BY: WILLIAM PARKER
Reader: I know a 33 old male who has been diagnosed with Multiple Sclerosis and receiving long term disability benefits. The terms of the disability policy require that he follow his doctor’s treatment recommendations or he does not receive benefits. Recently, the doctor has prescribed costly medications which also have serious side effects. Can the medications be refused without losing his benefits?
Each long-term disability policy is different but most include a clause requiring that claimants seek and follow the treatment of a doctor and attempt rehabilitation. In the situation you describe the first thing to do is to discuss the situation with the doctor and see if they may recommend a treatment that is more agreeable.
It may also be the case that the insurer can’t use a refusal to follow treatment as a basis to deny benefits. Courts have recognized that rehabilitation works for some disabilities and not others. For example, in the case of Kirkness Estate v. Imperial Life Assurance Co, an insurance policy required someone who was disabled due to a mental illness to be under the regular care of a psychiatrist. The insurance company denied benefits because a mentally ill claimant refused such care. However, the Ontario Court of Appeal ruled that the insurance company could not insist on regular psychiatric care as a precondition for benefits where there was no chance of it allowing the claimant to return to work. The individual’s illness was serious enough that they would not be able to work regardless of the care they received.
For someone with Multiple Sclerosis it may be possible that a doctor will agree to a change in their treatment plan. It may also be the case that regardless of the treatment they receive this individual can’t return to work and therefore should be entitled to benefits.
EDITOR’S NOTE: This publication is the seventeenth installment of our firm’s Legal Matters series, which answers a reader’s question every week. If you have a general legal question that you would like to have addressed please send it via email to email@example.com.