O’Neill v. Canadian International Paper Co. and Continental Casualty Co.

O’Neill v. Canadian International Paper Co. and Continental Casualty Co.

The insured's individual certificate governs his rights; where a condition in the master group policy (the 'actively at work' clause) is not set out in the individual certificate it cannot be relied on against the insured under s.214 R.S.Q. c.295; the insured met the certificate's conditions for coverage; the insurer's liability for periodic benefits commenced after the 180‑day elimination period (Aug 23, 1966) so proof of loss and prescription are measured from that date; consequentially Continental was liable for benefits from Aug 23, 1966, and the plaintiff's pleadings and amendment were properly allowed.

Citation
[1973] SCR 802
Parties
Plaintiff/appellant: Charles Patrick O'Neill; Defendant/respondent: Canadian International Paper Co.; Defendant/respondent: Continental Casualty Co.
Court
Supreme Court of Canada
Jurisdiction
Canada
Judgment Date
22 November 1972
Procedural Posture
Appeal (civil Insurance/disability) / Supreme Court of Canada on Appeal From the Court of Queen's Bench, Appeal Side, Province of Quebec
Outcome
Appeal allowed in part: appeal allowed as to Continental Casualty Co. (judgment varied) and dismissed as to Canadian International Paper Co.
Legal Topics
Group Disability Insurance, Presence at Work Condition, Pre Existing Illness, Certificate Versus Master Policy, Proof of Loss Timing, Amendment of Pleadings, Prescription/limitation Periods, Interpretation of Insurance Act Ss.214 and 217
Source Language
English
Insurance Law Contract Law Civil Procedure Limitation/prescription Group Disability Insurance Presence at Work Condition Pre Existing Illness Certificate Versus Master Policy +4 more

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Parties

Charles Patrick O'Neill

Plaintiff/appellant

Canadian International Paper Co.

Defendant/respondent

Continental Casualty Co.

Defendant/respondent

Procedural Posture

Appeal (civil Insurance/disability) / Supreme Court of Canada on Appeal From the Court of Queen's Bench, Appeal Side, Province of Quebec

Legal Issues

  1. 1 Whether a condition in the master group policy not reproduced in the individual certificate can be invoked against the insured
  2. 2 Whether the employer was a stipulator for the benefit of a third party or merely an intermediary
  3. 3 Whether the appellant met the 'actively at work' condition so that coverage became effective

Ratio Decidendi

The insured's individual certificate governs his rights; where a condition in the master group policy (the 'actively at work' clause) is not set out in the individual certificate it cannot be relied on against the insured under s.214 R.S.Q. c.295; the insured met the certificate's conditions for coverage; the insurer's liability for periodic benefits commenced after the 180‑day elimination period (Aug 23, 1966) so proof of loss and prescription are measured from that date; consequentially Continental was liable for benefits from Aug 23, 1966, and the plaintiff's pleadings and amendment were properly allowed.

Court Disposition

Appeal allowed in part: appeal allowed as to Continental Casualty Co. (judgment varied) and dismissed as to Canadian International Paper Co.

Orders

  • Declare that Charles Patrick O'Neill is entitled to receive from Continental Casualty Company $575.24 per month from August 23, 1966 until age 65 if he meets the other terms and conditions of the policy
  • Order Continental Casualty Company to pay plaintiff for twenty monthly payments due up to May 27, 1968 the sum of $11,504.80 with interest computed from each payment date since the first, and costs