Important B.C. Case Decides Working Through A Disability Should Not Affect Entitlement To Long-Term Disability Benefits

by Kris Bonn
Legal ruling on long-term disability benefits

An important long-term disability case out of B.C. clarifies when a disabled worker will be entitled to disability benefits and answers a number of difficult questions. In the case of Tanious v. Empire Life, 2016 BCSC 110, Justice Brown ruled that just because Ms. Tanious continued to work with her disability, does not mean that she is not entitled to long-term disability benefits. The key issue is the person’s medical condition. As Justice Brown states in his judgment, “…it is the Plaintiff’s medical condition, not whether they are working at the time, which determines to what extent the claimant is disabled.”.

Concurrent causes of disability were ruled not to limit entitlement to long-term disability benefits.

In this case, Ms. Tanious was diagnosed with Multiple Sclerosis (MS) in 2005, which caused her to suffer fatigue, depression and anxiety. She continued working until early 2012. In the spring of 2011, the year before she stopped working, Ms. Tanious began self-medicating with crystal meth. Empire Life argued that Ms. Tanious was not entitled to long-term disability benefits because:

- she was working at the time she says she was totally disabled; and

- alternatively, she was disabled from her substance abuse (crystal meth) which was an exclusion under the policy

Justice Brown rejected both of the insurer’s positions. He ruled that the test for disability benefits is not whether the insured (Ms. Tanious) actually refrained from work but rather, whether one of ordinary prudence who suffered from the insured’s injuries would desist from his or her business or occupation to effectuate a cure. With respect to the insurer’s second argument on the substance abuse exclusion, Justice Brown ruled that the proximate cause of Ms. Tanious’ disability was her MS. He went further and ruled that even if the substance abuse and the MS were both causes of her disability, that the exclusion would not operate in this case as the exclusion did not clearly contemplate excluding in the case of concurrent causes of disability.

An important case for lawyers representing clients with long-term disability claims.

Finally, Justice Brown awarded Ms. Tanious $15,000 in aggravated damages for mental distress, loss of peace of mind and loss of dignity. As the successful party at trial, Ms. Tanious was entitled to legal costs from Empire Life. Typically, the losing party pays the winning party 40-60 percent of their actual legal costs. In this case, Justice Brown ordered Empire Life to fully indemnify Ms. Tanious for her legal costs, awarding her 100 percent of her legal costs. Justice Brown ruled the reason for doing so, “…to ensure that the Plaintiff will recover the full benefit of an insurance contract they have had to litigate to enforce and thereby be put in the same position they would have been in had the insurer fulfilled its obligations initially.”

This is a great case for plaintiffs and one that all lawyers who represent clients with long-term disability cases should have in their back pocket.