Can a plaintiff obtain LTD benefits from a disability plan if they do not specify a breakdown under a settlement?

New Brunswick, Canada


The following excerpt is from Carter v Province of New Brunswick, 2013 NBQB 239 (CanLII):

[32] In Young v. Saskatchewan [1992] S.J. No. 255, the plaintiff received a lump sum settlement which did not specify a breakdown under the various heads of damages for loss of income, pain and suffering et cetera. The plaintiff was entitled to LTD benefits under a plan similar to the one at bar. The quantum of benefits under the plan depended in part on compensation received by the plaintiff for loss of earnings from a third party. Baynton J. said the following in the determination of a breakdown of the plaintiff’s third party liability settlement at page 5 and 6 of 7: ”The onus is on the defendant to establish that the plaintiff has received third party liability loss of earnings compensation from a source or in a manner that falls within the definitions of the policy. Once this has been done, especially where the particulars of the compensation are not available to the defendants, the burden shifts to the plaintiff to establish that the compensation does not fall within the deduction provisions of the policy … In a settlement type of scenario, as opposed to a court award, the plan sponsor need only prove that the plaintiff received a settlement from a third party and the onus shifts to the plaintiff to establish the breakdown. But what about a settlement in which the plaintiff either deliberately or inadvertently did not break down the proceeds by category? Can he satisfy the onus of proving the nature and allocation of the settlement proceeds by simply relying on the fact that they were not specified? I think not. The plaintiff has sued the plan for benefits. Those benefits depend on what the plaintiff received for wage compensation. To get the benefits the plaintiff must establish what he received for wage compensation whether or not the allocation of the compensation was specified in the settlement itself. This requirement may be of no concern to the third party but it is of vital concern to the plan sponsor. It is untenable for a plaintiff to take the position that he can satisfy this onus of proof, (and thereby obtain additional disability benefits under the plan to which he is not entitled) by simply relying on the fact that the settlement itself did not expressly allocate the proceeds among the various heads of damages for which the plaintiff received compensation. The fact that it may now be difficult to determine in retrospect the breakdown of the plaintiff’s settlement does not relieve the plaintiff from doing so. Nor is there any term of the plan, express or implied, that waives the required deduction and increases the plaintiff’s benefits payable under the plan because of such difficulty“

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