A common source of dispute is whether certain benefits received by an injured person receiving long-term disability payments are deducted from their benefit payment.

There is no one rule regarding when a benefit is offset or deducted from long-term disability payments. The starting point for any analysis is the policy wording.

GENERAL CONTRACT INSTRUCTION

The onus is on the insurance company to prove entitlement to an offset.

The principles of statutory construction require a court to attempt to determine the intention of parties to the contract. If the words of a contract are ambiguous the contract should be interpreted against the one who wrote the words i.e. in favour of the insured and against the insurer.

Coverage provisions that benefit the injured should be construed broadly and exclusion clauses narrowly. One must always be alert to the unequal bargaining power at work in insurance contracts, and interpret such policies accordingly.

The courts do try to give effect to the reasonable expectations of the parties, without reading in “windfalls” in favour of any of them. In essence, the courts should be loath to support a construction which would either enable the insurer to pocket the premium without risk or the insured to achieve a recovery which could neither be sensibly sought nor anticipated at the time of the contract.

DEDUCTIBILITY ISSUES:

The most common questions regarding deductibility is found through receipt of the following benefits:

1. Canada Pension Plan

2. Income Replacement Benefits

3. Workplace Safety and Insurance Board Benefits

4. Severance Pay

5. Pension income

There are a number of issues that affect a person’s Long Term Disability benefits. To ensure you are being treated fairly under the contract, representation by a lawyer is necessary.

A worthwhile read: Lawyer’s group wants hard cap on referral fees

By Jeffrey Shinehoft • April 26, 2017

I was very happy to see this article in the Toronto Star. It is an important read about cracking down on fees from one lawyer to another lawyer.

Most referral fees paid between lawyers will be under $5,000 if a recommendation to the Law Society of Upper Canada is accepted, a report reveals.

And clients who were previously in the dark over referrals and the fees associated with them will now see the payments as part of an agreement all parties will be asked to sign.

Click here to read the full Toronto Star article.