Can a plaintiff recover the indemnity provided under a policy of sickness insurance?

Saskatchewan, Canada

The following excerpt is from Froelich v. Continental Casualty Company, 1956 CanLII 202 (SK CA):

In Kempfert v. Continental Casualty Co. 1932 CanLII 250 (SK CA), [1933] 1 WWR 70 [application for special leave to appeal dismissed (1933) 1933 CanLII 221 (SK CA), 1 WWR 709] this court dealt with a policy of sickness insurance under which the insurer covenanted to pay the insured a certain indemnity during the period in which “he was totally disabled by sickness and also by reason thereof necessarily and continuously confined within the house and throughout which he is therein regularly visited by a legally qualified physician.” The court found that the plaintiff was disabled by sickness but that he was not by reason thereof “necessarily and continuously confined within the house and he was not, during the time of his sickness, regularly visited by a legally qualified physician,” and that he was accordingly not entitled to recover the indemnity provided in the policy.

In Gyles v. Mutual Benefit, Health and Accident Assn. (1940) 7 Ins LR 195, the plaintiff brought action on a policy of insurance issued to him by the defendant company The policy insured against loss of time resulting from certain diseases subject to certain limitations therein stated. One of the conditions stated was that the policy did not cover while the insured was not continuously under the professional care and regular attendance at least once a week beginning with the first treatment of a physician. Another condition was that the disability must confine the insured continuously within doors. Rose C.J. found from the evidence that the insured was never confined continuously within doors and had not been attended by a qualified physician. He was of the opinion that the provisions of the policy were plain, that there was no ambiguity and he dismissed the action.

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