Executive Summary: Key Legal and Evidentiary Issues

• Whether Mr. Hashem met the contractual definition of “invalidity” by being totally unable to perform the usual tasks of his sales adviser occupation after August/October 2019.
• Credibility and weight of contemporaneous medical notes versus later insurer claim forms, especially where physicians recorded that symptoms had resolved and questioned the legitimacy of renewed disability claims.
• Extent to which ongoing activities (Uber driving, real estate studies, managing rental properties, handling litigation and household responsibilities) were compatible or incompatible with alleged total disability.
• Impact of policy conditions requiring regular medical follow-up, prohibition on remunerated activity, and provision of satisfactory proof of disability on the insured’s entitlement to further benefits.
• Role and persuasiveness of the psychiatrist’s independent expert opinion compared with treating physicians’ forms that appeared to mirror the claimant’s own requests.
• Effect of prior CNESST work-accident and disability determinations, and whether they bind or influence the court’s interpretation of “invalidity” under the private insurance contracts.

Facts and background

Rayan Hashem was employed as a sales adviser with Meubles Léon ltée (Léon) between March 2017 and December 2018, when he was suspended without pay. In January 2019, his treating physician, Dr Samuel Issid, diagnosed him with an adjustment disorder with depressed mood and certified a total incapacity for work for an indeterminate period. This mental health condition stemmed from psychological harassment at work that had been accepted by the CNESST as a work accident. Canada Life had issued two creditor insurance products through the Royal Bank of Canada: “HomeProtector Insurance” covering Mr. Hashem’s mortgage and “LoanProtector Insurance” covering his line of credit. These policies promised disability benefits if the insured met the contractual definition of invalidity. After a first disability claim in January 2019, Canada Life accepted coverage and, after the 60-day waiting period, paid monthly benefits directly to RBC: $2,300.38 on the mortgage and $496.84 on the line of credit. These payments continued through summer 2019. Mr. Hashem’s condition improved by June and July 2019. Dr Issid repeatedly noted that while a return to Léon was impossible, Mr. Hashem was able to work for another employer. In July 2019, Dr Issid endorsed a gradual return to work and effectively stated he had nothing more to offer medically. In August 2019, Dr Issid considered the adjustment disorder resolved. Canada Life notified Mr. Hashem that disability benefits would end in early September 2019 under both products, although an extra month of payments was voluntarily added as an administrative accommodation to support his return to work. From August to November 2019, Mr. Hashem drove for Uber and earned income from that activity. On 4 October 2019 he returned to Dr Issid complaining of a deterioration in his condition. Dr Issid again mentioned an adjustment disorder but specifically recorded that Mr. Hashem could not return to work at Léon, while confirming that he could do “something else,” and he requested an assessment from the CNESST. No new medical work stoppage was issued at that time, and Mr. Hashem continued working for Uber until November 2019, stopping because he did not like the job, not because of incapacity.

Subsequent medical consultations and disability claims

After October 2019, Mr. Hashem did not see Dr Issid again for this problem until 22 January 2020. In that note, Dr Issid recorded that Mr. Hashem held a taxi/Uber permit, was studying to become a real estate broker, and bluntly described him as “lazy” and seeking “two more weeks of pay at the expense” of the CNESST. Dr Issid also wrote that an expertise had already been requested and that he could not help further and did not want to see him again for this case. From March to September 2020, Dr Issid’s practice was suspended due to the COVID-19 pandemic, and Mr. Hashem did not consult other physicians about his alleged disability in that period. In April 2020, he saw another physician, Dr Yves I-Bing Cheng, to obtain a “medical paper to reactivate his file and claim insurance.” Dr Cheng refused to sign such a document because he had not been involved in the case and noted that Mr. Hashem had already seen Dr Issid three times since August 2019 and could have raised it then. On 24 September 2020, after Dr Issid’s return, Mr. Hashem had him complete forms for both CNESST and Canada Life, including a new Disability Benefit Claim Form. Although Mr. Hashem alleged disability since October 2019, this was his first new formal disability claim to Canada Life after benefits had ended in September 2019. The court gave little weight to this form. Dr Issid stated that invalidity had begun back on 14 December 2018, even though he himself had previously declared the condition resolved in August 2019. He also wrote that Mr. Hashem’s condition had “improved but regressed because of COVID,” despite not seeing him between February and September 2020 and despite the alleged relapse predating the pandemic. In his contemporaneous clinical note the same day, Dr Issid recorded that he had not seen Mr. Hashem since February, that the claimant wanted the CNESST and home insurance forms filled out, and that he signed while indicating he could not support the claim. This further undermined the reliability of the information written on the insurance form. In March 2021, Dr Cheng completed another Disability Benefit Claim Form for Canada Life stating that Mr. Hashem had been totally disabled since 14 December 2018 due to an adjustment disorder with anxious-depressive mood and could not yet return to work, although he could begin rehabilitation immediately. Again, the court found these statements unreliable because Dr Cheng’s own clinical note that day acknowledged that he filled in the form “point by point” with the patient to ensure it conformed to the “desire” of the claimant. A later note in October 2021 also showed Dr Cheng reproducing almost verbatim a medical certificate dictated by Mr. Hashem, stating that he had been unable to work since December 2018 except during the short Uber period. Overall, the judgment emphasized that most of the later forms and notes supporting continued disability appeared to be driven by Mr. Hashem’s requests rather than objective clinical assessment, and that only one note—dated 19 November 2021—actually prescribed a work stoppage, without specifying any duration.

Policy terms and definition of invalidity

The HomeProtector and LoanProtector certificates contained identical key provisions regarding invalidity, eligibility for benefits, and termination of payments. Invalidity was defined broadly as a sickness, injury, mental illness or nervous disorder that “totally prevents” the insured from performing the usual tasks of the occupation they held immediately before becoming disabled (with variants for seasonal or retired workers). To receive disability benefits, several cumulative conditions had to be met. The insured had to be under the care of a qualified physician, psychiatrist or psychologist (depending on the nature of the illness) who was not the insured or a family member. The insured could not be engaged in any activity for remuneration or profit. The insured also had to provide, at their own expense, proof of disability that the insurer considered satisfactory, whenever requested. The certificates also provided that disability benefits ended at the earliest of several events, including when the insured ceased to be disabled or returned to work, when the insured began any remunerated activity, when 24 monthly benefits had been paid, when the insurance terminated, or when the underlying mortgage or line of credit was refinanced or repaid. Another clause dealt with “overlapping” or recurrent disabilities: if the insured recovered but became disabled again from the same cause within 21 consecutive days and remained disabled at least five consecutive working days, the insurer would treat this as the same disability, waive a new waiting period, and resume benefits. The court noted that Mr. Hashem’s own remodified pleadings implicitly recognized that he had recovered by the time benefits ended in September 2019, because he originally invoked the overlapping disability clause, which presupposes a prior recovery. At trial, however, he changed his position and argued instead that there had been a new relapse from 4 October 2019 giving rise to a fresh 24-month period of disability.

Legal framework and burden of proof

The court applied established principles of Quebec disability insurance law. Under the leading case law, the insured bears the onus of proving on a balance of probabilities that he satisfies the contractual definition of invalidity for the specific period claimed. This was not a case where the insurer had to justify stopping payments; rather, it was about new claims submitted after an earlier recognized disability had ended. Determining “invalidity” was characterized as a legal question informed by both lay and expert evidence. A mere diagnosis does not guarantee entitlement to benefits; what matters is the functional impact of the condition—whether it prevents the insured from performing the main tasks of his occupation, not every single task. Insurers are entitled to seek all necessary information to assess the claim and to require the insured to undergo a medical examination under article 2438 of the Civil Code of Québec and the policy terms. In this case, Mr. Hashem therefore had to show that, from 4 October 2019 or any later date covered by his demands, he was affected by an illness or mental disorder that rendered him unable to carry out the principal usual duties of his sales adviser role, and that he also complied with the contractual conditions: regular medical follow-up, no remunerated activity, and provision of satisfactory proof.

Assessment of medical and factual evidence

The court found that while some physicians continued to record an adjustment disorder after October 2019, the evidence as a whole did not establish a contractually defined invalidity. Contemporaneous notes in August and October 2019 indicated that Dr Issid regarded the adjustment disorder as resolved, that Mr. Hashem could work elsewhere than at Léon, and that no work stoppage was medically prescribed. The January 2020 note described active engagement in Uber driving and real estate studies, and explicitly suggested secondary gain motives rather than genuine incapacity. Subsequent attempts to reframe the entire period since December 2018 as continuous total disability, aside from the Uber interval, were based largely on forms and certificates dictated or heavily influenced by the claimant. None of the treating doctors testified at trial to explain or support these documents. The non-medical evidence also showed Mr. Hashem functioning at a relatively high level from late 2019 onwards: he drove for Uber, managed a home shared with family, helped raise his nephew, handled rental property management, pursued and passed a real estate agent course, and conducted several court cases without a lawyer. The court considered these activities inconsistent with a complete inability to perform the core tasks of a sales adviser, particularly in a different work environment than Léon. The court also found Mr. Hashem’s own testimony largely not credible. He gave detailed explanations when presenting medical notes that supported his position, but his answers became vague or selectively amnesic under cross-examination, especially on matters related to work capacity. He attributed his memory lapses to his mental condition, but the court rejected this explanation because the lapses appeared only when answers might hurt his case. His insistence that he would not accept any employment other than his former role at Léon reflected a subjective refusal, not an objective incapacity to work in comparable sales positions with other employers.

Expert psychiatric opinion

Canada Life obtained an independent psychiatric assessment from Dr Paul-André Lafleur under article 2438 C.c.Q. and the policy clauses. Dr Lafleur, a psychiatrist with nearly forty years’ experience, evaluated Mr. Hashem in October 2023 and reviewed his medical and CNESST files. He confirmed the original diagnosis of a work-related adjustment disorder in December 2018 but explained that such disorders usually remit within about six months once the workplace stressor is removed. In his view, Mr. Hashem’s condition significantly improved during spring and summer 2019 and was in advanced remission by July 2019, when he could study, work and manage household responsibilities. Dr Lafleur concluded that between August 2019 and December 2022 there were no psychiatric limitations that would have rendered Mr. Hashem incapable of occupying his sales adviser role, except that he could not reasonably return to that specific job at Léon due to the prior conflictual environment. Relying on the documented activities mentioned above, he opined that the persistent work stoppage was driven by dissatisfaction with his professional circumstances rather than symptom-based disability. He also reviewed the treating physicians’ notes and characterized as “unorthodox” those forms and certificates in which the content largely reproduced what Mr. Hashem wanted written. The court carefully examined attempts by the claimant to highlight alleged inconsistencies between what he told Dr Lafleur and what appeared in the expert report, but it found no material contradictions undermining the expert’s credibility or impartiality. No counter-expert report was produced on behalf of Mr. Hashem.

Court’s analysis on invalidity and entitlement to benefits

Weighing all the evidence, the court held that Mr. Hashem had not demonstrated that he met the contractual definition of invalidity from 4 October 2019 onward. The court accepted that he had suffered a genuine, work-related adjustment disorder that initially justified disability benefits, but concluded that by August 2019 he was in remission and could perform the essential tasks of a sales adviser for employers other than Léon. Subsequent complaints and forms did not prove that he was totally prevented from carrying out the main duties of that occupation. The court emphasized that the insured must prove both the existence of a recognized illness and its functional impact on work capacity, and that here the functional evidence—including his remunerated activity, studies, property management and legal self-representation—showed sufficient capability to work. Additionally, Mr. Hashem failed to establish compliance with key policy conditions: he did not maintain regular medical follow-up between September 2019 and September 2020, he engaged in remunerated activity contrary to the policy, and he did not provide objective proof of disability satisfactory to the insurer. On this basis, the court held that Canada Life was justified in refusing to pay further disability benefits on the new claims filed in September 2020 and March 2021.

Outcome and financial consequences

Having found no qualifying invalidity under the insurance certificates after September 2019, the court dismissed Mr. Hashem’s remodified originating application in its entirety. As a result, his claim for $67,133.28 in additional disability benefits and $10,000 in moral damages was rejected. The successful party was The Canada Life Assurance Company. The judgment awarded Canada Life its legal costs (“frais de justice”), but the total amount of those costs and any monetary award in its favor is not specified in the reasons and cannot be determined from the decision itself.