Nasab v. Sun Life Assurance Company of Canada, 2024 ONSC 6921
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By: Sarah Richard (Articled Clerk)
In this case, originating in Ontario, Sun Life Assurance Company of Canada, the Defendant, sought summary judgment to dismiss the claim of Saloomeh Nazary Nasab, the Plaintiff, for short-term disability (STD) and long-term disability (LTD) benefits.
The Plaintiff was a sales manager at Nordstrom and suffered from chronic back pain. She initially received STD benefits for her chronic back pain but her benefits were terminated in June 2017. The Defendant argued that the denial was justified under the terms of the policy, which included an out-of-country exclusion for STD benefits and a pre-existing condition exclusion for LTD benefits.
Regarding STD benefits, the Plaintiff travelled outside of Canada from June to September 2017. According to the policy, the out-of-country exclusion allows an absence from Canada for 4 weeks unless pre-approved by the Defendant. The Plaintiff argued that her benefits were suspended during her absence but should have been reinstated upon her return, allowing her to receive the full value of 26 weeks of benefits. The Court denied this, stating the 26-week period was a maximum timeline and not subject to extension. The Plaintiff therefore forfeited her eligibility for further STD benefits by leaving the country for more than 4 weeks without permission from the Defendant .
Regarding LTD benefits, the Defendant’s position was that the pre-existing condition policy exclusion applied to the Plaintiff’s claim. This exclusion is applicable when a disability arises from a condition for which the insured sought treatment or advice within 90 days before coverage began. The Defendant provided evidence that the Plaintiff’s chronic back pain pre-dated her January 2017 coverage commencement. The Plaintiff argued that her condition had worsened, however, the court found that the worsening of symptoms does not change the underlying cause of the disability. As the Plaintiff’s back pain was pre-existing, the exclusion prevented her from receiving LTD benefits for a work absence caused by this condition.
Ultimately, the court found the Defendant had applied the policy terms appropriately and dismissed the Plaintiff’s claims for both STD and LTD benefits. The decision reinforces the importance of adhering to benefit plan exclusions, such as limits on travel and pre-existing conditions, and clarifies that policy benefit periods are not automatically extended when coverage is interrupted.
