Appeals Court rules Insurer may deduct Non-earner Benefits from LTD Payments

The civil action," Hamblin v. Standard Life Assurance" was commenced after the plaintiff/appellant, Catherine Hamblin was injured in two separate motor vehicle accidents. After the first accident, she applied for, and received long term disability (LTD) payments from a group insurance plan indemnified by Standard Life Assurance, the respondent in this appeal.

By the date of the second accident, the appellant was not working and as a result, opted to apply for non-earner benefits (NEB) from her own vehicle insurer. In order to qualify, she was required to establish that she suffered a "complete inability to carry on a normal life as a result of and within 104 weeks after the accident" and also, that she did not qualify for income replacement benefits. As defined in the Statutory Accident Benefits Schedule (SABS), Ms. Hamblin's vehicle insurer was entitled to deduct the LTD benefits she was receiving from the NEB payable to her, but for unexplained reasons, they chose not to do so.

As a result, Standard Life proceeded to deduct the amount of NEB from the LTD benefits payable. " They justified their decision based on the terms of the group insurance plan signed by the appellant, which stated that the insurer is entitled to reduce monthly LTD payments by "any disability or retirement benefit"¦payable"¦under a provincial auto insurance law." In other words, Standard Life argued that they were entitled to deduct the payments as long as the vehicle insurer was not deducting the LTD payments from the NEB. The appellant challenged the insurer's decision. However, the application judge ruled that the words "any disability"¦benefit" were indeed broad enough to include NEB, which he stated was a "disability benefit payable because of impairments which render a person completely unable to carry on a normal life". The appellant disagreed and filed an appeal of the application judge's ruling.

Relying on the ruling in" Bannon v. McNeely" and" Walker v. Ritchie, the appellant argued that NEB should not be deductible under the "apples from apples" principle because it is a disability benefit and not an income benefit, such as long-term disability payments.

The Court of Appeal disagreed with the appellant, and asserted that" Bannon v. McNeely" dealt with statutorily-mandated deductions from tort damage awards in regard to the" Insurance Act, but the current issue arose due to the terms of the appellant's insurance policy with the respondent. The judges further stated that the language of the policy must be examined to determine deductibility" and in this case, the language was clear and unambiguous and justified the respondent's right to make the deduction, as long as her vehicle insurer was not deducting the monthly LTD payments. For these reasons, the judge dismissed the appellant's appeal.

It is very important to get clarification and understand all the implications of your insurance policy. A failure to do so may, in some circumstances, result in a loss of benefits to which you are entitled. " Our team at Rastin Gluckstein Lawyers have years of experience in successfully representing clients in disputes with" insurers and personal injury claims. If you or someone you love has been the victim of a personal injury, do not hesitate to call our office today. " We provide a no-obligation consultation to discuss the specifics of your case and provide our expert opinion on your best options moving forward.