A person must be under the ongoing care of physician to claim disability benefits
The Plaintiff's claim for past disability benefits was dismissed on the basis of a limitation defence and her claim for ongoing disability benefits was dismissed as the Plaintiff was not under the regular and personal care of a physician.
Andreychuk v. RBC Insurance Co. March 6, 2008. British Columbia Supreme Court Vickers J.
The Plaintiff was a 44 year old lawyer who sought an order that she had been continuously disabled since September 14, 2000 and was entitled to long term disability benefits pursuant to the terms of a policy with RBC. The Plaintiff also sought damages for negligent investigation, damages for breach of duty of good faith and punitive and aggravated damages.
In fall, 1999, the Plaintiff began to experience trouble sleeping and had difficulty concentrating and eventually left her office on September 14, 2000 and did not return to work. The Plaintiff qualified for LTD benefits but on May 3, 2002 RBC wrote to the Plaintiff advising that she no longer qualified due to a positive opinion obtained by RBC from an independent medical examination indicating that the Plaintiff could work in other situations. The Plaintiff did not commence her action until March 10, 2005.
Under Section 89 of part 4 of the Insurance Act RSBC, 1996, c. 226, an action or proceeding against an accident and sickness insurer must not be commenced more than one year after the date the insurance benefits became payable. The Court cited the decision in Holme Estate v. Unum Life Insurance Co., 2000 BCCA 627, where it was held that this was a rolling limitation period rather than a single fixed date which required the action to be commenced one year from the date when each payment became payable. As the Plaintiff did not commence her action until March 10, 2005, the Court held that her claims for benefits preceding March 10, 2004 was statute barred.
The Court reviewed the evidence and concluded that from March 10, 2004 to the time the policy lapsed, the Plaintiff was not under the regular and personal care of a physician. Therefore, she was not totally disabled as defined by the terms of the policy. As a result the Plaintiff's action for a declaration of entitlement to ongoing disability benefits was dismissed.
The Court further held that the Plaintiff's action for extra contractual damages must also fail as where an insurer prevails on a breach-of-contract action, it could not be found liable for acting in bad faith in its relationship with the policy holder.
This case was digested by Jonathan D. Meadows and edited by David Pilley.