Many of us go through life trusting that the endless stacks of insurance paperwork that is thrown our way is fair and just. We rely on our employers to ensure that the policies they buy will cover and compensate us if ever the need arises. While it is sometimes common to have access to adequate insurance through employment, insurance companies usually scrutinize all claims in an effort to both weed out falsified claims for compensation, and to sometimes reduce benefits where possible for valid claims (in an effort to protect their bottom line).
In previous blogs, we have explained that a summary judgment is a legal action taken to possibly prevent a trial from beginning by affecting key elements of a case. Its primary purpose is to allow one party to challenge the foundation of a case or elements within a case before a trial commences.
In the case of Nguyen v. SSQ Life Insurance, Mr. Nguyen was being denied a claim for long term disability (LTD) after an accident on the basis that the time period had elapsed under both the contractual and statutory periods. The insurance company filed for a summary judgment based on those grounds.
The type of policy provided to Mr. Nguyen (the plaintiff) through his place of employment encompassed the following:
- Sixty percent of the month’s gross salary would be provided for long term disability where total disability was proven
- A little over a three month period has to elapse before the entitlement period begins
- A ninety day window is afforded after the three month elimination period to allow for the filing of claims
The plaintiff is a native of Vietnam and had attained a high school level of education. He could not read or write English and had very little skill in understanding the language. He migrated to Canada in 1992 and was insured through his current employer. He was then given a booklet in English about his type of policy.
Unfortunately in March of 2010, he was involved in a vehicular accident where he was a passenger. Sometime after the accident, he informed his employer that he was unable to work and would not be returning. He did not receive any advisement concerning applying for long term benefits and he was unaware that he was entitled to them.
He originally hired a paralegal firm to aid in the application of the Statutory Accident Benefits after the accident, but then hired a personal injury lawyer in October of the same year to handle his claim for SAB. During this period he was still in the dark about long term benefits.
It was only during his lawyer’s probing pertaining to his tort claim in January of 2013 that he discovered his policy’s provisions for long term disability. He filed for LTD in April of that year.
The insurance company found his claim to be lacking key elements of proof and asked that he provide the necessary paperwork to verify his claim. Within about a month from that request, he complied and a month after that in July, received a denial response from the insurance company.
In August of that same year, he filed suit against the insurance company who then filed for summary judgment.
The insurance company surmised that the lateness of the application hindered certain steps and procedures required to investigate the validity of the claim.
After examining the circumstances, the Judge concluded that due to the issues specific to this case, the plaintiff should be granted the discretion of an “untimely” application entry (which is provided in the policy by the insurer).
Mr. Nguyen did not understand the language that the booklet was written in and his employer did not make the necessary arrangements to ensure that he understood the parameters of this insurance policy.
In the policy that was purchased, the employer had the legal obligation to assist its employee both upon insuring him and then after being made aware of his inability to return to work. They failed on both ends and it was proven to the Judge’s satisfaction that the plaintiff did not maliciously or deliberately fail in his responsibility for filing his claim.
Based on this decision, the Judge granted a relief from forfeiture, which is when the legal rights of a party (the insurance company) is forgone/not applied if founded on an error or mistake.
While it is true that the insurance company does bear some disadvantage in the lateness of the claim, the extent cannot be determined and due to the nature of the disability (long term), they are still able to assess to some degree the validity of his injuries.
Experience, compassion and professionalism are just some of the characteristics that we at Rastin & Associates embody. We ensure that we assess your case in its entirety and fight for your deserved compensation. If you have been in a similar situation or know of someone who has, please contact us. We a ready and willing to offer a free initial consultation no matter your injury and get you the legal advice and direction needed to start you on the road to recovery.