Insurer punished for withholding undisputed insurance benefit.
On May 3, 2022, the BC Supreme Court ordered that a homeowner’s insurer pay PUNITIVE DAMAGES for withholding payment of the undisputed parts of a fire loss claim. In Green Estate v. Sonnet Insurance Co., 2022 BCSC 709, an executor brought an application against the estate’s insurance company for breach of statutory condition 12 and breach of the implied duty of good faith in failing to indemnify the estate for losses arising out of a house fire. Statutory condition 12 requires the insurer to pay or reject a claim 60 days after proof of loss. The insurer initially agreed to pay the...
read moreCovid-19 testing and disability benefits.
The lack of Covid-19 testing should have no impact on whether a long-term disability (LTD) claim is successful. With the shortage of PCR tests and the rapid spread of the Omicron variant, many are concerned that their inability to confirm Covid-19 through a positive PCR test will prevent them from getting approved for LTD benefits if they remain disabled from work. Diagnosis not a prerequisite to getting benefits A diagnosis of COVID-19, or any diagnosis, is not a prerequisite to getting LTD benefits. Look at the language of any standard LTD policy and you will find nothing requiring a...
read moreMental Illness and LTD benefits: a Sun Life Report
Sun Life recently released some internal statistics regarding mental health and long term disability claims. The report confirms what many in the industry have suspected for some time: LTD claims for depression, anxiety, and other mental illnesses are on the rise. In fact, 30% of all long term disability claims are mental health related, which is more than the next two most common causes of disability combined, with cancer at 15% and accidents at 12%. About the report. Sun Life insures more than six million Canadians. It has vast amounts of health, employment, and other data related to...
read moreMedical conditions that qualify for LTD benefits.
You may be wondering which are the medical conditions that qualify for disability benefits? The truth is that any medical condition may potentially qualify for disability benefits. The analysis focusses on the extent of the functional disability caused by the medical condition, and whether the extent of functional disability meets the requirements for various disability benefits plans and programs. Which medical conditions qualify for disability benefits? Any medical condition may qualify for disability benefits. Generally speaking, most disability benefits programs in...
read morePre-existing conditions and LTD benefits.
A pre-existing condition is a condition that you previously received treatment for, that is in some way connected to the medical issue that is currently preventing you from working. It does not refer to any condition that you have ever had before. Sometimes an insurer will rely on an exclusion clause in your policy that says that you cannot receive benefits if you are suffering from a pre-existing condition. This is one way an insurance company tries to avoid paying you benefits. There are many instances in which insurers try to deny claims on the basis of a pre-existing condition and are...
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