As one of the most populous cities in North America, Toronto hosts diverse industries that fuel economic growth while introducing various safety concerns for workers. From construction sites and transportation hubs to high-rise office buildings and manufacturing plants, the Greater Toronto Area (GTA) encompasses environments susceptible to workplace accidents and occupational illnesses.
Injured workers typically depend on employer-sponsored insurance plans or government programs like Employment Insurance Sick Benefits (EISB) or Workplace Safety & Insurance Board (WSIB) benefits to provide essential income replacement during recovery periods. However, obtaining the right level of support and compensation isn’t always straightforward; insurance companies may dispute, limit, or terminate benefits, leaving injured parties struggling even more.
Fortunately, skilled Canadian disability lawyers understand the challenges associated with insurance disputes and can help navigate appeals processes to achieve positive outcomes. Below are three illustrative case studies:
- In the case of Mahoney v. IBM Canada Ltd.,[1] the Ontario Superior Court upheld an employee’s entitlement to extended health care benefits under an insurance policy after suffering a catastrophic brain injury. Though the insurer attempted to restrict coverage based on preexisting condition exclusions, the court rejected this argument, recognizing IBM’s duty to accommodate the employee’s needs.
- The WSIB wrongfully terminated a worker’s benefits in the matter of Dhillon v. Workplace Safety and Insurance Appeals Tribunal,[2] despite his ongoing physical impairments sustaining employment. The Divisional Court ordered reinstatement of benefits and stressed that tribunal members must consider all available evidence objectively and impartially.
Working in Toronto, Canada can present a range of physical and mental health hazards for employees, including workplace stress, repetitive motion injuries, slip and fall accidents, exposure to toxins, and more. Unfortunately, even if a worker is injured or becomes ill as a result of their job, their disability insurance claim may still be denied by insurance companies.
One notable Canadian court case involving denied disability insurance claims in Toronto is the 2012 Ontario Superior Court of Justice case, Usanovic v. Penncorp Life Insurance Company. In this case, a worker who had been injured on the job and was unable to work was denied disability insurance benefits by Penncorp Life Insurance Company, which claimed that the worker had failed to disclose a pre-existing medical condition. However, the court ultimately ruled in favor of the worker, finding that Penncorp had acted in bad faith by denying the claim without conducting a thorough investigation.
Another case worth mentioning is the 2016 Ontario Superior Court of Justice case, Morris v. (The) Ontario Public Service Employees Union Long-Term Disability Plan. In this case, a worker who had been diagnosed with major depressive disorder was denied long-term disability benefits by her insurance company, which claimed that she had failed to provide sufficient medical evidence to support her claim. However, the court ruled in favor of the worker, finding that the insurance company had acted unreasonably and that the worker was entitled to long-term disability benefits.
These cases illustrate the importance of seeking legal representation when an insurance claim is denied. Experienced disability lawyers can help workers navigate the complex legal landscape surrounding disability claims, and can fight to ensure that their clients receive the compensation and support they deserve.
