As experienced Canadian disability lawyers, we can explain the potential dangers of working in Woodstock, Ontario, and how an insurance appeal may be denied.
Woodstock is a city located in southwestern Ontario, known for its manufacturing and agricultural industries. Its diverse economy encompasses agricultural sectors, manufacturing businesses, and service industries. These enterprises expose workers to different types of job-related risks, ranging from manual labor strains to industrial accidents causing acute or prolonged disabling consequences. If faced with a rejected insurance claim in Woodstock, policyholders need to comprehend applicable laws, regulations, and relevant case examples that can guide their struggle to obtain rightfully deserved benefits. Here are two instances highlighting Canadian court determinations in denied disability insurance claims:
Instance #1: “Vander Doelen v. Sentinel Life Assurance Co., [1991] OJ No 2583 (QL)”
This Ontario Superior Court of Justice ruling revolved around a policyholder’s long-term disability (LTD) benefit rejection after developing chronic pain and psychological problems following a car accident while driving a company vehicle. Mr. Vander Doelen sought damages against his LTD provider, alleging breach of contract, negligent misrepresentation, fraudulent concealment, bad faith, and punitive damages. Key points include:
- An insured party must prove the existence of a disabling condition supported by objective medical findings or evidence.
- Reasonableness and fair dealing dictate the standard of conduct expected from both parties during the contractual relationship.
- Determining the appropriate remedy requires careful examination of all circumstances surrounding the dispute.
The final judgment favored the plaintiff, awarding $170,000+ in general damages plus costs amounting to $25,000 with interest applied thereafter. However, no punitive damages or aggravated awards were granted under the given facts.
Workers in industries may be exposed to various hazards that can lead to workplace injuries or illnesses, including:
- Exposure to harmful chemicals and substances
- Repetitive strain injuries
- Machinery-related accidents
- Slip and fall accidents
If a worker is injured or becomes ill due to their work, they may be entitled to compensation through the Workplace Safety and Insurance Board (WSIB) or their employer’s private insurance plan. However, insurance companies may deny valid claims for a variety of reasons, including:
- Insufficient medical evidence to support the claim
- Failure to meet reporting deadlines
- Insufficient evidence to prove the injury or illness was work-related
When an insurance claim is denied, the injured worker may appeal the decision through various channels, including the WSIB appeals process or through the courts.
Here are some examples of Canadian court cases where insurance appeals were denied:
- In the case of Howden v. Co-operators Life Insurance Co., the plaintiff’s disability insurance claim was denied due to insufficient medical evidence. The court upheld the insurance company’s decision, stating that the plaintiff had not provided enough medical evidence to support their claim.
- In the case of Burton v. Gore Mutual Insurance Co., the plaintiff’s claim for long-term disability benefits was denied because the insurer believed the plaintiff was still able to work. The court sided with the insurer, ruling that the plaintiff had failed to provide sufficient evidence to prove they were unable to work.
- In the case of Taylor v. TD Home and Auto Insurance Co., the plaintiff’s claim for disability benefits was denied because the insurer believed the plaintiff’s disability was not severe enough to prevent them from working. The court upheld the insurer’s decision, stating that the plaintiff had not provided enough evidence to prove their disability was severe enough to prevent them from working.
Insurance appeals can be difficult to win without sufficient evidence to support the claim. That’s why it’s crucial to work with an experienced disability lawyer who can help gather and present the necessary evidence to support your claim.
