Category: Limitation Period

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)

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)

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)

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)

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)

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.

V.M.L. v. Aviva General Insurance Company (18-001713)

The claimant filed for reconsideration on a previous decision in which the Tribunal ruled that the claimant was statute barred from proceeding with her appeal of the denial of IRBs, and the Tribunal’s decision not to extend the limitation period under section 7 of the LAT Act. Adjudicator Johal allowed the case to proceed, noting that a delay of 13 days was not considered a significant delay by any means. The claimant had also given evidence that it was her intention to appeal the denial of IRBs, and that the delay was not her fault as an employee at the law firm failed to follow her instructions and file the appeal when instructed to do so. The insurer also failed to provide any evidence as to the prejudice it would suffer should the matter be allowed to proceed, nor did it provide any submissions with respect to section 7 of the LAT Act.

M.T.G. v. Aviva General Insurance (17-002122)

The claimant requested an extension under section 7 of the LAT Act to extend the limitation period beyond the two year statutory limits to dispute his entitlement to IRBs. The insurer denied IRBs on February 15, 2015, the claimant then initiated a FSCO dispute with a mediation scheduled for May 28, 2016. Claimant’s counsel submitted a Request for Failed Mediation Report to FSCO on May 26, 2016 and FSCO closed the file on May 28, 2016. The two year limitation expired on February 15, 2017 and the claimant filed with the LAT on March 31, 2017. Vice Chair Flude concluded that the claimant had failed to prove there was a clear intention to appeal during the limitation period, as he had been undeniably aware of the denial letter and limitation since at least February 6, 2017 when settlement discussions took place and did not move expeditiously to file a dispute. The adjusting notes from this insurer also noted that the claimant’s counsel had not yet decided whether to appeal the denial, and would speak to the claimant and get back to the adjuster. The dispute was not filed until over a month later on March 31, 2017. Vice Chair Flude also noted that the claimant had failed to provide any evidence that should his extension be allowed to proceed that he would be entitled to IRBs, instead providing a statement claiming he was not working and on social assistance with no evidence of the same.

S.A. vs. Aviva General Insurance (19-001903)

The claimant was involved in an accident on February 13, 2016 and disputed entitlement to three treatment plans on September 18, 2018; within the two-year limitation of the denied treatment plans. The insurer argued that the application was filed with the Tribunal on January 17, 2019, beyond the two-year limitation period. Adjudicator Norris ruled in favour of the claimant, noting that the filing date of January 17, 2019 was an administrative error by the Tribunal. The claimant had provided a fax confirmation to the LAT which confirmed that the application as received on September 18, 2018. The claimant also provided certificates of service to the insurer dated September 18, 2018. The fact that the claimant re-filed the Application on January 17, 2019 due to not receiving a notice to the original September 2018 application from the Tribunal was irrelevant.

R.C. v. Intact Insurance Company (18-010864)

The insurer brought a preliminary issue hearing on the grounds that the claimant was statute-barred from proceeding with his claim for IRBs for failure to commence the application within the two year limitation period. Adjudicator Victor agreed with the insurer, and held that the application was statute-barred. The insurer’s letter denying the claimant’s entitlement to IRBs was valid, and the LAT application was filed more than two years after the expiry of the limitation period. Adjudicator Victor further noted that the claimant had not established reasonable grounds for extending the limitation period pursuant to section 7 of the LAT Act.