Category: Limitation Period

Applicant v. TD General Insurance Company (16-001308)

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Post date August 29, 2017
No Comments on Applicant v. TD General Insurance Company (16-001308)

The claimant sought entitlement to IRBs beyond the date of termination. The insurer argued that the claimant failed to apply to the LAT before the limitation period expired. Adjudicator Gottfried rejected the insurer’s submissions and held that the claimant applied to the LAT within 90 days after FSCO Mediator’s Report. However, she denied the claimant any further IRBs. She held that the claimant’s credibility was suspect, and that he had returned to work in some capacity following the accident up until he was injured in a subsequent accident. She also accepted the opinions of the IE assessors that the claimant did not suffer a substantial inability to perform his pre-accident employment.

Applicant v TD General Insurance Company (16-001308)

Post author By tgp-admin
Post date August 29, 2017
No Comments on Applicant v TD General Insurance Company (16-001308)

The claimant sought entitlement to IRBs, interest, and expenses. The Tribunal was also asked to determine whether the applicant was statute-barred from proceeding with his application. Adjudicator Gottfried held that the applicant was not statue-barred, as he brought his application within the 90-day time limit after receipt of a FSCO mediation report. Adjudicator Gottfried further determined that the applicant was not credible, and that he was not substantially unable to perform the essential tasks of his employment; therefore, he was not entitled to IRBs or interests. As neither party addressed the issue, Adjudicator Gottfried declined to make an order regarding expenses.

Applicant (By his Litigation Guardian) v. State Farm Insurance (16-001691)

Post author By tgp-admin
Post date August 23, 2017
No Comments on Applicant (By his Litigation Guardian) v. State Farm Insurance (16-001691)

The insurer denied payment of IRBs following the 104 week period. The claimant brought an application before the LAT; however, the insurer asserted a limitation position. Adjudicator D. Gregory Flude reviewed the chronology of events and noted the claimant’s steadily declined in condition and eventual need for a court appointed litigation guardian. Nevertheless, no explanation was provided for the critical period when the limitations period was set to expire. Accordingly, since there is no ambiguity in the provisions, no extension can be granted. The claimant was deemed barred from proceeding with the claims in dispute for failing to comply with the limitations period.

D.S. v. Allstate Insurance Company of Canada (17-000224)

Post author By tgp-admin
Post date June 30, 2017
No Comments on D.S. v. Allstate Insurance Company of Canada (17-000224)

The claimant sought entitlement to income replacement benefits and three treatment plans. The insurer advanced a limitations defence. Vice Chair Flude noted there was no evidence presented to refute the validity of the insurer’s denials. The notices were deemed compliant with the requirements of Smith v Co-Operators and the claimant was considered outside of the limitations period. The application for arbitration was dismissed.

Applicant v. Co-operators General Insurance Company (16-001976)

Post author By tgp-admin
Post date June 7, 2017
No Comments on Applicant v. Co-operators General Insurance Company (16-001976)

The claimant applied for FSCO mediation on January 21, 2016 and disputed a denial of IRBs dated February 26, 2014. The FSCO Mediation was scheduled for May 6, 2016 and was not successful. The claimant subsequently applied to the LAT on August 11, 2016 (97 days after the report of mediator). The insurer raised a preliminary issue asserting the claim was time-barred. The Tribunal agreed and dismissed the claim. On reconsideration, Executive Chair Lamoureux affirmed the applicability of the limitations provisions. The notice letters of the insurer were considered compliant and the insurer was not estopped from relying on the denial letter when it requested a subsequent IE.

Applicant v. Allstate Canada Group (16-002892)

Post author By tgp-admin
Post date May 5, 2017
No Comments on Applicant v. Allstate Canada Group (16-002892)

In this preliminary motion, the insurer sought an order that the claimant was barred by the limitation period from seeking NEBs. The insurer also argued that the period for NEB entitlement did not commence until a completed disability certificate was received almost two years after the accident. Adjudicator Purdy first held that the claimant was not barred from seeking NEBs by the limitation period. She noted that section 64(8) of the SABS deems a mailed document to be received five days later, meaning the LAT application was filed in a timely manner. Second, Adjudicator Purdy relied upon FSCO case law and held that the insurer had sufficient information within a month of the accident to know that the claimant was applying for NEBs.

N.T. v. Unica Insurance Inc. (16-000920)

Post author By tgp-admin
Post date May 5, 2017
No Comments on N.T. v. Unica Insurance Inc. (16-000920)

The insurer requested a preliminary issue to address whether the claim for attendant care benefits was barred by the limitation period. The claimant argued that his Form 1 did not qualify as an application for attendant care benefits, and that the insurer therefore could not have denied attendant care benefits. Adjudicator John held that the submission of the Form 1 was an application and triggered a positive obligation on the part of the insurer to pay benefits, even without the submission of expense forms. She also held that the claim for attendant care benefits had been denied more than two years prior, and was therefore time-barred.

A.A. v. State Farm Mutual Automobile Insurance Company (16-000449)

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Post date April 11, 2017
No Comments on A.A. v. State Farm Mutual Automobile Insurance Company (16-000449)

A preliminary hearing was held to decide whether the claim for NEBs was barred due to the limitation period. Adjudicator Sewrattan held that the insurer’s denial was clear and unequivocal, and that the claimant was therefore barred from seeking NEBs.

G.A. v. Co-Operators General Insurance Company (16-001976)

Post author By tgp-admin
Post date March 27, 2017
No Comments on G.A. v. Co-Operators General Insurance Company (16-001976)

The claimant sought entitlement to income replacement benefits. The insurer asserted a limitations defence. Adjudicator Sewrattan noted that the LAT assumed jurisdiction of accident benefits disputes on April 1, 2016. The parties agreed the 90-day grace period beyond a report of mediator is not applicable to LAT disputes. Adjudicator Sewrattan noted the claimant had ample time when counsel was retained to dispute IRBs. Accordingly, the limitations provisions of section 56 governed and the claimant was time-barred from bringing an IRB claim.

T.E. v. Unifund Assurance Company (16-001326)

Post author By tgp-admin
Post date March 24, 2017
No Comments on T.E. v. Unifund Assurance Company (16-001326)

A preliminary hearing was held to decide whether the claim for IRBs was barred by the limitation period. Adjudicator Sewrattan concluded that the denials by the insurer were clear and unequivocal, and that the claim for IRBs was therefore barred. No costs were awarded.

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