Insured is no longer entitled to long-term disability benefits because she can return to work: court

In February 2014, the Defendant informed the Plaintiff that she was suspending the payment of her own occupation benefits because she had not provided the updated medical reports as requested in a September 2013 letter. Despite this, the defendant continued to pay benefits until May 2014. Upon completion of the payment of his own employment benefits, the defendant considered that the plaintiff was not eligible for long term disability benefits during the “Any” period of occupancy under the insurance. Politics. The defendant dismissed the plaintiff’s two appeals against the termination of her long-term disability benefits.

The plaintiff applied for long-term disability benefits to the Saskatchewan Court of Queen’s Bench, stating that she disagreed with the defendant’s assessment that she did not respond. not to the definition of invalidity at the time when his benefits were converted from benefits of his own profession to any other profession. advantages. The defendant, on the other hand, sought summary judgment dismissing the plaintiff’s claim.

The Saskatchewan Court of Queen’s Bench granted summary judgment and dismissed the plaintiff’s claim. The court upheld the termination of the plaintiff’s benefits, noting that the defendant undertook a thorough review and took numerous steps to determine whether the plaintiff was entitled to benefits throughout this process, including through the conduct of the first and second calls, a peer assessment, functional capacity assessment and transferable skills analysis. The Respondent also provided the Applicant with numerous opportunities to submit her medical information.

The court reviewed the evidence and found that although the plaintiff was unable to return to her own occupation, she was able to return to a non-physical and sedentary job and did not meet the definition of disability. under the professional benefits portion of the insurance policy. Among the testimonies of medical experts and specialists, the court preferred the timely assessment which was subsequent to the applicant’s heart surgery and which indicated that the applicant could now return to non-physical work.

On whether the plaintiff was medically fit to practice a profession, the court found that the defendant had relied on medical information and independent assessments to support its decision that the plaintiff could return to non-physical employment and had correctly established that there was no real issue requiring trial. The onus then shifted to the plaintiff, who did not refute or contradict that evidence, the court said.