Category: Limitation Period

J.G. v. Co-operators General Insurance Company (18-012430)

The claimant sought entitlement to NEBs. The insurer argued that the limitation period barred the dispute. Adjudicator Boyce agreed with the insurer. He concluded that while the denial of NEBs could be considered “pre-emptive” it was still a valid denial, following the Court of Appeal’s decisions in Bonaccorso and Sietzema. The insurer’s post-denial conduct in investigating the claim for NEBs did not vitiate the initial denial. Finally, the adjudicator held that section 7 of the LAT Act should not apply to allow an extension of the limitation period. Prior to the two-year anniversary of the denial, it was clear to the claimant that the insurer was refusing to pay NEBs.

Applicant v. Allstate Insurance (18-006253)

The claimant sought entitlement to over $24,000 in catastrophic impairment rebuttal reports. The insurer argued that dispute was statute barred. Adjudicator Grant held that catastrophic impairment assessments are not “benefits” and therefore not subject to the two year limitation period. Adjudicator Grant concluded that the proposed assessments were reasonable and necessary, and were therefore payable. It was not a requirement that the assessments be proposed prior to the OCF-19 submission or prior to the insurer’s IE assessments being completed. A total of $2,000 per assessment was approved, and did not come out of the claimant’s medical benefits limits.

L.R. v. RSA Insurance Company of Canada (18-002989)

This preliminary issue addressed the limitation period in the context of a claim for IRBs and ACBs. The insurer denied the benefits more than two years prior to the LAT application. The claimant was found in June 2016 to lack capacity to instruct counsel and to require the assistance of a litigation guardian. Adjudicator Punyarthi held that the provisions suspending the Limitations Act did not apply to the Tribunal’s proceedings. However, Adjudicator Punyarthi concluded that section 7 of the LAT Act permitted the extension of the limitation period until the time his LAT application was filed. The adjudicator wrote that the reason for the delay was explained and that there was a bona fide intention to apply to the LAT within the two-year time period. There was also no prejudice to the insurer and there was potential merit to the claims.

A.O. v. Unifund Assurance Company (18-003798)

This preliminary issue hearing was brought to determine whether the claimant was statute barred from proceeding with her claim for IRBs because she failed to apply within the two year limitation period after its refusal to pay IRBs. The claimant conceded that she did not file her application within the two year limitation period, and instead requested that the Tribunal extend her time for filing pursuant to section 7 of the LAT Act. Adjudicator Lake allowed the claimant to proceed with her claim for IRBs, because the length of delay was minimal (7 business days), the prejudice to the respondent was non-existent, and there was merit to the claimant’s appeal of the respondent’s denial.

P.D. v. Western Assurance Company (17-005066)

The insurer sought reconsideration of the Tribunal’s decision that the limitation period did not bar the claims for attendant care benefits and medical benefits. Associate Chair Batty granted the reconsideration, reasoning that the denials were “clear and unequivocal.” The denials were based on the claimant having exhausted her non-catastrophic medical benefits limits.

A.F. v. North Blenheim Mutual Insurance Company (16-002336)

The claimant sought reconsideration of the Tribunal’s decision that he was barred from seeking entitlement to certain benefits due to the limitation period. In particular, he argued that section 7 of the LAT Act applied in extending the time by which he had to apply to the LAT. Vice Chair Kershaw granted the reconsideration and allowed the claimant’s application to proceed. She held the Tribunal made an error in law by: failing to consider that the claimant continuously demonstrated his intention to dispute entitlement to denied benefits; including the time delay caused by the backlog at FSCO; concluding that there was prejudice to the insurer by the delay, since the claimant had applied for mediation at FSCO within the designated time frame; and concluding that the claimant had not spoken to a LAT representative by telephone and was advised that the 90 day post-mediation extension applied to LAT applications.

A.F. v. North Blenheim Mutual Insurance Company (16-002336)

The claimant sought reconsideration of the Tribunal’s decision that he was barred from seeking entitlement to certain benefits due to the limitation period. In particular, he argued that section 7 of the LAT Act applied in extending the time by which he had to apply to the LAT. Vice Chair Kershaw granted the reconsideration and allowed the claimant’s application to proceed. She held the Tribunal made an error in law by: failing to consider that the claimant continuously demonstrated his intention to dispute entitlement to denied benefits; including the time delay caused by the backlog at FSCO; concluding that there was prejudice to the insurer by the delay, since the claimant had applied for mediation at FSCO within the designated time frame; and concluding that the claimant had not spoken to a LAT representative by telephone and was advised that the 90 day post-mediation extension applied to LAT applications.

A.F. v. North Blenheim Mutual Insurance Company (16-002336)

The claimant sought reconsideration of the Tribunal’s decision that he was barred from seeking entitlement to certain benefits due to the limitation period. In particular, he argued that section 7 of the LAT Act applied in extending the time by which he had to apply to the LAT. Vice Chair Kershaw granted the reconsideration and allowed the claimant’s application to proceed. She held the Tribunal made an error in law by: failing to consider that the claimant continuously demonstrated his intention to dispute entitlement to denied benefits; including the time delay caused by the backlog at FSCO; concluding that there was prejudice to the insurer by the delay, since the claimant had applied for mediation at FSCO within the designated time frame; and concluding that the claimant had not spoken to a LAT representative by telephone and was advised that the 90 day post-mediation extension applied to LAT applications.

N.F. v. North Blenheim Mutual Insurance Company (16-002606)

The claimant sought reconsideration of the Tribunal’s decision that he was barred from seeking entitlement to certain benefits due to the limitation period. In particular, he argued that section 7 of the LAT Act applied in extending the time by which he had to apply to the LAT. Vice Chair Kershaw granted the reconsideration and allowed the claimant’s application to proceed. She held the Tribunal made an error in law by: failing to consider that the claimant continuously demonstrated his intention to dispute entitlement to denied benefits; including the time delay caused by the backlog at FSCO; concluding that there was prejudice to the insurer by the delay, since the claimant had applied for mediation at FSCO within the designated time frame; and concluding that the claimant had not spoken to a LAT representative by telephone and was advised that the 90 day post-mediation extension applied to LAT applications.

A.F. v. North Blenheim Mutual Insurance Company (16-002336)

The claimant sought reconsideration of the Tribunal’s decision that he was barred from seeking entitlement to certain benefits due to the limitation period. In particular, he argued that section 7 of the LAT Act applied in extending the time by which he had to apply to the LAT. Vice Chair Kershaw granted the reconsideration and allowed the claimant’s application to proceed. She held the Tribunal made an error in law by: failing to consider that the claimant continuously demonstrated his intention to dispute entitlement to denied benefits; including the time delay caused by the backlog at FSCO; concluding that there was prejudice to the insurer by the delay, since the claimant had applied for mediation at FSCO within the designated time frame; and concluding that the claimant had not spoken to a LAT representative by telephone and was advised that the 90 day post-mediation extension applied to LAT applications.