Case information

Insurance — Personal insurance — Disability insurance — Total disability — Rider amending definition of total disability in insurance policy — Standard of review applicable to question of whether insured has total disability within meaning of disability insurance contract — Whether concept of total disability requires demonstration that insured is no longer able to perform any important duties of their occupation or rather that insured is no longer able to substantially perform important duties of their occupation.

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(Publication ban in case) (Sealing order) (Certain information not available to the public)

The applicant had a disability insurance policy issued by the respondent. The policy included a rider that amended the definition of total disability in the policy. In March 2015, the applicant believed that he was no longer able to perform his work duties because of anxiety-related problems. In April 2015, the applicant filed a claim for disability benefits with the respondent. He received partial or residual disability benefits for some time. The applicant maintained that the respondent should recognize him as having a total disability instead because he could no longer perform the important duties of the occupation he held at the time he became disabled. He brought legal proceedings in the Quebec Superior Court, which allowed his application in part. It declared that he had had a total disability within the meaning of the rider since April 1, 2015, and that he was entitled to the monthly disability benefits provided for in such cases as of June 30, 2015. It therefore ordered the respondent to pay the applicant the difference between the disability benefits it had paid him between June 30, 2015, and July 31, 2017, and the total disability benefits that it should have paid him as of the same date. It also ordered the respondent to pay the applicant total disability benefits monthly as long as the disability lasted or until the contract expired. It dismissed the applicant’s claim for moral damages. The respondent appealed the trial judgment. The Quebec Court of Appeal allowed the appeal and set aside the trial judgment. It also dismissed the applicant’s originating application.