The insured under a disability insurance policy (“Brown”) was successful in obtaining a declaration that he was totally disabled from employment as defined by the policy issued by his disability insurer (“Mutual Life”) where the Court concluded that Brown had a “medically determinable physical impairment due to injury” for a period of approximately two years

Brown v. Mutual Life Assurance Co. of Canada, [2005] A.J. No. 1003, Alberta Court of Queen’s Bench

Brown was injured during the course of his employment at Smoky River Coal Limited. Mutual Life had issued a group insurance disability policy to Smoky River. Brown’s last day of work at Smoky River was May 10, 1995. From May 10, 1995 to December 6, 1997, Brown received disability benefits from Mutual Life. After December 6, 1997, Mutual Life ceased payment of the benefits.

The group insurance policy provided that after a 24-month period , “totally disabled” meant that the member had a medically determinable physical or mental impairment due to injury or disease which prevented him from performing the duties of any occupation. The Court interpreted the phrase “medically determinable physical impairment due to injury” as requiring a medical determination of physical impairment of a part of an individual’s body structure (muscular skeletal) which is objectively detectable on examination or investigation such as X-ray/imaging or by some other medical method that any reasonable physician using the same techniques would likely detect.

After reviewing the lengthy medical evidence, the Court was satisfied that the Plaintiff’s disability for which he originally received benefits arose due to a problem with his SI joint which was evident on X-rays taken of his joint on January 17, 1997. However, imaging evidence resulting from an examination conducted on January 5, 2000 demonstrated that the medically determinable impairment had resolved. This resolution was further confirmed by imaging done in 2004. As a result, the Court held that the Plaintiff suffered from a medically determinative physical impairment, within the meaning of the policy, from December 6, 1997 to January 5, 2000.

Mutual Life further argued that the Plaintiff was reasonably capable of performing the duties of “any occupation” after December 6, 1997 and was not entitled to benefits after that date. The Court disagreed with this argument, noting that the policy definition of “any occupation” limited this to any occupation:

1. for which he has at least the minimum qualifications; and

2. that provides an income that is equal to or greater than the amount of monthly disability benefit payable under this provision, adjusted annually by the Consumer Price Index

The Court agreed that Brown was physically capable, as of December 6, 1997, of performing the majority of tasks associated with a limited number of entry level jobs. However, the Court further noted that the Plaintiff was suffering a great deal of pain during this time period and would not have been able to leave these jobs whenever his pain required him to do so. Further, none of the jobs likely available to the Plaintiff during this time period would have paid him an income equal to or greater than the amount of the disability benefits. Based on this evidence, the Court held that there were no jobs which Brown was physically capable of performing to the extent that he would have been able to earn the policy threshold amount available during the December 6, 1997 to January 5, 2000 time period. Therefore, Brown was entitled to disability benefits for this period.

The Court declined to award aggravated or punitive damages, finding that the behaviour of Mutual Life and its employees, although mistaken, was not so unreasonable in the circumstances as to support such claims.

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