Nature of Claim: Ms. Nasab sought additional short-term disability (STD) benefits (15 weeks) and long-term disability (LTD) benefits under her Sun Life insurance policy, citing chronic back pain.
Key Facts:
- Ms. Nasab was employed as a sales manager at Nordstrom, with coverage starting in January 2017.
- Her last day of work was March 11, 2017, and she claimed STD benefits due to back pain.
- STD benefits were initially approved from March 20 to June 11, 2017. Subsequent claims were denied because of her absence from Canada without prior approval.
- LTD benefits were not claimed at the time, and her condition was deemed pre-existing under policy exclusions.
Issues Considered:
- Eligibility for additional STD benefits despite being out of the country.
- Entitlement to LTD benefits despite the pre-existing condition exclusion.
Court's Findings:
- STD Benefits: Denied. The policy stipulated that benefits cease if the insured is outside Canada for more than four weeks without prior approval. This exclusion was upheld.
- LTD Benefits: Denied. The court ruled that her chronic back pain was a pre-existing condition based on medical history before policy commencement, invoking the exclusion clause.
Outcome:
- Sun Life’s motion for summary judgment was granted, dismissing the claims.
- Costs of $7,500 were awarded to Sun Life, payable within 30 days.
