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[Employment Disability Insurance: Proving the Claim]

Employment Disability Insurance: Proving the Claim

This section discusses the evidentiary issues which often arise in proving the claim for disability benefits, including the legal tests particularly for the “own occupation” and “any occupation” periods.

The weight to be placed on the GAF score is also reviewed. This is often considered by the lay person as a reliable objective assessment of disability, but this often is not the case. The development of the GAF is interesting. At one time the DSM considered homosexuality to be an emotional disorder. Evidence which is purported to be an objective score of the ability to function and hence a denial of the claim often may be successfully challenged.

The impact of a successful CPP disability application is also considered. It is not surprising that this is not considered a conclusive factor, given the differing test but its potential influence, however modest, should be considered.

Also reviewed is the impact of surveillance evidence upon the insured’s claim and the manner in which such evidence may be successfully discounted. What may often, on first review, be considered damning evidence frequently may be overcome once the means of rebuttal is considered.

The question of the disability policy as being one of non-indemnity is also discussed. Often disability policies are viewed as indemnity but the reality is the disability policy is truly a hybrid. Absent words of exclusion in the policy, an insured serving time in jail has, on two occasions, recovered benefits. It is significant to understand the essentials of the claim in this respect.

The question of the explanations of entitlement set out in a descriptive brochure may also, on occasion, be determinative of eligibility. Again, a review of this issue may be important to the presentation of the claim in circumstances discussed here.

🗂️ Category: Employment Disability Insurance

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