The appellant benefits from a group insurance contract between his employer and La Capitale Civil Service Insurer Inc., which contains a two-phase disability benefit. The first phase provides that within the first 24 months, benefits shall be paid when the total disability of the member prevents them from performing every single duty listed in their job description, and the second provides that after this 24-month period, benefits shall be paid if their total disability prevents them from practicing any income-earning activity whatsoever.
On January 17, 2012, the appellant suffered a back sprain that prevented him from performing his job duties. He submitted a claim for benefits to his insurer, which was rejected on January 10, 2013. On December 19, 2013, the insurer reviewed its decision and agreed to compensate the appellant for the first disability period, namely until January 17, 2014. The insurer considered that the appellant’s health condition did not meet the definition of disability listed for the second phase.
(en français)