Category: Limitation Period

The claimant appealed the Tribunal’s decision that her dispute over a partially approved treatment plan was brought after the expiry of the limitation period. The claimant argued that the denial did not comply with the SABS because it did not explain all appeal rights following a LAT decision, nor did it explain the principles of discoverability. The Court dismissed the appeal, holding that the insurer was not required to explain the right to an appeal of a LAT decision, nor was the insurer required to explain the principle of discoverability or stated that the limitation clock “may” begin at the time of denial rather than stating that the limitation clock “will” begin at the time of denial.

The claimant appealed the Tribunal’s decision that his IRB claim was barred by the limitation period. The claimant initially made an application for IRBs, but the returned to full time work. The claimant subsequently went off work more than three years later. He argued that his IRB claim was not discoverable until he went back off work. The Tribunal disagreed, holding that the insurer’s denial of IRBs when the claimant returned to work was sufficient to trigger the limitation clock, and that the claimant did not dispute entitlement within two years. The Court dismissed the appeal, holding that the Tribunal applied the law correctly. The Court held that the initial denial was clear and unequivocal. Subsequent communications by the insurer regarding calculation of the IRB for the period the claimant was initially off work did not re-start the limitation clock. Finally, the Court held that the claimant did not discover his claim for IRBs after going off work a second time, and that the claimant could not “re-apply” for post-104 week IRBs.

The insurer sought judicial review of the Tribunal’s decision that the claimant’s IRB entitlement was barred by the limitation period. The Tribunal had found that the denial in 2015 was not clear or unequivocal because it stated that if the claimant stopped working again, she could submit a new Disability Certificate to determine eligibility. The Court dismissed the judicial review, finding that the Tribunal’s decision was reasonable, and that there was no unfairness to the insurer in the hearing process.

The claimant appealed the Tribunal’s decision that the limitation period barred his IRB claim. He returned to work one day after the accident. The insurer denied the claim for IRBs at that point in May 2016. The claimant then went off work 16 months later and required hip surgery. He applied for IRBs in January 2019. The insurer argued that the May 2016 constituted a valid denial triggering the limitation period. The claimant argued that his IRB claim was not discoverable until he stopped working. The Court granted the appeal, agreeing with the claimant. The Court held that the Tribunal failed to take into account the discoverability principles set out in Tomec v. Economical, and that the denial of IRBs in May 2016 prior to the claimant’s stoppage of work was contrary to the consumer protection goals of the SABS.

The claimant appealed the LAT’s decision that the limitation period barred the application. The Court allowed the appeal and remitted the matter to the Tribunal for a new hearing. The Court found the Tribunal erred in concluding that the denial letter was received on the day it was authored, as no evidence was before the Tribunal to prove the date of receipt. The Court also held the Tribunal erred in putting the onus on the claimant to refute the date the insurer alleged the denial letter was received by the claimant in the mail.