Category: Limitation Period

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

Following a reconsideration of the initial decision, the Tribunal was asked to decide whether the limitation period should be waived in accordance with section 7 of the LAT Act. Adjudicator Watt concluded that the limitation period should not be waived. He held that the claimant had failed to heed direction from the LAT that the 90 day grace period which had applied at FSCO did not apply at the LAT, the claimant’s delay caused additional preliminary issues, the insurer was prejudiced because it might be unable to locate, produce, or rely on old evidence, and the claimant did not provide any evidence of the merits of the appeal.

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

Following a reconsideration of the initial decision, the Tribunal was asked to decide whether the limitation period should be waived in accordance with section 7 of the LAT Act. Adjudicator Watt concluded that the limitation period should not be waived. He held that the claimant had failed to heed direction from the LAT that the 90 day grace period which had applied at FSCO did not apply at the LAT, the claimant’s delay caused additional preliminary issues, the insurer was prejudiced because it might be unable to locate, produce, or rely on old evidence, and the claimant did not provide any evidence of the merits of the appeal.

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

Following a reconsideration of the initial decision, the Tribunal was asked to decide whether the limitation period should be waived in accordance with section 7 of the LAT Act. Adjudicator Watt concluded that the limitation period should not be waived. He held that the claimant had failed to heed direction from the LAT that the 90 day grace period which had applied at FSCO did not apply at the LAT, the claimant’s delay caused additional preliminary issues, the insurer was prejudiced because it might be unable to locate, produce, or rely on old evidence, and the claimant did not provide any evidence of the merits of the appeal.

Applicant v. Aviva General Insurance (17-006831)

The claimant sought a determination that her impairments were outside of the MIG and entitlement to attendant care and medical benefits proposed in six treatment plans. Pursuant to s. 56 of the SABS, Adjudicator Watt found that the claimant was statute barred from seeking attendant care benefits as the benefits were denied more than two years before the LAT application was filed. The respondent’s letter advising that there was no entitlement to attendant care benefits as the claimant’s injuries were within the MIG was found to have started the limitations period clock. Adjudicator Watt also found that there was no evidence demonstrating attendant care benefits had been incurred or were reasonable and necessary. Adjudicator Watt found that the claimant’s injuries fell with the MIG and that none of the treatment plans in dispute were payable as the MIG limits had been exhausted.

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

Following a reconsideration of the initial decision, the Tribunal was asked to decide whether the limitation period should be waived in accordance with section 7 of the LAT Act. Adjudicator Watt concluded that the limitation period should not be waived. He held that the claimant had failed to heed direction from the LAT that the 90 day grace period which had applied at FSCO did not apply at the LAT, the claimant’s delay caused additional preliminary issues, the insurer was prejudiced because it might be unable to locate, produce, or rely on old evidence, and the claimant did not provide any evidence of the merits of the appeal.

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

Following a reconsideration of the initial decision, the Tribunal was asked to decide whether the limitation period should be waived in accordance with section 7 of the LAT Act. Adjudicator Watt concluded that the limitation period should not be waived. He held that the claimant had failed to heed direction from the LAT that the 90 day grace period which had applied at FSCO did not apply at the LAT, the claimant’s delay caused additional preliminary issues, the insurer was prejudiced because it might be unable to locate, produce, or rely on old evidence, and the claimant did not provide any evidence of the merits of the appeal.

M.R. v Aviva Insurance Canada (17-007428)

The claimant sought entitlement to various medical benefits and the costs of a chronic pain examination. The Tribunal was also asked to determine whether the claimant was statute-barred from disputing one of the denied benefits, as he failed to commence his application within the two year time frame. Adjudicator Kepman concluded that the application for one benefit was time-barred as the claimant failed to provide any reasons for the delay. Adjudicator Kepman further concluded that the claimant had failed to adduce evidence to indicate that the requested benefits or the chronic pain examination were reasonably or necessary.

Applicant v. Economical Mutual Insurance Company (17-004874)

The claimant was a minor at the time of the accident. The insurer denied NEBs around the six months mark. The claimant applied to the LAT to dispute NEBs more than two years after turning 18 years old. The insurer argued that the limitation period barred the claim. Adjudicator Johal agreed that the claim was statute barred even thought the initial denial did not indicate that the claimant was not entitled to NEBs until turning 18 years old. Adjudicator Johal also held that none of the factors relating to extending the limitation period under the Licence Appeal Tribunal Act applied to the claim: the claimant did not have a bona fide intention to appeal within the appeal period; the delay of eight months after the limitation period was not reasonable; the insurer would be prejudiced if the claim was to continue; and the merits of the claim were not enough to outweigh the remaining factors.

S.S. v. Economical Mutual Insurance Company (17-002867)

The claimant sought entitlement to attendant care benefits and housekeeping expenses after a catastrophic impairment application. The insurer argued that those benefits had been denied more than two years prior, and were therefore statute barred. Adjudicator Johal agreed with the insurer. He held that the denials of HK expenses and ACBs were clear and unequivocal despite referencing the wrong section numbers of the SABS. He also held that payment of past ACBs and HK expenses which were made in error after the catastrophic impairment determination did not negate the initial denial (the LAT application was made more than two years after the insurer notified the claimant of the error). Adjudicator Johal also noted that post-104 week HK expenses and ACBs were not new benefits, and that the denial of those benefits before the 104 week mark applied equally to those benefits after the 104 week mark. Finally, the adjudicator held that the catastrophic impairment determination did not support a “discoverability” argument that restarted the limitation period.

S.S. v. Economical Mutual Insurance Company (17-002867)

The claimant sought entitlement to attendant care benefits and housekeeping expenses after a catastrophic impairment application. The insurer argued that those benefits had been denied more than two years prior, and were therefore statute barred. Adjudicator Johal agreed with the insurer. He held that the denials of HK expenses and ACBs were clear and unequivocal despite referencing the wrong section numbers of the SABS. He also held that payment of past ACBs and HK expenses which were made in error after the catastrophic impairment determination did not negate the initial denial (the LAT application was made more than two years after the insurer notified the claimant of the error). Adjudicator Johal also noted that post-104 week HK expenses and ACBs were not new benefits, and that the denial of those benefits before the 104 week mark applied equally to those benefits after the 104 week mark. Finally, the adjudicator held that the catastrophic impairment determination did not support a “discoverability” argument that restarted the limitation period.