Not Considered A Substantial Wrong
A civil action can be commenced against a long term disability carrier. Many of these carriers offer disability policies through employers. Examples include, Manulife, SunLife, Citadel to name a few. A civil action against a long term disability carrier is defined as a breach of contract. This is based on the fact that employees whose employers offer group disability insurance enter into a contract with the disability carrier by virtue of their employment. The contract has standard wording that offers disability benefits for those who qualify. The definition of a disability is often what becomes a bone of contention between parties.
In the reported case of Barlow v. The Citadel General Assurance Company, the trial judge stated that the insurance company bore the responsibility of proving the insured (the person applying for benefits) was disabled since they accepted the claim and made payment. Citadel General Assurance Company's appeal to the Ontario Court of Appeal was dismissed by a very brief decision.
The Ontario Court of Appeal acknowledged the trial judge made an error in law. However, the court did not classify the error as a, "substantial wrong or miscarriage of justice." The Ontario Court of Appeal ordered a new trial.
In long term disability cases, the insured will typically have to satisfy the test for disability as defined by the long term disability carriers policy. While few civil cases for personal injury make it to trial. Even fewer breach of contract, long term disability cases make it to trial.
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