The Court held that the insured was obligated to repay long term disability benefits to the extent that the insured had received compensation under the Workers Compensation Act in connection with the “same disability”. The Court also held that the insured was entitled to benefits to the age of 65.

McGill v. Worthing, [2005] B.C.J. No. 1759, British Columbia Supreme Court

The insured received short-term disability benefits under the Teamsters Local 213 Health and Welfare Plan (the “Plan”) from 1987 to 1988 due to a knee injury. He received long-term disability benefits from 1991 to 2001.

In 1987, the insured signed a Reimbursement Agreement wherein he agreed that (1) the insurer had allowed the payment of benefits on the sole understanding that a proper claim had been made to the Workers’ Compensation Board and had been rejected; and (2) should the disability be recognized as being due to or arising from his occupation, he would promptly refund the full amount in regard to such disability.

In August 1993, the insured’s physician remitted a statement to the insurer advising that the insured suffered from a back injury in addition to the knee injury.

In October 2001, the insured received retroactive payment from the Workers Compensation Board (“WCB”) with respect to the knee injury, for the period from April 1991 to October 2001. The Trustees of the Plan claimed that there had been an overpayment to the insured with respect to that period.

The Court held that the Reimbursement Agreement applied only to the initial short-term disability period and did not apply to the benefits received under the long-term disability portion of the Plan.

The Court further found that from 1993 onwards the Plan had paid benefits to the insured based on both the knee and back injuries. The Court found that the knee injury and the back injury were not the “same disability”. The insured had received payment from the WCB only with respect to the knee injury. The Court held that the insured was obligated to repay the plaintiffs, on a pro rata basis, one-half of the payments he received from August 1993 to 2001.

The plaintiffs acknowledged that the insured’s back injury was disabling. The Court thus held that the insured was entitled to benefits from November 2001 until he reached the age of 65 years, which would occur on September 30, 2005.

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