-The plaintiff, who was diagnosed as suffering from Chronic Fatigue Syndrome (“CFS”), brought an action against the insurer he was entitled to long-term disability benefits under the disability insurance policy issued by the defendant, and for punitive and aggravated damages.
-The defendant did not dispute the diagnosis of CFS but took the position that the plaintiff’s condition did not meet the definition of “total disability” in the policy as the functional limitations caused by his condition did not render him unable to perform the duties of any gainful employment.
-In support of that position, the defendant produced surveillance footage of the plaintiff and evidence of his performance on a functional abilities evaluation.
-The fact that the plaintiff’s own doctors believed in him and acknowledged that they wanted to assist him in securing his long-term disability benefits did not mean that they were advocates for the plaintiff.
-“Total Disability” or “Totally Disabled” means that, because of a medically determinable mental or physical impairment due to illness or accidental injury, you are:
(a) unable to perform the duties of any gainful occupation for which you are reasonably fitted by education, training or experience, and
(b) at any time not working at any job for wage or profit. -The onus is upon plaintiff in this case to prove eligibility for long-term disability benefits.
