2015 Disability Claims Management & Litigation Conference Summary

On May 27th and 28th, Kirk Wirsig co-chaired the 8th Edition of “Disability Claims: Management and Litigation”, a legal conference for lawyers and other insurance professionals, including human resource personnel and medical specialists. Both Kirk Wirsig and Martin Willemse were speakers at the conference.

Disability claims management is a complex area and these conferences aim to keep those working in this area up to date on medical research, case law and best practices in order to better serve those suffering with disabilities and to fairly resolve disputes.

2015 Disability Claim Topics

This year’s conference focused on:

  • Mental health disability claims — case law and developments;
  • Changes in CPP disability legislation;
  • Objective medical evidence to support claims for conditions like fibromyalgia chronic fatigue; and
  • Limitation periods

We had a well-known rheumatologist speak and provided great insights on types of physical but “non-visible” disabilities such as chronic fatigue, fibromyalgia and chronic pain. These are “real” conditions and while they may rely on “subjective” evidence, our courts have accepted that people suffering with these symptoms can become severely limited in their daily function.  To learn more on case law updates, read Martin Willemse’s paper on this topic.

2015 Updates to CPP Disability Appeal Procedures

Recent changes have also occurred to the CPP disability appeal procedures, such as:

  • Abolishment of the 3-panel tribunal appeal
  • Abolishment of the Pension Appeal Board
  • Abolishment of the right to appeal to the Federal Court
  • Appeal hearings conducted over the telephone without representation by Service Canada

To learn more on this topic, read Mr. Wirsig’s paper outlining these changes.

Regular and Appropriate Care of a Physician

Another important topic was defining “regular and appropriate care of a physician”.  Policies differ as to where this is defined under the contract. This in turn has an impact on the rights and obligations of the insurer and claimant as to why and when insurers can expect that the claimant be under regular and appropriate care of a physician. While it seems straight forward, particular wording is subject to interpretation by the courts and has resulted in varying outcomes in litigation.

Limitation Periods on Disability Claims

Limitation periods in disability claims have always been a complicated maze to navigate. While recent legislative changes have mandated that insurers advise claimants of the existence of limitation periods, it remains a complicated area as to when the “clock begins to count down”. For example, the internal appeal process offered by the insurance company does not stop the limitation period from running. If the limitation period runs out, you may lose your right to sue.

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