Category: Limitation Period

U.Y. v. TD Insurance Meloche Monnex (18-002397)

Post author By tgp-admin
Post date April 23, 2020
No Comments on U.Y. v. TD Insurance Meloche Monnex (18-002397)

The claimant filed a request for reconsideration arising from a decision in which the Tribunal found that her application for IRBs and housekeeping and home maintenance benefits were statute-barred as a result of the two-year limitation period. Adjudicator Maedel dismissed the request for reconsideration on the grounds that the claimant received a valid denial of the IRB and the housekeeping and home maintenance benefits which included a Dispute Resolution Form. The claimant was accordingly made aware of the dispute resolution process, yet she failed to file her application with the Tribunal within the statutory two-year limitation period.

Y.M. v Security National Insurance Company (19-001141)

Post author By tgp-admin
Post date April 22, 2020
No Comments on Y.M. v Security National Insurance Company (19-001141)

The claimant sought removal from the MIG, and entitlement to various medical benefits. The insurer argued that the claimant was barred from disputing the claimed benefits due to the limitation period and due to failure to attend an IE. Adjudicator Grant agreed that two of the disputed medical benefits were barred by the limitation period, and that the claimant failed to attend a scheduled IE without reasonable explanation. Finally, he concluded that the claimant’s injuries fell within the MIG.

Applicant v. Co-operators General Insurance Company (18-003622)

Post author By tgp-admin
Post date April 7, 2020
No Comments on Applicant v. Co-operators General Insurance Company (18-003622)

The claimant was involved in an accident in 2003. His entitlement to ACBs and HK expenses were denied in 2012. He applied to the LAT disputing further entitlement. The insurer argued that the claimed were barred by the limitation period. Adjudicator Helt concluded that the limitation period did not apply because the claimant was deemed catastrophically impaired as a result of the accident in 2015, and the Court of Appeal’s reasons in Tomec. In order for the limitation period to apply to ACBs or HK expenses, there had to be a new denial to trigger the limitation period. Such a letter was sent to the claimant in December 2017, but he applied to the LAT within two years of that date.

R.S. v. Pafco Insurance Company (19-006331)

Post author By tgp-admin
Post date April 7, 2020
No Comments on R.S. v. Pafco Insurance Company (19-006331)

The claimant sought a determination that he sustained a catastrophic impairment, and entitlement to IRBs and various medical expenses. The insurer argued that the claimant was barred from proceeding with a catastrophic impairment determination until he attended a neurological IE, and also argued that the claimant was barred from proceeding with the claims for IRBs and medical benefits due to the limitation period. Adjudicator Boyce found that the insurer’s proposed IE was reasonably necessary for a determination of CAT and the request was timely, made in good faith, and appropriate. Therefore, Adjudicator Boyce concluded that the claimant was barred from proceeding with the CAT dispute until the he attended the IE. Secondly, Adjudicator Boyce found that the claimant’s delays of 130 and 334 days were unacceptable. The claimant failed to demonstrate why not extending the limitation would prejudice him or why the Tribunal should assign greater weight to this factor.

M.K. v TD General Insurance Company (19-003616)

Post author By tgp-admin
Post date April 6, 2020
No Comments on M.K. v TD General Insurance Company (19-003616)

The insurer brought this preliminary issue hearing arguing that the claimant was barred from disputing the denial of non-earner benefits on the grounds that the claimant did not do so within the two year limitation period. Adjudicator Grant found that the insurer issued a valid denial of non-earner benefits which triggered the limitation period. The denial was clear and unequivocal and provided the claimant with the required information to determine whether to dispute the denial. As the claimant did not appeal in time, she was barred from proceeding with her application.

V.C. v. Unifund Assurance Company (18-005144)

Post author By tgp-admin
Post date April 3, 2020
No Comments on V.C. v. Unifund Assurance Company (18-005144)

The claimant applied to the LAT for NEBs. The insurer argued that the application was made after the two year limitation period. Vice Chair Shapiro agreed with the insurer and held that the application was made three months too late. He also rejected the request to apply section 7 of the LAT Act because none of the four factors were satisfied.

Q.S.Z. v. TD General Insurance Company (19-000403)

Post author By tgp-admin
Post date March 27, 2020
No Comments on Q.S.Z. v. TD General Insurance Company (19-000403)

The insurer sought a preliminary issue hearing to determine whether the claimant was statute-barred from proceeding with her application for income replacement benefits for failing to dispute that insurer’s denial within the 2 year limitation. Adjudicator Derek Grant found that the insurer had failed to properly deny the claimant’s application for IRBs and the claimant was able to proceed with her claim. Adjudicator Grant based his reasons on the insurer’s letters that did not contain clear and unequivocal denials and the limitation period had therefore not been triggered.

Applicant v. TD Home and Auto Insurance Company (17-008493)

Post author By tgp-admin
Post date March 20, 2020
No Comments on Applicant v. TD Home and Auto Insurance Company (17-008493)

The claimant sought reconsideration of the Tribunal’s decision that his claim for ACBs and HK expenses was barred by the limitation period. Adjudicator Boyce granted the reconsideration request based on the Court of Appeal’s decision in Tomec v. Economical. The claimant’s ACBs and HK expenses had been denied in 2005. In 2015, the insurer accepted that the claimant suffered a catastrophic impairment, but refused to pay any ACBs or HK expenses based on the earlier denial. Adjudicator Boyce held on reconsideration that the claimant did not discover his claim for ACBs and HK expenses until he was determined to suffer a catastrophic impairment. He also held that the insurer’s denial in 2005 was pre-emptive and was not valid, because the claimant did not require such services at that time.

S. S. v. Allstate Canada (18-002292)

Post author By tgp-admin
Post date March 6, 2020
No Comments on S. S. v. Allstate Canada (18-002292)

The claimant sought reconsideration of the Tribunal’s decision that the limitation period barred the claim for NEBs. Adjudicator Norris rejected the reconsideration, holding that there was no legal error made in the Tribunal’s conclusions that the claimant did not have a bona fide intention to appeal within the two year period. He also concluded that the other factors to extend the limitation period did not favour the claimant.

X.J.W. v. Certas Home and Auto Insurance Company (19-000222)

Post author By tgp-admin
Post date February 25, 2020
No Comments on X.J.W. v. Certas Home and Auto Insurance Company (19-000222)

This preliminary hearing was brought to determine whether the claimant was statute barred from appealing the insurer’s denial of his claims for medical benefits and IRBs because the appeal was filed more than two years after the denials. The claimant had applied for a FSCO mediation in April 2016 in regard to the denials, and his FSCO file was closed on June 15, 2016. The claimant conceded that he did not file his LAT dispute within the two year limitation period but argued that there was confusion over the closure date of the file due to the transition to the Tribunal from FSCO. The claimant submitted that the Tribunal should extend the deadline to appeal the denials pursuant to section 7 of the LAT Act. Adjudicator Victor found no evidence to indicate an intention to apply to the LAT within the appeal period and found that the claimant’s appeal was statute-barred.

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