Veronica Mohan

Appellant suffered a traumatic brain injury and severe back injury during a company-sponsored event while employed by respondent.

Appellant was unaware of the permanent and disabling nature of the brain injury until after resignation.

Appellant subsequently applied for long-term disability benefits under the employer's policy approximately five years after the injury occurred.

The insurer denied the claim on the basis that coverage terminated upon cessation of active employment.

The trial court upheld the denial.

On appeal, the court reversed, holding that the policy language, when read as a whole, provides coverage for claims arising from incidents occurring during the currency of employment, regardless of when the claim is subsequently filed.

The court also granted relief from forfeiture for the late filing of proof of claim and addressed the applicability of contractual and statutory limitation periods.

The plaintiff, Mr. MacIvor, sought long-term disability (LTD) benefits from Manulife under a group insurance policy held by his former employer, Pitney Bowes, after being seriously injured.

Manulife denied liability, arguing that the plaintiff's coverage ceased when he resigned from Pitney Bowes and that his claim was made after the limitation period.

The court found that the plaintiff was not a "Covered Person" under the policy at the time he made his claim, as coverage terminated upon his resignation.

Section 297(1) of the Insurance Act was deemed inapplicable as the policy itself had not terminated.

Consequently, the plaintiff's action was dismissed.

Following dismissal of a claim for payment of an accidental death benefit under a group insurance policy, the successful defendant sought partial indemnity costs exceeding $28,500.

The central issue at trial had been whether the deceased insured’s blood alcohol concentration exceeded the policy exclusion threshold of .08, which the court ultimately found it did based on toxicology evidence.

In determining costs under s.131 of the Courts of Justice Act and Rule 57.01 of the Rules of Civil Procedure, the court considered the plaintiff’s reasonable basis for pursuing the claim, limitations in the toxicology evidence before trial, and the plaintiff’s financial circumstances.

Emphasizing fairness, proportionality, and access to justice, the court significantly reduced the costs award despite the defendant’s success and an offer to settle.

The defendant was awarded modest all-inclusive costs.

The plaintiff sought payment of a $100,000 accidental death benefit under a group life insurance policy after the insured died in a motor vehicle accident.

The insurer paid the basic life benefit but relied on an exclusion denying coverage where an accident occurs while the insured operates a vehicle with a blood alcohol concentration exceeding 80 mg/100 ml.

Expert evidence was called regarding the reliability of post‑mortem toxicology testing and the insured’s blood alcohol level at the time of death.

The court accepted the reliability of the femoral blood sample analysis showing a concentration of 211 mg/100 ml and held the insurer met its burden of proving the exclusion on a balance of probabilities.

The court further held the exclusion did not require proof that alcohol caused the accident, only that the accident occurred while the insured’s BAC exceeded the specified level.

The appellants appealed a judgment dismissing their claim against the respondent insurer.

The Court of Appeal upheld the motion judge's finding that the limitation period expired in 2005.

The court rejected the appellants' argument that equitable doctrines, such as unjust enrichment, could override the express terms of the insurance contract, the Limitations Act, 2002, and the Insurance Act, particularly since the claim did not fall within the policy terms as it was not an accident.

The appeal was dismissed with costs.