New Brunswick lumber operator denied STD benefits despite diagnosis

Worker didn't satisfy 'total disability' definition

Stress at work, due to the nature of his job, and conflict with a coworker caused an equipment operator to book two weeks off work, after he saw his doctor.

Corey Elliot, who worked for Grand Lake Timber in New Brunswick since 2012, advised his family doctor in June 2017 that various factors at work had caused him to become unable to work. 

The doctor prescribed medication, in addition to time off, for anxiety and depression. 

On June 2, Elliot applied for STD coverage under the employer’s insurer Medavie-Blue Cross. He indicated “stress” on the form under the nature of illness. As well, Elliot authorized the release of any medical files and other documentation relation to his health status.

On June 7, a case-management coordinator with Medavie-Blue Cross requested more detailed information from Elliot’s physician. 

Under the heading of primary diagnosis, the doctor wrote: “Weight loss. NYD (not yet determined) — psychological?” On the same form, the doctor indicated “stressors @ work” under the secondary heading, and added “anxious, nervous, (weight) loss” under the heading of subjective symptoms.

The claim was denied on June 16 by Kimberley Field, disability claim specialist with Medavie-Blue Cross, who had taken over the case. After Elliot appealed, further information from doctors were requested.

On Aug. 17, Field advised Elliot that his claim was approved from June 9 until June 27, but after that he was no longer eligible for STD benefits.

Two separate doctors indicated that although Elliot was currently experiencing stress that prevented him from working, he would be able to return eventually, after treatment as well as Elliot having no further contact with the coworker that had originally caused him stress.

“The information you and your health professionals provided indicated you were able to perform your regular occupation duties, or any accommodated work that is reasonably available through your employer. Although you may have a medical situation, you retain the capability to perform your occupation tasks and therefore you do not meet the definition of total disability,” wrote Field via letter to Elliot.

The union, Unifor, Local 104, grieved the decision, and argued the employer violated the collective agreement when it denied the benefit. 

After a “functional telephone interview” with Elliot, Field concluded that his situation did not meet the definition of disability, so that was why she denied the claim.

But, said the union, Field was not qualified to make such a determination.

Arbitrator Michel Doucet agreed and ordered Elliot to receive 15 weeks of STD payments.

“Having considered the medical evidence that supports the conclusion that (Elliot) was diagnosed with anxiety and stress, I am satisfied, on a balance of probabilities, that (Elliot) was unable, at the relevant time, to perform the duties of his occupation because of his medical condition. I therefore conclude that he is entitled to the short-term disability benefits according to article 23.01,” said Doucet.

When Field denied the claim, she relied too heavily on their talk via phone, according to the arbitrator. 

“Instead, in disregard of the medical information before her, Field decided to give preference to what the grievor had told her during their phone conversation of June 27, 2017 ,” said Doucet.
Grand Lake Timber’s argument that when it accommodated Elliot by segregating him from the offending coworker, that was sufficient to alleviate his disability was dismissed by the arbitrator.

“In this case, it might be that the relationship between the grievor and a coworker contributed in a large measure to his condition. It might also be that (Elliot) is functioning better at home. However, that in itself, is not an appropriate basis for denying his claim,” said Doucet.

Reference: Grand Lake Timber and Unifor, Local 104. Michel Doucet — arbitrator. Clarence Bennett, Sheila Lanctôt for the employer. Brenda Comeau for the employee. May 30, 2018. 2018 CarswellNB 208

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