Attempting to return to work after receiving long-term disability insurance benefits can seem daunting. Many questions arise, but one we often hear is “what happens if I fail or get sick again?”  The short answer is that it depends on the amount of time that has passed since you returned work. You may start receiving long-term disability benefits again without having to wait.  Or in other words, without having to satisfy another “elimination period”.

Most long-term disability insurance policies have terms dealing with successive periods of total disability.  If you have returned to work and are unsuccessful or become ill again, then it will be important to review the terms of your policy with a disability benefits lawyer. The terms and time limits to qualify may vary from policy to policy.

Recurrent Disability

Long term disability insurance policies will often have certain requirements. Some will allow an employee to restart benefits if they become ill or are unable to work due to the same illness or cause within a specific time period.  For example, an employee with Fibromyalgia attempts to return to work following a one-year absence. A progressive return to work plan is established and the employee returns to work.  Unfortunately, she suffers from a flair up of her symptoms and her treating physician provides the insurance company with a medical report stating that the employee is unable to work.  Providing the recurrence took place within the time limit, this employee would qualify for an immediate reinstatement of benefits. Typically, the time limit for a recurrence of the same illness is 12 months.

Related Disability

Long term disability insurance policies will also often have provisions allowing benefits to be reinstated. This occurs if the employee becomes ill or is otherwise unable to work due to a related illness within a specific period of time, typically 6 months.  A related illness is one that results from the same cause as the initial illness or disability.  For example, an employee who develops mental health issues as a result of a physical disability. If they cannot work, this would be considered totally disabled due to a related disability.  An employee whose related illness renders them totally disabled would qualify for an immediate reinstatement of benefits. Of course, this is providing the recurrence took place within the time limit provided in the policy.

Unrelated Disability

In the event of Total Disability due to an unrelated cause or illness, Long term disability insurance policies also often provide for a reinstatement of benefits.  In this case the time limit is typically one month.  If this period has passed, then the employee will be required to satisfy the “elimination period” before having access to long term disability benefits.

Unfortunately, insurance companies may refuse to reinstate benefits even if the employee is within the time limit provided in the policy. They may argue that the fact that the employee was able to return to work temporarily demonstrates that they are not totally disabled.

Insurance companies may also refuse to reinstate benefits. This occurs when they do not believe the employee is experiencing a recurrence of the same illness or disability. It can also happen because they do not believe the new disability is related to the previous illness or disability.

Contact a disability benefits lawyer for assistance if your claim for reinstatement of long-term disability benefits is denied. We can often assist in resolving the issue with the insurance company. We can take action to obtain the necessary updated medical information or medical reports from the employee’s treating physicians or specialists.

[This article is for informational purposes only and does not constitute legal advice. Legal advice cannot be given without consideration of your individual circumstances.]

In a recent decision, a labour arbitrator found that an employer had failed to exhaust the search for accommodation options for an employee with a permanent disability before attempting to terminate her employment. 

In Sodexo Canada Ltd v Canadian Union of Public Employees, Local 145, Arbitrator Randi Abramsky recognized that the search for accommodation for the grievor’s disability had been a long and difficult one. Nonetheless, she determined that the employer had not yet met the point of undue hardship in accommodating the grievor when it attempted to end her employment in mid-2018.

The Arbitrator found that the employer had not addressed two considerations which were fundamental to its duty to accommodate. First, the employer could not establish that the grievor was unable to perform a modified version of her former position using assistive equipment. Second, even if the grievor could not perform her own position, the Arbitrator found that the employer had not looked beyond the grievor’s original work location to attempt to find position she could perform at other worksites.

As a result, the Arbitrator concluded that the employer had breached its procedural duty to accommodate the grievor, contrary to the Human Rights Code. She therefore directed the employer to work with the grievor and the Union to explore these accommodation options, with the issue of damages and compensation for the breach to be determined once the accommodation process concluded.

The Union was represented in this case by Morgan Rowe of RavenLaw.

David Yazbeck was one of several experts from across the globe who was recently invited to speak on effective whistleblower protection with Financier Worldwide Magazine, based in Birmingham, UK. David provided his insight into establishing effective whistleblower protection, whether through legislation or through internal company policies.

The article was published in February 2019 and can be found on the Financier Worldwide Magazine website.

In a recent victory for CUPE Local 109, Jessica Greenwood provided representation to an employee whose rights under the collective agreement and the Human Rights Code were violated due to an unfair termination of her employment.

In the July 29, 2019 decision, Arbitrator Eli A. Gedalof affirmed that an employer cannot rely on a pattern of innocent absenteeism to establish frustration of contract when the absences are due to exceptional events, the employee has demonstrated a substantial improvement in attendance, and there is objective evidence that the employee will be successful in maintaining regular attendance moving forward. The decision also affirms the employer’s obligation under the Human Rights Code to accommodate an employee’s disability to the degree of undue hardship.

The Union successfully argued that the City relied on an improper and discriminatory application of their Attendance Management Program (AMP) to the Grievor’s case.  This application of the AMP program served to hide the fact that the Grievor’s attendance had improved dramatically and was continuing to improve.

Arbitrator Gedalof ruled that the City had not met its burden under the first part of the test, by failing to establish repetitive and consistent absenteeism triggering the decision to terminate. Arbitrator Gedalof noted “far from demonstrating an escalating pattern of absence in 2018 leading up to her termination, the grievor demonstrated the opposite…. what precipitated the grievor’s termination was a single day of absence following an extended period of acceptable attendance. The grievor’s attendance in 2018 reflected a substantial improvement over an extended period of time, and effectively disrupted the pattern of absences in 2017”.

Even if the employer had met the first part of the test, the Arbitrator concluded that frustration of the employment contract would still not be established on the facts. The Union had satisfied the second part of the test, which places a burden on the grievor to present objective evidence demonstrating good reason to believe that any issues that contributed to the excessive absences have been addressed and the grievor will be able to provide regular and consistent attendance in the immediate and foreseeable future. Arbitrator Gedalof noted, “The most straightforward objective evidence of the grievor’s ability to attend work is that at the time of her termination, she had in fact been attending work regularly for an extended period of time.”

As a result, despite finding that the City had applied the AMP program absent bad faith, the City’s “decision to terminate the grievor without just cause, in the absence of frustration and due to attendance issues related to their medical condition, nonetheless violated the Collective Agreement and (s.5 of) the Human Rights Code”.

The Grievor was awarded re-instatement, with no loss of service or seniority, compensation for lost wages and benefits since the termination, and damages for the breach of the Code.

RavenLaw congratulates the Grievor and CUPE Local 109 for another successful defence of employee rights!

In March 2019, David Yazbeck was re-elected as an Institutional Board Member for the Workers’ History Museum. David’s re-election continues RavenLaw’s long-standing support for the Workers’ History Museum. In addition to David’s role as a Board Member, RavenLaw has been an institutional member of the Board of Directors for a number of years.

The Workers’ History Museum was founded in 2011 with the goal of developing and preserving workers’ history, heritage, and culture in the National Capital Region and Ottawa Valley.

On September 17, 2019, Raphaëlle Laframboise-Carignan gave a presentation to the members of the Mood Disorders Ottawa (MDO) support group, a peer-run organization aimed at enhancing the lives of people with mood disorders. She presented on the topics of Short-Term Disability, Long-Term Disability, Canada Pension Plan Disability benefits, and accommodation in the workplace. Raphaëlle would like to thank the MDO group for inviting her to participate in their session.

In a recent judgment, the Ontario Court of Appeal overturned a lower court decision and held that there is no independent tort of harassment in Ontario. The Court explained that there was no support in the case law in Canada or internationally to extend the law to recognize this new tort. This judgment has left many Ontario employees wondering – what recourse do I have now, if I experience workplace harassment? This post will explore some of the possible options you may still have to pursue your rights, depending on your particular circumstances.

Discriminatory harassment – human rights complaint

Is the workplace harassment you are experiencing based on a prohibited ground of discrimination? For example, is it harassment based on your sex, race, age, or disability? If so, you could bring an Application to the Human Rights Tribunal of Ontario, alleging that you have experienced discrimination and harassment in the course of your employment. If the Tribunal finds in your favour, you could be awarded monetary compensation, reinstatement to your employment if you’ve been terminated, and systemic orders against your employer to comply with human rights legislation going forward.

Workplace harassment in a unionized environment – grievance

Are you a unionized employee? If so, you could talk to your union about filing a grievance about the workplace harassment. Many unionized workplaces have collective agreement protections against harassment, or employer policies prohibiting harassment in the workplace, that can form the basis of a grievance. Harassment grievances are often challenging to succeed in, but if successful, an arbitrator has broad discretion to award an appropriate remedy.

Failure of employer to conduct harassment investigation – Ministry of Labour complaint

​Did you ask your employer to investigate the harassment incident, and the employer failed to do so? If so, you could file a complaint with the Ministry of Labour. All Ontario workplaces have obligations to implement appropriate harassment policies and programs under the Occupational Health and Safety Act, and a Ministry of Labour inspector could order the employer to comply with the Act if it has failed to do so. However, this avenue of recourse is limited, as a Ministry inspector cannot investigate whether workplace harassment actually occurred, and cannot award any individual remedies to an employee.

Harassment leading to resignation – claim for constructive dismissal

Was the harassment so severe that it led you to resign from your employment? If so, you may be able to pursue a claim for constructive dismissal in court. This claim requires conduct by your employer that is inconsistent with an intention to continue to be bound by your employment contract, including creating a toxic work environment due to harassment. If successful in a claim of constructive dismissal, a court may award you damages similar to what you would receive if your employment had been wrongfully terminated.

Flagrant or outrageous harassment – claim for intentional infliction of mental distress

Depending on the severity of the workplace harassment, you may still have a tort claim available in the courts. In Merrifield​, the Ontario Court of Appeal noted that the tort of intentional infliction of mental distress still exists in the employment context, and is available in situations where someone like Merrifield would seek to claim damages for harassment. The test for intentional infliction of mental distress is stricter than the test the lower court had articulated for harassment, however; it requires conduct that : a) is flagrant and outrageous ; b) is calculated to produce harm; and c) results in visible and provable illness. This is a relatively high threshold to meet, but if it can be met, it could result in an award of general damages.

If all else fails – attempt to revive the tort of harassment?

Curiously, the Ontario Court of Appeal left the door open to accept the existence of the tort of harassment in the future. The Court held that it did “not foreclose the development of a properly conceived tort of harassment that might apply in appropriate contexts”. The Court did not elaborate on what those appropriate contexts might be. Accordingly, if none of the above avenues of recourse apply, but the claim for workplace harassment is compelling based on the evidence, it may be worth revisiting the potential existence of this tort.

[This article is for informational purposes only and does not constitute legal advice, which cannot be given without consideration of your individual circumstances.]

RavenLaw was pleased to be invited to consult on this year’s Lancaster House Human Rights and Labour Law conference in Ottawa and to present on multiple panels. The annual two-day conference addresses a wide range of topical and emerging issues in the area of labour and human rights law.

Andrew Astritis served on the conference’s Advisory Committee this year, helping to plan the event. Wassim Garzouzi presented on October 10, 2019 as part of the panel “Taking Stock, Looking Ahead: Major caselaw and legislative update.” Morgan Rowepresented on October 11, 2019, discussing the difficult questions that arise when workers experience illnesses and disabilities due to workplace stress, bullying, and interpersonal conflicts.

As an employee, once you have applied for Long Term Disability (LTD) benefits, you have certain responsibilities you must fulfil to ensure that your claim for benefits is accepted or to ensure that you continue receiving benefits. The specifics of these responsibilities will be listed in the benefits policy and will usually include the following:

• Making reasonable efforts to recover

As part of your responsibilities, the insurance company expects that you will make efforts to recover from your illness or injury. This includes being under the care of a physician, specialist, or other treatment providers and also requires you to participate in any reasonable and customary treatment or rehabilitative program.

If you and your treating physician(s) believe that you cannot take part in a program recommended by the insurance company, you will need to provide medical evidence as to why you cannot take part. This should state that your participation in a program would hinder your recovery efforts and explain why in detail.

• Making reasonable efforts to attempt a return to work 

The insurance company will also expect you to make reasonable efforts to attempt to return to work either in your own occupation or in an alternate job.

Usually, a return to work will start gradually, taking your physicians’ advice regarding hours, schedule, restrictions, and limitations. The return to work may also consist of modified duties for a certain period, depending on your physician’s advice.

• Applying for other benefits 

Your policy will most likely set out your responsibility to apply for other benefits that you may qualify for, such as Canada Pension Plan (CPP) Disability benefits. Some policies will even ask that you appeal any decision denying those benefits.

Insurers usually set up their insurance policies, so they become the “payors of last resort”. This means that other sources of income, such as CPP Disability benefits, are deducted or offset from your LTD benefit. You will also be required to let your insurance company know if you apply for other benefits and they are approved. Those new benefits may reduce the amount you receive from the insurance company.

For more information on this topic, please refer to our article on long term disability offsets.

• Reporting other income 

The insurance company will expect you to report any income you are receiving from sources other than your LTD claim.

It is important for you to advise your caseworker about any other sources of income from other employment or benefits. If you do not advise your insurance company, you could be responsible for repaying some or all of the LTD benefits you have already received.

Check your specific policy to see what qualifies as reportable income, but generally, it consists of the following:

• CPP Disability Benefits;
• WSIB payments;
• Notice or Severance payment from your employer if you are terminated; and
• Employment Income not previously approved by the insurance company.
• Cooperating with the Insurance Company regarding your health 

 It is important to cooperate with your insurance company and provide them with updated medical documents and medical information when they ask for them. This might include surgery dates, new diagnosis, new findings, test results, and new medications.

Unlike the employment context, where there is no obligation to provide all medical reports or diagnoses to your employer when on sick leave or when making an accommodation request, dealing with an insurance company is different. You are required to provide them with medical reports and diagnosis to show that you meet the definition of disability as set out in the LTD policy.

It is also valuable to inform the insurance company of your progress or setbacks regarding your illness/injury.

We are here to help navigate the Long Term Disability claim process. Consult one of our experienced Disability lawyers at Raven, Cameron, Ballantyne and Yazbeck LLP if you are considering making a claim for disability benefits or if your disability claim for benefits has been denied. 

[This article is for informational purposes only and does not constitute legal advice, which cannot be given without consideration of your individual circumstances.]

How is the employment start date affected when an employee resigns, but then continues working under a new employment agreement for the same employer? The Ontario Court of Appeal has recently released two decisions that discuss how an employee resigning and then continuing to work affects the start date of their employment. The decisions show that the specific facts of the resignation and re-hire will determine whether an individual will be limited by the terms and conditions of their new employment agreement.

In Ariss v. NORR Limited Architects & Engineers, 2019 ONCA 449, the employee had agreed to waive his previous years of service to make the change from full-time to part-time hours. The Court determined that the employee was not bound by the new employment agreement because he had not intended to resign. By contrast, in Theberge-Lindsay v. 3395022 Canada Inc. (Kutcher Dentistry Professional Corporation), 2019 ONCA 469, the Court determined that an employee who resigned and then withdrew her resignation before her last day of work was bound by her new employment agreement.

Ariss v. NORR Limited Architects & Engineers, 2019 ONCA 449

In 1986, the employee started full-time employment as an architect. When the business was sold, the employee was notified that his employment would be terminated because of the sale. He signed a new offer of employment, which did not contain any termination provisions. In 2013, the employee wanted to reduce to part-time hours. The employer agreed, but only if the employee resigned and entered into a new employment agreement, where the employee specifically agreed to waive his previous years of service. The employer told him that these terms were non-negotiable. The employee agreed to these terms and changed to part-time employment.

Three years later, in 2016, the employee was dismissed without cause from his employment. The employer relied on the 2013 employment agreement and limited the employee to his minimum statutory entitlements, as though the employee had started his employment in 2013.

The motion judge determined that the employee had not waived his years of service. On appeal, the Ontario Court of Appeal found that the 2013 agreement to waive the employee’s previous service was in violation of the Employment Standards Act, because neither the employer or employee actually intended the employee to resign at the time. The Court found the agreement was constructed to circumvent statutory notice and severance based on the employee’s actual years of service.

Theberge-Lindsay v. 3395022 Canada Inc. (Kutcher Dentistry Professional Corporation), 2019 ONCA 469

In 1993, the employee started her employment as a dental hygienist. Over the course of her employment, she was required to sign a series of employment agreements. In 2005, the employee gave her notice of resignation, but then she changed her mind before her last day of work. Her employer agreed to let the employee stay but required her to sign a new contract. When the employee was terminated without cause in December 2012, the employer relied on the newest employment agreement to limit her statutory entitlement to one year of service.

The trial judge found that the employee’s employment had continued uninterrupted since 1993, and she was not limited to one year of service. The trial judge found that none of the three employment contracts signed by the employee during her employment were enforceable because they lacked consideration. Therefore, the trial judge determined that the employee was wrongfully dismissed and assessed her damages at 15 months’ notice.

On appeal, the employer argued that the trial judge erred in failing to take account of the employee’s 2005 resignation. The Court of Appeal held that the employee’s resignation, even though it was rescinded, opened the door to the employer instituting a new contract. Even though the employee never stopped working, there was effectively a resignation and a re-hiring, which broke the employee’s length of service. The Court determined a valid contract had been formed after the employee’s resignation because the employee offered to be employed again and the employer accepted her offer. The employee was therefore limited to the minimum statutory entitlements under the Employment Standards Act as though she had started her service after her resignation.

Commentary

These two decisions from the Ontario Court of Appeal, highlight that the circumstances of the resignation and the subsequent re-hire will be crucial to determining an employee’s start date. If neither the employee nor the employer intends for the employee to resign, and the new employment agreement is just a legal fiction, then the courts will likely find that employee’s previous years of service count when determining their reasonable notice entitlements. However, if the employee did intend to resign, but changes their mind, then the employer may be entitled to ask the employee to sign a new employment agreement, waiving the employee’s previous years of service.

[This article is for informational purposes only and does not constitute legal advice, which cannot be given without consideration of your individual circumstances.]