Case information

Insurance — Disability insurance — Insured who has subjective type illness — Burden of proof — Whether, for application of group disability insurance contract in case of dispute relating to obligation to pay disability benefits to insured with subjective type illness, burden of proof on parties requires establishment of preponderance of objective and scientific evidence — Extent to which insurer’s obligation to pay disability benefits to insured with subjective type illness depends on credibility of insured.

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Ms. Forest, the respondent, stopped working in November 2007 after a diagnosis of chronic fatigue syndrome. She availed herself of the group disability insurance plan guaranteed by the applicant, Industrielle Alliance (“insurer”), first by receiving short-term disability benefits. She then received benefits under the long-term plan, but in 2011 the insurer stopped paying benefits on the basis that Ms. Forest no longer met the eligibility criteria. Ms. Forest instituted an action for restoration of the disability benefits and for damages against the insurer, but was unsuccessful. The Court of Appeal allowed her appeal in part.