Source: https://www.sharelawyers.com/establishingtotaldisabilityinltdclaimsofchronicpai.html
Timestamp: 2019-04-19 16:14:57+00:00

Document:
With chronic pain and fibromyalgia affecting increasing numbers of Canadians each year, there has been improved diagnosis, education, medical recognition and treatment options for those who suffer from these debilitating conditions. Yet, disability insurance claims based on these ailments are often subject to increased scrutiny by disability insurers. Frequently viewing these claims with skepticism, the disability insurer will typically hone in on the primary issue, being the legitimacy of the claimant’s condition and the degree to which it is inherently disabling. In effect, the credibility of the Plaintiff generally becomes the driving force behind the success or loss of disputes over a Plaintiff’s entitlement to disability benefits. While the parties’ arguments may be couched in a consideration of the physician’s opinions, the clinical notes and records, physical examinations, diagnostic imaging, the nature of treatment, surveillance and the conduct and evidence of the Plaintiff, underlying these assessments is, in the authors’ opinion, a scrutiny of an insured’s credibility.
Claims for long-term disability (“LTD”) benefits are, of course, dependent upon the relevant LTD policy of insurance. In particular, it is the “test” of disability, as provided in the policy, which becomes the centre of dispute within chronic pain-related litigation. Needles to say, it is the definition of disability with which Plaintiff’s counsel must contend, and apply, in advancing the rights of their disabled clients.
Disability insurance policies usually categorize “disability” into two classes, requiring a claimant to satisfy the definition of disability in order to be eligible for LTD insurance benefits; these two tests, being the “own occupation” and “any occupation” criteria are addressed below.
I am not stating any new principle when I say that the court should be exceedingly careful when there is little or no objective evidence of continuing injury and when complaints of pain persist for long periods extending beyond the normal or usual recovery period.
An injured person is entitled to be fully and properly compensated for any injury or disability caused by a wrongdoer. But no one can expect his fellow citizen or citizens to compensate him in the absence of convincing evidence – which could be just his own evidence if the surrounding circumstances are consistent – that his complaints of pain are true reflections of a continuing injury.
McEarchern, J.’s comments are applicable to the litigation of a contractual claim for LTD benefits, especially where a claim is based on an “invisible” disability, such as chronic pain or fibromyalgia, where there is frequently no objective evidence of an individual’s ailments. Accordingly, these cases will often rise and fall on the evidence that supports or refutes the Plaintiff’s credibility.
What is abundantly clear from a review of the medical evidence is that the diagnosis of the Applicant’s physical condition is not contested. Manulife, in its own reports and letters accepts that the Applicant suffers from fibromyalgia and that this condition restricts her ability to perform certain physical tasks.
In McCallum, the Court acknowledged the “extensive period of treatment, including the various medications and physiotherapy” that the Plaintiff had “put herself through”.15 These efforts to mitigate were depicted by the Court to legitimize the Plaintiff’s condition and disability (and hence bolster her credibility), with the Court noting that “it is unlikely that she would have gone through all that if she did not have some genuine belief in the validity of her condition and symptoms”.16 The authors submit that perhaps it was the Plaintiff’s overall credibility that impacted upon the lens by which her treatment was viewed; certainly many claimants who have undergone exhaustive medical and non-pharmacological treatments have nonetheless seen their LTD benefits denied or terminated.
Fibromyalgia is not a disease but is a syndrome: a constellation of symptoms. Fibromyalgia is a chronic musculoskeletal pain disorder, a particular form of chronic pain syndrome. A patient’s self-report of his or her history and symptoms dominates diagnosis. Validation by medical practitioners is often difficult to impossible.
of a diagnosis of fibromyalgia or chronic pain appears not to trouble the Courts in LTD cases; that is, with the assistance of experts and increased medical knowledge, there appears to be at least an understanding and awareness of fibromyalgia and chronic pain as it may exist, as well as an appreciation for the fact that these ailments can certainly result in disability from one’s own or any occupation. Rather, where these cases are tried, the controversy generally lies on the appropriateness of the Plaintiff’s diagnosis and, moreover, on its impact on his working capacity.
The issue of assessing the extent of pain in the context of a disability insurance policy was articulated by the Court in Chaplin v.
The above reasoning appears to support the imposition of a particularly high standard for awarding bad faith damages against insurers who become overly-enthusiastic in investigating LTD claims based on chronic pain. That is, an insurer may get away with troubling conduct by excusing otherwise unjustified investigations on the basis that the Plaintiff’s symptoms are subjective in nature and thus more difficult to substantiate.
…I find that the Echelon file notes are evidence of an adversarial approach to the Plaintiff ab initio and in behaving in this manner, the Defendant has breached its’ contract of insurance with the Plaintiff.
It is the authors’ opinion that in claims relating to chronic pain, Plaintiff’s counsel should, on a case-by-case basis, carefully consider advancing allegations of mental distress in accordance with Fidler. Indeed, as discussed above, the subjects of these claims are sometimes unfairly forced to endure overly-zealous investigations that are driven by the claimant’s “likeability”, or a lack of objective proof of their subjective experience of pain. Alternatively, an insurer’s denial or termination of LTD benefits may result from a rush to judgment without a thorough review and based on various biases against those who suffer from chronic pain. In either event, where the insurer’s conduct results in emotional hardship, advancing a claim for mental suffering is prudent.
Evidence of the Plaintiff’s credibility (or lack thereof) can sometimes be ascertained by a review of Independent Medical Examination (“IME”) assessment reports that are prepared for the purposes of unrelated proceedings. That is, an LTD claimant with ongoing litigation arising from his denied or terminated disability benefits, may have been (or may concurrently still be) involved in a claim for Accident Benefits under the Statutory Accident Benefits Schedule (“SABS”) or in a tort action arising from personal injuries that he sustained (and which may have resulted in the injuries for which he is now claiming LTD). Where IMEs are prepared for the insurer or Defendant in a proceeding extraneous to the LTD action, a question arises as to whether the IME reports are admissible in the trial of an LTD claim, particularly given Rule 53.02 of the Rules of Civil Procedure, which came into effect on January 1, 2010.
I see no reason to require a high standard be met by consulting medical experts retained by the parties and a different lower standard from consulting medical experts who just happened to have been retained by a non-party but whose opinions might be read to assist one of the parties at this trial.
Since Beasley other Courts have considered Rule 53.03 in determining the admissibility of reports that were prepared outside of the impugned litigation. The decision of Beasley was followed in Jeffrey v. Baker,62 where the Court ordered the Plaintiff to attend a medical examination at the request of the Defendant so as to bring an expert’s report in compliance with Rule 53.03, thereby allowing the expert to testify at trial.
As stated by the Court in McNeill, “[t]he existing jurisprudence interpreting Rule 53.03 is in a state of flux and uncertainty”71. Only time will tell how this issue plays out in the Courts. Certainly, the potential inclusion of additional medical and other expert reports (from unrelated proceedings) in the LTD litigation may provide fodder for a Defendant disability insurer seeking to discredit a Plaintiff with chronic pain.
Clearly then, Plaintiff’s counsel will be well-served by reinforcing the Plaintiff’s credibility, and minimizing attacks thereto, in advancing her claim for LTD benefits on the basis of chronic pain or fibromyalgia. Indeed, more so than with other illnesses, these “invisible” disabilities elicit a scrutiny of the Plaintiff’s self-reports and presentation to physicians, defence counsel and the Courts, with which Plaintiffs Counsel must be prepared to contend. Plaintiff’s counsel should be cognizant of the potential to advance claims for mental distress in LTD cases. They should also be aware of the recent debate over including extraneous medical reports, which may bolster or undermine a Plaintiff’s credibility, in the LTD litigation.
2 Share, David & Leanne Goldstein, “Treatment Rehabilitation and Retraining: How far does the claimant’s duty to mitigate go?” in The Canadian Institute’s Second Annual Managing and Litigating Depression Disability Claims (Toronto: Canadian Institute, 2004).
3 Supra note 1 at para 10.
6 Butler v. Blaylock, decided October 7, 1981, Vancouver No. B781505 (unreported).
7 Price v. Kostryba 70 B.C.L.R. 397 (B.C.S.C.) at para 4.
9 Ibid at para. 35 & 36.
10 Ibid at para. 40.
11 Chaplin v. Sun Life Assurance Co. of Canada (2001), 27 C.C.L.I. (3d) 70 (B.C.S.C) [Chaplin] at para 20.
13 Ibid at para. 37.
14 Ibid at para. 28.
15 Ibid at para. 30.
16 Ibid at para. 30.
17 Ibid at para 31.
19 Plouffe v. Mutual Life Assurance Co. of Canada,  3 W.W.R. 633 (B.C.C.A.).
20 Supra note 18 at para. 39.
22 Ibid at para 60.
23 Mathers v. Sun Life Assurance Co. of Canada (1999), 9 C.C.L.I. (3d) 151 (B.C.C.A.) at para. 8 (leave to appeal refused at  S.C.C.A. No. 334 (S.C.C. Mar. 16, 2000).
24 Lies De. Ruddere, et. al., “When you dislike patients, pain is taken less seriously”, 2011, 152, Pain. 2342-2347.
26 Prkachin, Kenneth M. and Elizabeth M. Rocha, “High Levels of Vicarious Exposure Bias Pain Judgments”, (Sept) 2010, Vol 11. No. 9, Journal of Pain, 904-909 at 904.
30 Supra note 11 at para. 38-39.
31 Ibid at para. 50.
32 Ibid at para. 52.
33 Ibid at para. 62.
34 Ibid at para. 63.
35 Ibid at para. 68.
37 Ibid at para 56, 57.
38 Ibid at para. 56.
39 Ibid at para. 54.
41 Ibid at para. 41.
42 Ibid at para 44.
43 Supra note 11 at para. 44.
45 Ibid at para. 8.
47 Ibid at para. 68.
49 Ibid at para. 9.br>50 Ibid at para. 9.
51 Ibid at para. 47.
52 Ibid at para. 47.
53 Ibid at para. 71.
54 Ibid at para. 66.
57 Supra, note 56 at page 16, pars. 58-59.
58 Beasley v. Berrand (2010), 101 O.R. (3d) 452 (Ont. Sup. Ct. J.)[Beasley] Leave to appeal dismissed (2010), 94 C.P.C. (6th) 347 (Ont. S.C.J.).
59 Ibid at para. 71.
60 Ibid at para. 69.
61 Ibid at para. 72.
64 Ibid at para. 1.
65 Ibid at para. 44.
66 Ibid at para. 45.
68 Supra note 51 at para. 45.
70 Supra note 51 at para. 48.
71 Ibid at para. at para 52.

References: v.

 v. 
 v. 
 v. 
 v. 
 v. 
 v. 
 v.