To be entitled to disability benefits an insured must be under the care of a phsyciain, even if there is no medical purpose for the treatment.
An unsuccessful appeal by an insured from a trial judgment dismissing her action for payment of disability benefits on the basis that she was not under the care of a physician, as required by the policy, during the period at issue.
Andreychuk v. RBC Life Ins. Co. [2008] B.C.J. 2307 British Columbia Court of Appeal R.T.A. Low, P.D. Lowry and E.C. Chiasson JJ.A. November 28, 2008.
The Appellant was a lawyer who had purchased an “own occupation” disability policy of insurance (“the policy) from the Respondent in 1993. In 2000 she left practice after she became seriously depressed. She filed a claim for benefits under the policy in October 2000. In July 2001 she was advised that her disability had been substantiated and her benefits were approved. However, nearly a year later, in May 2002, she was advised that based on an April 2002 medical report she no longer qualified for benefits. Pursuant to the wording of the policy she was required to be under the regular care of a physician to be entitled to benefits. In May 2004 she was seen by a psychiatrist who found that she had been free of depressive symptoms for a prolonged period. As a result, he established a regime to wean her off of her antidepressants. In February of 2005 the policy expired for want of payment of premiums. She subsequently saw a physician with respect to depression again in 2006.
The Appellant claimed for benefits, damages due to mental distress, and a return of her premiums. She asserted that she was suffering from an undiagnosed anxiety disorder during the period at issue and therefore was entitled to benefits even though she was not under the care of a physician. It was also argued that she was at risk for becoming depressed if she returned to work. At trial, the Court considered whether she was entitled to benefits and whether she failed to mitigate her loss. Her claim for benefits was ultimately denied as well as her claim for mental distress and for the return of her premiums.
On appeal, the Court affirmed the trial judge’s conclusion that she was not under the care of a physician during the period that she was claiming for. Furthermore, the Court supported the trial judge’s application of the B.C. Court of Appeal decision in Rose v. Paul Revere Life Insurance Co. (1991), 85 D.L.R. (4th) 433. In that case the Plaintiff had recovered from her depression and anxiety and visits to a physician were no longer required. The Court in Rose held that benefits are to continue only as long as medical treatment continues and the fact that a Claimant’s condition may reappear upon return to work does not entitle the claimant to continued benefits.
The Court rejected the reasoning in American authorities which involved a policy provision that clearly required the care of a physician, but concluded that the insured is not required to comply with it. The Court also held that the wording of the subject policy was not ambiguous so the contra proferentum was inapplicable.
This case was originally summarized by kyee@harpergrey.com and originally edited by dpilley@harpergrey.com
