Manulife wrong to deny disability benefits for chronic fatigue.

On November 28, 2005 the BC Supreme Court decided that The Manufacturers Life Insurance Company (“Manulife”) was wrong to deny long term disability benefits to a woman suffering from chronic fatigue syndrome.

The case was called Milner v. Manufacturers Life Insurance Company, 2005 BCSC 1661.

In September 2001, Cindy Milner, age 45, was hired as a manager at a residential care facility for the elderly. She was responsible for managing nurses, care aids and related staff and ensuring that the facility had all the necessary supplies. In late October, she contracted pneumonia and was off work for one week. When she returned to work, Ms. Milner described having strange headaches, being unbelievably tired, and being forgetful and “foggy”. She left her job for good three weeks later, suffering from a multitude of symptoms later diagnosed as chronic fatigue syndrome.

Before developing chronic fatigue syndrome, Ms. Milner had a physically active lifestyle with sporadic involvement in a number of sports such as cycling, swimming, cross-country skiing, wind surfing, scuba diving and ice skating. Afterwards, she stated that she could do very little of anything in the way of physical activity and had little energy to do household chores, cooking or working outside the home.

Notwithstanding all of these alleged difficulties, however, Ms. Milner had been able to complete her Master’s thesis and received her Master of Nursing degree from the University of Victoria in June 2004.

Ms. Milner made a claim for long-term disability insurance with Manulife. The disability policy, which was provided as part of Ms. Milner’s employment, stipulated that a benefit would be paid to employees in the event that an illness or bodily injury prevented them from performing the duties of their job. After 24 months, the benefit would be payable if the employee was disabled from performing any job for which they were fitted by education, training, or experience.

Manulife caused surveillance to be carried out on Ms. Milner on several occasions. The surveillance showed Ms. Milner moving in an apparently normal fashion during such activities as walking, standing and sitting at sporting events involving her children, holding the child of a friend, and shopping.

Manulife denied Ms. Milner’s claim for long-term disability benefits on the grounds that she was not disabled. As a result, Ms. Milner hired a disability lawyer and brought a lawsuit against Manulife.

The court commented that Manulife had good reason to seriously question whether Ms. Milner was disabled. For example, it had surveillance which showed Ms. Milner moving in an apparently relaxed and. normal way as she walked, stood and sat in various situations as well as driving her car, carrying parcels from her car to her house, sewing and so on. All of these activities appeared to contradict the severe subjective symptoms Ms. Milner had reported to her doctors.

The court also pointed to the fact that Ms. Milner, since becoming ill, had written and defended a thesis for her master’s degree in nursing. Manulife argued that the capacity of someone to write such a document was evidence that Ms. Milner had work capacity. However, the court found that Ms. Milner had obtained substantial assistance from friends to complete her thesis.

The court found that despite the fact that Ms. Milner had exaggerated some of her symptoms and her incapacities, she truly suffered from chronic fatigue syndrome which disabled her from employment. The court was swayed at least partially by the “compelling and believable” evidence of Ms. Milner’s daughter who testified about Ms. Milner’s ongoing fatigue and how it affected their family life and her relationship with her mother.

The court concluded that Ms. Milner was totally disabled from her occupation and any other occupations, jobs or work within the meaning of the Manulife policy and she was therefore entitled to receive disability benefits.