Insurance law – Group insurance – Disability insurance – Policies and insurance contracts – Benefits – Long term disability – Medical treatment – Proof of disability – Good faith
The defendant’s summary judgment application for a dismissal of the plaintiff’s action for one month of long term disability benefits, entitlement to two treatment plans, and damages for mental distress, and aggravated and punitive damages was dismissed. The Court concluded the defendant’s decisions were based upon proper principles and were not carried out in bad faith.
 O.J. No. 1132
2016 ONSC 1522
Ontario Superior Court of Justice
March 3, 2016
J.F. Diamond J.
The plaintiff was injured in a motor vehicle accident on June 10, 2002. At the time of the accident, the plaintiff was an employee of the Canadian Imperial Bank of Commerce (“CIBC”). As part of the terms of her employment, the plaintiff was entitled to short term disability and long term disability income benefits through CIBC’s self‑funded Income Protection‑Long Term Plan (the “Plan”). The Plan was managed and administered by Great-West Life Assurance Company. In April 2008, the plaintiff left Ontario for El Salvador to visit her ill father. The Plan required Great‑West Life to provide the plaintiff with approval prior to her leaving Ontario. The plaintiff did not seek approval from Great‑West Life and her benefits were suspended. CIBC ultimately revised its position and continued payment of the plaintiff’s benefits for 30 days but advised the plaintiff that her benefits would be suspended after May 3, 2008 if she still remained out of province. The plaintiff remained in El Salvador until June 4, 2008. She did not receive benefits for the additional four weeks she was in El Salvador.
In late 2008, at the request of Great‑West Life, the plaintiff underwent a multi‑disciplinary assessment at a rehabilitation facility known as Odyssey Health Services (“Odyssey”). As a result of the assessment, Odyssey recommended a treatment plan that cost $72,750. The Odyssey recommendation was provided to CIBC and CIBC refused to approve payment of the treatment plan. CIBC was of the opinion the plaintiff’s chances of success for recovery after the proposed treatment plan were approximately 15% and the methods and treatment recommendations were so onerous the plaintiff could not comply.
After CIBC communicated its refusal to implement the Odyssey treatment plan, the plaintiff submitted a further treatment plan which she received from Back to Health. The Back to Health treatment plan was based upon the recommendations made by Odyssey and CIBC denied the plaintiff funding for the Back to Health treatment plan on the basis it was nothing more than the Odyssey treatment plan revisited.
Subsequently, the plaintiff commenced an action against CIBC and Great‑West Life Assurance Co. for payment of the one month of missing benefits, entitlement to the Odyssey treatment plan, entitlement to the Back to Health treatment plan, and damages for mental distress and aggravated and punitive damages.
The defendant CIBC brought a summary judgment motion for a dismissal of the action against it. The Court found that in the circumstances it was able to find the necessary facts and apply the relevant law to the evidence and the summary judgment process was a just and proportionate outcome for the parties. The Court found that the plaintiff had not tendered evidence which met the threshold of proving that CIBC breached its duty of good faith. Regarding the missing month of benefits, the Court found the plaintiff had an obligation to comply with the terms of the Plan and CIBC was justified in its decision to stop payment of the benefits. In addition, the Court found that CIBC was entitled to exercise its discretion under the plan when considering treatment plans and that it did so in the circumstances on proper principles and did not breach its duty of good faith. Accordingly, the plaintiff’s action against CIBC was dismissed.
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