaving the company. The key point, said the court, was that the worker was injured while employed at the firm and the policy continued to cover him.

He tells Top Lawyers that insurance companies may rewrite policies to avoid similar long term disability insurance claims and situations in future.

The ruling by Justice Jean L. MacFarland stated the termination clause in the policy is for future claims, but still offered coverage of claims for injuries suffered while employed.

“The language of the (insurance policy) when considered as a whole is clear — it means that coverage does not continue when an employee begins working for another employer or after the employee has retired,” she found.

“The ‘Termination of Coverage’ language relates to future claims, not claims that may have arisen during the course of the employee’s employment,” MacFarland said. “In other words, if an employee’s claim arises as the result of an occurrence that takes place during their employment, the policy provides coverage.”

Cahill describes the ruling as important for workers who feel they may be entitled to long-term disability although no longer employed with the same company.

“Every policy is different, so there may be individual discrepancies among people’s coverage, although many are also very similar,” he says.

“One thing is certain — once you stop working for a company, the benefits stop,” he said. “What was different with this case is that the plaintiff suffered a very serious injury while at work in 2005.”

The plaintiff, a senior employee at a company, suffered injuries to his brain and back and took four months off to recover.

According to the court ruling, the man’s work performance “deteriorated dramatically from what it had been.” His responsibilities were continuously reduced and, in frustration, he quit in August 2008.

He found another job within days but “the difficulties he’d experienced in job performance” with his previous employer continued and he was fired after one year, says the ruling.

The plaintiff then realized he was disabled and requested LTD from the first company but was initially denied, says Cahill.

“Although the coverage may have ended when he stopped working, the fact is that his entitlement to a claim crystallized when he became disabled in 2005, while he was employed and had coverage,” says Cahill.

Because the injury occurred while he was working and covered, it allowed the plaintiff to make the claim, he says.

The ruling points out the “policy could have contained exclusionary language that may have prevented claims like this, and insurers may rewrite policies to prevent them in future,” Cahill says.

“I’m sure the insurance industry will follow this decision with great interest and may review their existing policies to see if changes are required,” he says. “I would say this kind of situation is probably quite unique.”

Cahill says most people stop work at the time of a serious injury or illness but in this case, the plaintiff tried to return to work before he was overtaken by his injuries years later.

“It’s a bit of an unusual fact situation which created an unusual dispute that needed to be resolved,” he says.

The court also focused on the policy’s time limits, says Cahill.

In the ruling, MacFarland turned to s. 5 of the Limitations Act.

“The only reasonable available conclusion on this record is that the appellant could not reasonably have appreciated he had a cause of action until the end of August 2009,” the judge ruled. “The claim was therefore not discovered until that time … Even on that basis, his action was commenced well within two years of that date.”

The court noted the plaintiff returned to work and “that effectively extended the time from when the benefits would begin and extended that window,” Cahill says.

He says the facts suggest the injury occurred during employment and to get around the time limits for making a claim, the person continued to earn an income so that there were no benefits received from an insurance company.

Does this article speak to you? Was it helpful?

Paul Cahill focuses his practice on serious personal injury, medical malpractice and LTD claims. If you have been denied your long term disability benefits, Contact Paul Cahill for a free, no obligation consultation.

View the profile of this Toronto LTD Insurance Lawyer

 

This and other articles / posts originally appeared on the now defunct advocatedaily.com. As expressed in writing by that website’s owner, the articles / posts, part of a paid service provided by Advocate Daily, are the intellectual property of the lawyer and/or legal service provider who wrote, or for whom the article / post was written and they are free to use as they wish. All articles / posts redeployed on Top Lawyers are done with the expressed consent of the professionals mentioned in said article / post.

Sponsored Ads: Firms to Keep Top of Mind

Lawyers: Join Today!

  • Increase your online visibility.
  • Drive traffic to your existing website.
  • Grow your legal practice.
  • Don't see your city and/or practice area?
    Just let us know - We can add it!
  • Click here for details.

Call: (Local) 416-988-4LAW (4529)
Call: (Toll Free) 1-888-645-5228
E-mail: info@toplawyerscanada.ca

Experienced Lawyers To Help With Your Legal Needs

One of the things that differentiates Top Lawyers from other directories is our exclusivity. As our name suggests, we only list experienced lawyers that meet strict, minimum practice, experience and/or recognition requirements.

These requirements include:
(One or more of the following)

  • Awarded the recognition of “Queen’s Counsel” (Q.C. Designation)
  • Recognized by their Bar Association or Law Society as a “Certified Specialist”
  • Partner in a law firm and in good standing with the legal governing body of their province
  • Have practiced in their preferred area of law for a minimum of ten years

What does this mean to you, the general public?

You can have confidence in selecting and retaining the experienced lawyers listed here. They have "Been there. Done that" and bring their considerable knowledge and skill to support every case they undertake. After all...

"When you really need a lawyer - You want a Top Lawyer.™"

Connect with us on Google+