Category: Limitation Period

The insurer denied payment of IRBs and NEBs on March 30, 2017. The claimant argued that he mistakenly claimed IRBs instead of NEBs and requested to correct the Application at a Case Conference on September 26, 2019. He further claimed that the denials by the insurer were not clear and unequivocal, but confusing, ambiguous and therefore the limitation period did not apply. Vice Chair Farlam noted that the EOB sent to the claimant clearly stated that he was “not eligible” for an IRB or NEB, and further noted that the insurer did not believe that the claimant had suffered a complete inability to carry on a normal life as a result of the subject accident. An Applicant’s Right to Dispute was attached. The claimant argued that he was not employed at the time of the subject accident, and therefore, NEBs was the only benefit he could have chose. Vice Chair Farlam was not persuaded, as the EOB denied both benefits and provided clear medical and other reasons for the denials. Vice Chair Farlam did not find a bona fide intention on the part of the claimant to appeal the denial within the two year period set out in the SABS, and thus declined to exercise her discretion to extend the limitation period. The application was dismissed and all issues were statute barred from further litigation.

This is a preliminary issue decision addressing whether the claimant was barred from proceeding with the claim for failing to commence the LAT application within two years after the insurer’s refusal to pay the amount claimed. Adjudicator Parish decided not to exercise her discretion to extend the limitation period under s. 7 of the LAT Rules based on a finding that there was no bona fide intention to file within the timeline, there was no reasonable explanation for the 8-month delay, and the delay would cause significant prejudice to the insurer (e.g. difficulty locating witnesses, changes in the claimant’s condition, and stale reports). The claimant was barred from proceeding with the claim for failure to apply to the LAT within the two-year limitation period.

The claimant sought entitlement to treatment outside of the MIG and benefits proposed in two treatment plans. The insurer raised the preliminary issue of whether the claimant was barred from proceeding with the claim as he failed to commence his application within two years after the insurer’s refusal to pay the amount claimed. The LAT application was filed by fax at 6:20 p.m. on the two-year anniversary of the denial of benefits. As it was filed after 5 p.m. on a Friday, Adjudicator Go found that it was deemed to have been filed on the following Monday, based on the deemed receipt rule in the LAT Rules. Adjudicator Go held that LAT adjudicators have the discretion to extend the limitation period pursuant to s. 7 of the LAT Act, and decided not to exercise her discretion in this matter based on a finding that there was no merit to the appeal and there was a lack of evidence of a bona fide intention to file within the timeline. The claimant was barred from proceeding with the claim.

The claimant sought entitlement to NEBs and medical benefits. The insurer argued that the claims were barred by the limitation period. The claimant argued that her substance abuse issues prevented her from filing an application in a timely manner, and requested an extension of time under section 7 of the LAT Act. Adjudicator Johal concluded that the Tribunal had jurisdiction to extend the limitation period under section 7, but the claimant had to meet the four-part test in order to be granted consideration. Upon review of the evidence, Adjudicator Johal noted that although the claimant did have drug issues, there was no evidence presented that she intended to dispute the denial during the two-years after the denial; furthermore, the nine month delay in filing an application was not supportive of a clear intent to dispute the issues. As the overall weight of the presented evidence considered did not show clear intent on the part of the claimant, nor a reasonable explanation as to why she could not file the LAT application sooner, the issues in dispute were barred by the limitation period.

The claimant sought entitlement to ACBs and HK expenses. The insurer argued that the claimant was barred from contesting the denials as she filed her application over two years after the benefits were denied. Adjudicator Mazerolle ruled that the claimant was allowed to proceed with her claim in accordance with Tomec v. Economical. He noted that the claimant only “discovered” her entitlement to post-104 week ACBs and HK expenses after she was deemed to suffer a catastrophic impairment, and any previous denial would not trigger the limitation period.

The claimant was involved in an accident in Quebec and elected to receive SABS in accordance with the SAAQ system. The insurer paid a lump sum in accordance with the SAAQ. The claimant disputed the lump sum, but the insurer argued that the limitation period applied. Adjudicator Grant concluded that the dispute was barred by the limitation period. The LAT application was filed more than two years after the insurer’s decision, and the claimant could not prove that she was unable to file a dispute within two years.