Category: Limitation Period

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

Post author By tgp-admin
Post date February 12, 2020
No Comments on 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)

Post author By tgp-admin
Post date February 11, 2020
No Comments on 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)

Post author By tgp-admin
Post date February 11, 2020
No Comments on 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)

Post author By tgp-admin
Post date February 5, 2020
No Comments on 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.

K.K. v. Coseco Insurance (18-002839)

Post author By tgp-admin
Post date February 3, 2020
No Comments on K.K. v. Coseco Insurance (18-002839)

The claimant disputed his MIG determination and entitlement to various medical benefits. The respondent raised a preliminary issue, arguing that the claimant was statute-barred from proceeding with his claim in respect of two of the disputed treatment plans for failure to dispute entitlement within the two year limitation period. Adjudicator Norris agreed, noting that the insurer’s denial letters were clear and unequivocal denials of the benefits and included notice of the two year limitation period, information on the claimant’s right to dispute, and medical and other reasons for the denial. Adjudicator Norris further concluded that the claimant had not met his onus of establishing that his injuries fell outside of the MIG, and was thus bound by the $3,500 funding limit.

P.V. v. Economical Insurance (19-000069)

Post author By tgp-admin
Post date January 24, 2020
No Comments on P.V. v. Economical Insurance (19-000069)

The claimant sought reconsideration of the Tribunal’s decision that the limitation period applied to his IRB claim. The claimant had continued to work for over three years after the accident, and the insurer had denied entitlement to IRBs during that period because he did not meet the “substantial inability” test. Adjudicator Boyce granted the reconsideration based on the Court of Appeal’s decision in Tomec v. Economical. He held that the claimant could not discover his potential entitlement to IRBs until he stopped working almost four years after the accident. Because he could not discover his impairment until then, the denial of IRBs prior to the work stoppage was deemed invalid and did not start the clock of the limitation period.

S.W. v. Aviva General Insurance (19-002127)

Post author By tgp-admin
Post date January 22, 2020
No Comments on S.W. v. Aviva General Insurance (19-002127)

The claimant sought entitlement to IRBs. The insurer argued that the limitation period barred the claim. Adjudicator Boyce concluded that the IRB denial was clear and unequivocal and that the limitation period expired on February 13, 2019, and that the claimant applied to the LAT on February 22, 2019. However, he allowed the claim to continue based on section 7 of the LAT Act, reasoning that the delay was minor, the claimant had a bona fide intention to appeal the denial, and the prejudice to the insurer was minimal.

J.C. v. Intact Insurance Company (18-010894)

Post author By tgp-admin
Post date January 21, 2020
No Comments on J.C. v. Intact Insurance Company (18-010894)

The claimant sought entitlement to IRBs. The insurer argued that the limitation period barred the claim. Adjudicator Parish held that the limitation period barred the claim. The insurer’s denial was clear and unequivocal, and the limitation period expired May 20, 2016. The LAT application in November 2018 was out of time, and was not saved by section 7 of the LAT Act because the delay was significant and there was prejudice to the insurer. The claimant also failed to demonstrate that the merits of the case justified the Tribunal granting an extension of time.

M.Z. v. Aviva Insurance Canada (18-001324)

Post author By tgp-admin
Post date January 17, 2020
No Comments on M.Z. v. Aviva Insurance Canada (18-001324)

The claimant sought entitlement to the balance of a chiropractic treatment plan, four other treatment plans, and an award. The claimant argued the balance of the chiropractic treatment plan should be approved because the insurer failed to provide a response within 10 business days pursuant to section 38(3) of the Schedule. The insurer argued that the limitation period applied to one of the treatment plans. Adjudicator Grant found that the insured mailed the denial letter to the claimant, and it was deemed to have been received by the claimant on the fifth business day after it was mailed under section 64(18). Based on that date, the claimant’s LAT application was filed after the two-year limitation period, making the chiropractic treatment plan not payable. The other treatment plans were also found not payable based on a lack of objective supporting evidence.

R.R. v. State Farm Insurance Company (19-000226)

Post author By tgp-admin
Post date November 28, 2019
No Comments on R.R. v. State Farm Insurance Company (19-000226)

The claimant sought entitlement to IRBs and two treatment plans for chiropractic services. The insurer argued that the claimant was barred from proceeding with the three disputed claims because she failed to dispute the denials within the two year limitation period. Adjudicator Norris agreed with the insurer, finding that the insurer’s refusals to pay the benefits claimed were clear and unequivocal. Adjudicator Norris also declined to exercise his discretion to extend the limitation period pursuant to section 7 of the LAT Act, noting that the length of the delay was significant (nearly one year beyond the expiration of the limitation period) and that the claimant made no submissions to indicate that she had an intention to dispute the denial prior to the expiration of the limitation period.

Contact Us

Contact Us

Contact Us