On January 23, 2014, the Supreme Court of Canada released their decision on Hryniak v. Mauldin, 2014 SCC 7, and with it an invitation to the legal profession to utilize summary judgment motions to reduce court costs and promote the efficient resolution of disputes. It certainly seems like long term disability carriers have taken this invitation to heart.
The Supreme Court instructed that summary judgment must be granted where there is no genuine issue requiring a trial. There will be no genuine issue for trial where the motions judge is able to reach a fair and just determination on the merits. Where there is a genuine issue requiring a trial, the judge may invoke new fact finding powers in an effort to come to a just resolution without needing to advance to trial.
In the three years prior to Hyrniak, there were two reported summary judgment motions relating to long term disability claims. In the three years since Hryniak, there have been nine reported summary judgment motions relating specifically to long term disability claims.1
With the advent of the Supreme Court's decision, it is clear that many issues that are presented by LTD claims are amenable to summary judgment motions. It is certainly useful where questions of limitation periods arise. A summary judgment motion allows for these preliminary matters to be addressed without the need of an expensive trial. Of the nine summary judgment motions, seven dealt with the issue of limitation periods. The following three cases demonstrate that the Courts are more than willing to address issues of limitations and policy obligations in a summary manner.
Todd v. Felton Brushes Ltd., 2016 ONSC 5252, was an interesting decision where the Plaintiff was injured in a car accident in 2005 and approved for short term benefits up to a maximum of 17 weeks. The Plaintiff was then subsequently approved for LTD benefits. Eventually, the Plaintiff returned to work on a full time basis. Her LTD carrier informed her they had closed her file. She did not contest this. The Policy was subsequently changed so that only employees working 35 hours per week would receive coverage going forward. At some point after this change the Plaintiff reduced her shifts to 20 hours per week. She was advised in 2007 that she was no longer covered for LTD benefits under the policy. The claimant ceased working for her employer in 2008. She never submitted a subsequent LTD claim. In 2011 she commenced a claim against her LTD carrier and third party administrator for a declaration she was disabled and for damages.
Lofchik J. granted the summary judgment motion and dismissed the Plaintiff's claim in its entirety. The Plaintiff's own evidence indicated that her claim was discoverable by March, 2007 at the latest. The Plaintiff was out of time.
Usanovic v. Capitale Life Insurance Co., 2016 ONSC 4624 was a decision of Broad J. dismissing a Plaintiff's LTD claim as statute barred by a limitation period. The plaintiff was injured in a fall in September 2007 and made a claim for disability benefits. He was approved by the LTD carrier and benefits were paid for a number of years. In early 2012, the LTD carrier made a determination that the Plaintiff no longer met the "any occupation" test based on medical and surveillance evidence. He was given 60 days to appeal the decision and provide new medical evidence. The Plaintiff did not commence an appeal, or subsequent claim, until early 2015. The policy contained a 1 year limitation period on all claims.
Broad J., found that the LTD carrier's letter of January 12, 2012, was unequivocal and commenced the two year limitation period and therefore the Plaintiff was out of time to bring his claim. More importantly, Broad J. found that there was no obligation in law on the LTD carrier to advise the plaintiff of the applicable limitation period in the Limitations Act. While the LTD carrier has a positive obligation to inform its insured of the nature of the benefits available under the policy, there was a marked difference in advising of the application of law external to the policy such as the Limitations Act.
Although summary judgment motions have proven effective for Insurers to proactively address an otherwise protracted litigation process, they have not been uniformly successful. In Nguyen v. SSQ Life Insurance Co., 2014 ONSC 6405 an Insurer's summary judgment motion to dismiss the Plaintiff's action as falling outside various policy or statutory limitation periods was dismissed. The Plaintiff in this case was a Vietnamese man who was largely illiterate and injured in an MVA in late 2009. He was employed at the time of the accident but claimed to be unaware that he had access to a group LTD plan. Perrell J., found that the record supported that Plaintiff was unaware of his entitlement to benefits until 2013 when his lawyer undertook to investigate the availability of an LTD policy through his employer. Given that the Plaintiff was illiterate and his employer had failed to provide the relevant documentation to him as per the Policy, Perrell J. found his claim was not untimely according to his interpretation of Policy. In the event that his claim was untimely, Perrell J. saw fit to grant relief from forfeiture. The motion was dismissed and the issue of the Plaintiff's substantive entitlement was directed to trial.
Given the proliferation of summary judgment motions since Hryniak, it seems apparent that insurers have been provided an exceptionally useful tool where there are discrete issues that can dispose of an entire claim. Although as Nguyen demonstrates, judges may still be wary to rule in favour of the insurer where there is a sympathetic plaintiff involved and this can have cost consequences. However, overall Insurers have been successful in these motions. While there are risks associated with any motion, Insurers who properly prepare and advance a summary judgment motion will often be rewarded with the resolution of a claim at an early stage without a long and costly trial on all the issues.
Footnote
1 There are significantly more if you include employment law disputes that may involve an LTD component.
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.
