Insured who suffered injury two days prior to expiration of waiting period was not entitled to benefits under a Group insurance policy

19. January 2016 0

There was no coverage for insured who suffered injury two days prior to expiration of waiting period for coverage under group disability policy.

Insurance law – Accident and sickness insurance – Group insurance – Interpretation of policy – Benefits – Waiting period – Total disability – Entitlement to benefits – Disability insurance – Exclusions

Funk v. Blue Cross Life Insurance Co., [2015] M.J. No. 294, November 20, 2015, Manitoba Court of Queen’s Bench, R.A. Dewar J.

The insured sued his insurer with respect to a group disability insurance policy. The insured had started a new position as a truck driver. One of the benefits offered to him was a group health plan including disability insurance. In order to qualify for coverage, one of the provisions of the policy mandated a “Plan Waiting Period” of 12 months of active permanent employment before the insured was entitled to participate in the plan.

Two days before the expiration of the Plan Waiting Period the insured suffered a heart attack which resulted in his being unable to carry on his employment as a truck driver. The insured made a claim under the disability policy. The insurer took the position that there was no coverage since the policy was not in effect at the time of the insured’s heart attack.

At trial, the insured argued that the insurer had misinterpreted or by its conduct abridged the Plan Waiting Period. The Court dismissed the action on the basis that there was no ambiguity in the definition of Plan Waiting Period and at the time the insured experienced his heart attack he was not covered under the policy as the plan waiting period had not expired. The Court did not accept that the insurer had, by its conduct, abridged the Plan Waiting Period.

This case was digested by Cameron B. Elder and edited by David W. Pilley of Harper Grey LLP. If you would like to discuss this case further, please feel free to contact them directly at [email protected] or [email protected] or review their biographies at http://www.harpergrey.com.

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