Category: 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.

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.

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.

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.