At our weekly meeting by videoconference, we discussed a case involving whether the plaintiff met the statutory threshold and a case involving the limitation period in a disability benefits claim.
Threshold Not Met
Ankita Abraham went over the case of McNamee v. Oickle, 2020 ONSC 2371, a decision addressing the statutory threshold in a motor vehicle accident claim.
The plaintiff was involved in a motor vehicle accident in February 2014. At trial, the jury awarded the plaintiff $30,000 for general damages, $2,500 for past loss of housekeeping and home maintenance capacity, $3,900 for past massage and physiotherapy, and $240 for past medication and parking.
The threshold analysis was based on the issue of causation. Specifically, the court, by using the “but for” causation test, had to determine whether the motor vehicle accident in question caused the alleged injuries.
Justice Beaudoin noted that a determination of causation is the first step in the threshold analysis. If the alleged impairments were not caused as a result of the subject collision, then the court does not need to go any further in examining whether the plaintiff meets the threshold.
The defendant argued that the plaintiff had a significant pre-accident history, which included a severe alcohol abuse disorder, depression, and pain in her neck and back. The defendant further argued that the plaintiff only sustained soft tissue injuries as a result of the motor vehicle accident, which was resolved by the Fall of 2014.
As such, the defendant claimed that the plaintiff’s alleged injuries were not related to the subject motor vehicle accident, and instead was related to her significant life stressors unrelated to the accident.
The plaintiff, in contrast, argued that she sustained “serious, continuing injuries in the accident which have impacted her function and have resulted in significant losses.” Specifically, the plaintiff argued that her pre-existing health conditions made her more vulnerable to sustain the injuries she suffered in the accident.
The plaintiff alleged that she suffered a new depressive episode, aggravation of her alcohol use disorder, and a new mental illness of somatic symptom disorder, predominately with pain as a result of the accident.
Justice Beaudoin, upon review of all the evidence, including expert evidence from both parties, found that the plaintiff’s experts relied too heavily on the plaintiff’s self-reporting, which was demonstrated to be unreliable and contradictive. Justice Beaudoin noted that the plaintiff’s experts had also testified without a review of all the relevant clinical notes and records.
Justice Beaudoin recognized and accepted the opinion of the defendant’s expert, who concluded that the plaintiff’s decline was as a result of the plaintiff’s subsequent life events, ultimately not related to the motor vehicle accident.
Accordingly, the court held that the plaintiff did not meet the statutory threshold, as she had failed on the issue of causation.
Plaintiff Successful in Limitations Dispute in Disability Benefits Claim
Matthew Umbrio addressed the case Halladay v. Manufacturers Life Insurance Company, 2020 ONSC 2802. The defendant, Manulife, brought a motion for summary judgment seeking a dismissal of the plaintiff’s claims for both short-term disability benefits and long-term disability benefits pursuant to two policies of disability insurance issued by Manulife to the plaintiff’s employer.
The plaintiff alleged that she was totally disabled and entitled to the payment of both benefits under the policy. Manulife contended that the claim had been issued after the expiration of the limitation periods in the policies.
The plaintiff was a full-time cleaner at Brockville Mental Health Centre in a unionized position. She went on sick leave in 2008 and never returned to work due to her mental health. She was approved for one month of short-term disability benefits, but she was unable to return to work following this period. Manulife requested additional documents to continue her benefits. Ultimately, she was denied benefits.
The plaintiff, however, had only applied for short-term disability benefits, not realizing that Manulife had issued two separate policies to her employer. Her application for short-term disability benefits was not a valid application for long-term disability benefits. As a result, when she appealed for the first time, she only appealed the decision on the short-term disability benefits.
She eventually authorized her union representative to continue to process on her behalf with Manulife. Manulife communicated to the union representative that the plaintiff had not applied for long-term disability benefits, who then promptly sent a letter to Manulife stating that the union representative was “hereby submitting a claim for long-term disability benefits”.
Following two further appeals, Manulife denied the plaintiff both short-term and long-term disability benefits finally in 2013. The plaintiff commenced this action in 2014.
Manulife argued that the limitation period should have commenced in 2009, after the first denial. Justice Abrams disagreed, holding that the final determination of the matter was not communicated until 2013 and that it was reasonable for the plaintiff to pursue the insurer’s internal appeals process before bringing an action in court.
Justice Abrams, citing the Court of Appeal’s decision in Kassburg v. Sun Life Assurance Company, held that, even though the plaintiff had not brought a formal cross-motion, he would be issuing a declaration that the plaintiff had commenced the action within the appropriate limitation period.
Manulife also contended that the plaintiff had not included any reference to a claim under the long-term disability policy in her prayer for relief in the Statement of Claim.
Justice Abrams held that it was reasonable that the plaintiff was unaware that Manulife had issued two separate policies to her employer as she was unable to obtain copies of these policies until the action had already been commenced. As a result, the Court granted leave to amend the Statement of Claim to include the long-term disability policy in the prayer for relief.
The plaintiff was successful on the motion, and was thus awarded costs.