Case information

Insurance — Personal insurance — Disability insurance — Total disability — Rider amending definition of total disability in insurance policy — Whether concept of total disability means inability to perform all important duties of an occupation or rather substantial inability to perform important duties of insured’s occupation.

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The applicant took out a disability insurance policy with an insurance company (today the respondent). The policy included a rider that amended the definition of total disability in the policy. On April 13, 2014, the applicant went into cardiac arrest. He received total disability benefits and partial disability benefits for some time. However, on January 7, 2016, the respondent informed him that it believed there was no objective medical evidence supporting a persistent partial disability that would have prevented him from resuming work full-time after February 11, 2015. The applicant brought legal proceedings in the Quebec Superior Court, seeking to be declared totally disabled and to receive disability benefits accordingly. To his application, he added alternative conclusions in which he sought residual disability benefits and reimbursement of the premiums paid between February 2015 and February 2016. The Superior Court allowed the applicant’s amended application in part. It declared that he did not have a total disability within the meaning of the insurance policy, except during the period of April 13, 2014, to April 11, 2015. In addition, having found that no amount was owing to him for the period prior to February 11, 2015, the Superior Court declared that he was entitled to total disability benefits only for the period of February 11 to April 11, 2015, and residual disability benefits only for the period of April 11, 2015, to February 11, 2016. It therefore ordered the respondent to pay the applicant a total of $49,247 in disability benefits and $3,053.44 to reimburse the premiums he had paid between February 1, 2015, and February 28, 2016. The applicant appealed the Superior Court’s judgment, but the Quebec Court of Appeal dismissed the appeal. In its view, the applicant did not have a total disability.