Executive Summary: Key Legal and Evidentiary Issues

• Central dispute concerned denial of long-term disability (LTD) benefits under a union-negotiated group insurance plan administered by 3sHealth.
• A key evidentiary issue was whether medical reports and Practitioner’s Return to Work Reports established that Ms. Sjogren met the Plan’s definition of disability.
• The trial judge preferred the independent expert opinion of physiatrist Dr. Sommer over the opinions of the appellant’s family physicians due to fuller examination and broader expertise.
• Questions of procedural fairness arose from the appellant being self-represented, including whether the trial judge gave sufficient assistance without becoming her advocate.
• The timing of the LTD application and relief from forfeiture under the Plan’s time-limit provisions were argued but ultimately not decided on appeal because the disability finding was dispositive.
• On appeal, the Court applied a deferential standard to factual and expert-evidence findings, intervening only if there was a palpable and overriding error, which it found was not present.

Facts of the case

The litigation arose from a dispute over long-term disability (LTD) benefits under a group insurance plan for unionized health-care workers in Saskatchewan. In 2009, Judy Sjogren (also referred to as Ms. Sjogren-Zuck) was employed at Wakaw Hospital as a laboratory and x-ray technician. She was a member of the Service Employees’ International Union (SEIU) – West and, through that unionized employment, was a participant in a disability insurance plan negotiated by her employer and the Union. The Saskatchewan Association of Health Organizations Inc. (SAHO) administered the plan at the time; 3sHealth Shared Services Saskatchewan later became the administrator as SAHO’s successor.

On May 22, 2009, while attending to a patient, she injured her back. She initially continued to work but stopped on June 2, 2009 after consulting her family physician, who diagnosed a back strain and recommended two weeks off followed by a gradual return to work. She then claimed and received Saskatchewan Workers’ Compensation Board (WCB) benefits and took part in a gradual return to work program. The trial judge later found that she voluntarily discontinued participation in that program on 24 August 2009 without clearance from either the WCB or her physician, a conclusion she disputed but partially conceded at trial by acknowledging that she “stopped going” on that date. The WCB discontinued her benefits as of 5 September 2009, and she did not return to work thereafter.

In September 2009, she asked her employer for the forms needed to apply for LTD benefits under the plan. For reasons not clearly established in the record, she did not receive those forms from her employer at that time. In January 2010, she was dismissed from her employment; the reason was not in evidence, though the trial judge speculated that the termination was likely linked to her failure to return to work. It was unclear whether she pursued a grievance through her union in relation to the termination, but evidence referenced a May 2013 meeting before the Saskatchewan Labour Relations Board involving the Union and the employer, with no indication that 3sHealth participated.

More than a year after the injury, in December 2010, she obtained LTD application forms directly from 3sHealth and submitted her application on 7 December 2010. 3sHealth rejected the application because it was filed outside the time limits specified by the plan. Later, in 2013, after the Labour Relations Board Registrar contacted 3sHealth’s disability manager, 3sHealth agreed to reassess the application despite its lateness, requested more supporting information, and, when none was provided, confirmed its earlier denial on timeliness grounds.

The trial decision and issues

In the Court of King’s Bench decision (2024 SKKB 151), the plaintiff brought a civil action for damages, claiming that 3sHealth had wrongfully denied her LTD benefits under the plan. The case involved both contractual and insurance-law features, as it turned on the interpretation and application of a group disability insurance plan negotiated through a collective agreement.

The trial judge addressed several core questions: whether the application for LTD benefits was submitted within the plan’s required time limits; if not, whether relief from forfeiture should be granted to prevent the late filing from defeating her claim; and whether, on the evidence, she met the definition of disability under the plan at the relevant times. While the full wording of the plan provisions is not reproduced in the appellate reasons, it is clear that the plan required applications to be submitted within a specified time after disability arose and that it contained a definition of disability (including the concept of being unable to perform one’s own occupation or any suitable occupation).

The plaintiff relied primarily on medical evidence from her family physicians, including Dr. Robert Ardell and Dr. Patricia Campbell, and on WCB Practitioner’s Return to Work Reports, to show that she was unable to work and therefore disabled under the plan. 3sHealth led evidence from a specialist, Dr. Hillel Sommer, a physiatrist with particular training in physical medicine and rehabilitation and in insurance-related medical evaluation. Dr. Sommer conducted an independent medical examination, reviewed the full medical file, and opined that she was not disabled within the meaning of the plan and was capable of performing her own or another suitable occupation.

The trial judge found that the LTD application was made outside the time limits set out in the plan and declined to exercise judicial discretion to grant relief from forfeiture. Independently of that issue, the judge also concluded that the plaintiff had failed to prove that she was disabled within the meaning of the plan. The judge was critical of the evidentiary basis for the opinions of Drs. Ardell and Campbell, finding that they appeared to rely heavily on the plaintiff’s subjective reports and, importantly, that there was no indication they had performed a complete physical examination. In particular, he found Dr. Campbell’s evidence to be of no assistance in the absence of a physical examination.

By contrast, the judge accepted Dr. Sommer’s evidence as that of an unbiased and highly knowledgeable expert who had undertaken a full review and examination. On this basis, the trial judge preferred Dr. Sommer’s opinion, found that the plaintiff was not disabled under the plan, and dismissed her claim in its entirety.

The appeal and fresh evidence application

The plaintiff appealed to the Court of Appeal for Saskatchewan (2025 SKCA 121). She represented herself and challenged the trial decision on multiple fronts. First, she applied to introduce what she described as “fresh evidence,” comprising her entire trial exhibit book, because she believed that several WCB Practitioner’s Return to Work Reports had not been admitted at trial. The appellate court reviewed the record and concluded that all three Practitioner’s Return to Work Reports in question had, in fact, been admitted into evidence as one exhibit (Exhibit “BB”). Because the materials she sought to introduce were already before the trial court, the fresh evidence application was dismissed.

She then argued that the trial was procedurally unfair, particularly given her status as a self-represented litigant with limited legal knowledge. She asserted that the supposed absence of the two Practitioner’s Return to Work Reports from the joint exhibit book undermined fairness and that she had been forced to represent herself without sufficient judicial guidance.

The Court of Appeal analyzed the legal framework governing assistance to self-represented parties. Referring to earlier Saskatchewan authorities, the court emphasized that trial judges have broad discretion in managing trials and in determining the level of assistance to provide to self-represented parties. That assistance must strike a balance: ensuring that self-represented litigants are not unfairly disadvantaged by their lack of familiarity with procedure, without turning the judge into an advocate or provider of legal advice.

On the record, the Court of Appeal found that the trial judge had been attentive to this responsibility. He had given the plaintiff full opportunity to present submissions, encouraged her to question witnesses and make a complete argument, and even intervened to question a key defence witness when she did not engage in meaningful cross-examination. The appellate court also stressed that she remained free to introduce her own evidence apart from the joint exhibit book that had been assembled with assistance from 3sHealth’s counsel. Given these circumstances, the Court concluded there was no procedural unfairness that could undermine the trial’s outcome.

The disability and evidentiary findings on appeal

On the substantive merits, the central appellate issue concerned the trial judge’s conclusion that the plaintiff was not disabled under the plan. She contended that the judge misweighed the medical evidence by favouring Dr. Sommer’s opinion over those of Drs. Ardell and Campbell, and by not according proper weight to the Practitioner’s Return to Work Reports. She argued that her own physicians, having followed her over time, were at least as qualified as Dr. Sommer to assess her condition and that their evidence, together with the WCB documentation, proved disability.

The Court of Appeal approached this issue through the standard of review applicable to factual and evidentiary assessments in civil appeals. The weighing of evidence—particularly competing expert evidence—is a question of fact, and appellate courts will interfere only where there is a palpable and overriding error: an error that is obvious and that goes to the heart of the outcome. The function of the trial judge is to evaluate and accept or reject competing expert opinions, in whole or in part; an appeal is not a fresh opportunity to re-weigh expert evidence and substitute the appellate court’s preference.

Applying that standard, the Court of Appeal upheld the trial judge’s preference for Dr. Sommer’s evidence. It accepted the trial judge’s findings that Dr. Sommer had greater relevant expertise in physical medicine and rehabilitation, had conducted an independent medical examination, and had reviewed the full record. It also accepted the finding that the personal physicians did not conduct a complete physical examination and that their diagnoses appeared to rest largely on subjective symptom reports. At trial, Dr. Campbell herself acknowledged that she did not practice or hold specific training in occupational medicine, underscoring that her expertise differed from that of Dr. Sommer.

Given these factual findings, the appellate court held that the trial judge’s reasoning in preferring Dr. Sommer’s evidence was open to him on the record and did not reflect any palpable and overriding error. It further agreed that Dr. Sommer’s evidence supported the conclusion that the plaintiff was fit to work in her own occupation or another suitable occupation. Consequently, the Court of Appeal affirmed the core finding that she had not met the plan’s definition of disability.

Plan terms, time limits and relief from forfeiture

The case also involved questions relating to the plan’s time-limit provisions for LTD applications and whether a court could, and should, grant relief from forfeiture where an application was filed late. The trial judge had found that the application was indeed outside the prescribed time limits and had chosen not to exercise discretion to grant relief. Those findings related to the contractual/insurance structure of the plan, which required timely notice and proof of claim as conditions of entitlement.

On appeal, the Court of Appeal identified the timeliness and relief-from-forfeiture issues but ultimately found it unnecessary to address them in detail. Because the trial judge’s conclusion that the plaintiff was not disabled under the plan was independently sufficient to dispose of the claim, the appellate court held that even if there were an error in dealing with the time-limit or forfeiture issues, it could not change the outcome. Accordingly, the Court confined its analysis to the procedural fairness and disability questions and left the time-limit and relief-from-forfeiture determinations undisturbed but unexamined.

Outcome of both decisions

Taken together, the Court of King’s Bench decision and the Court of Appeal decision provide a consistent outcome. At first instance, the trial judge dismissed the plaintiff’s claim for LTD benefits after finding both that her application was late under the plan and that she had not established disability on the evidence. On appeal, the Court of Appeal rejected her fresh-evidence application, found no procedural unfairness in how the self-represented plaintiff had been treated at trial, and upheld the trial judge’s assessment of the medical and other evidence. It confirmed that there was no palpable and overriding error in preferring the independent expert evidence of Dr. Sommer and in concluding that she did not meet the plan’s definition of disability. As a result, the appellate court dismissed the appeal. The successful party across both levels of court was 3sHealth Shared Services Saskatchewan, and no damages or LTD benefits were awarded to the plaintiff. While the Court of Appeal ordered that 3sHealth was entitled to its costs of the appeal and of the fresh evidence application “in the usual manner,” the written reasons do not specify a dollar amount, so the exact monetary value of those costs cannot be determined from the decisions, and there was no monetary award of damages or benefits made in favour of the plaintiff.