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Long Term Disability Benefit Denial? You May Still Be Entitled To Coverage If You Give Late Notice

January 18, 2016

If you become disabled from working and have short or long term disability insurance, you are entitled to be paid disability benefits. To make a claim, most long and short term disability policies provided by insurance companies (such as Manulife and Sunlife) require you to provide notice to the insurance company within a certain period of time. In many cases the notice must be provided in as little as 30, 60 or 90 days from the date of disability.

There are many times when people who have been injured or impaired miss the notice period for a variety of reasons. They may have hoped that the disability was temporary and did not consider that they needed or were entitled to insurance. They may have been confused about the benefits available from different insurance companies; especially when there are other insurance companies involved, such as in a car accident case. Sometimes people receive false or inaccurate information about the availability of long term disability benefits from their colleagues or an employer.

Whatever the reason, if you provide your notice of a claim later than the maximum notice period, the insurance company will likely deny your claim. When this happens, can you successfully sue your insurance company for benefits? This issue was recently addressed by the Ontario Court of Appeal in Dube v. RBC Life Insurance Company, 2015 ONCA 641. In this case, Mr. Dube was involved in a motor vehicle accident on May 24, 2010. His long term disability insurance policy with RBC contained the following clause regarding the notice periods:

Written notice of a claim should be sent within 30 days after the date your disability begins. However, you must send RBC Insurance written proof of your claim no later than 90 days after the date your disability begins. If it is not possible to give proof within 90 days, it must be given no later than 1 year after the time proof is otherwise required except in the absence of legal incapacity.

Mr. Dube did not notify RBC of his potential disability claim until March 9, 2012 and did not submit a claim for long-term disability (“LTD”) benefits to RBC until June 5, 2013. In other words, he gave late notice of his claim to RBC. As a result, RBC denied LTD benefits. Mr. Dube brought a lawsuit to claim the benefits and RBC responded by arguing that the case should be thrown out because of the missed notice period.

The Ontario Court of Appeal held that Mr. Dube was entitled to what is termed “relief from forfeiture.” In other words, even though he had not complied with a term of the policy, he was still entitled to long term disability benefits.

The court will consider the following factors when deciding whether to grant relief from forfeiture:

  1.  The conduct of the person applying for benefits;
  2.  The seriousness of the breach; and
  3.  The value of benefits in comparison to the damage caused by the breach.

When assessing the conduct of the insured, the court will examine the reasons why the notice was late. When assessing the seriousness of the breach, the court will look at whether there has been prejudice to the insurance company. What medical evidence is available or lacking because the insurance company was not able to investigate the claim earlier? Finally, the court will consider the value of the benefits claimed, compared to the seriousness of any prejudice claimed by the insurance company.

If your long term disability insurance company has denied your claim for long term disability benefits because of a late notice or for any other reason, it is important that you contact an experienced long term disability benefit law firm or lawyer. Even though you may have given late notice of your claim, you may still be entitled to benefits.

For more information about long term disability claims handled by Sean Giovannetti, click here.

If you live in Ottawa or anywhere in Eastern Ontario and would like to discuss your potential short or long term disability benefit claim on a no fee or obligation basis, contact Sean Giovannetti:

Call Sean Giovannetti at 613-225-0037.
Email Sean at info@sginjurylaw.ca.
Or fill out our Case Form.


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