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Fu v. Pembridge Insurance Company (21-012902)

  • December 21, 2022

The claimant applied to the LAT seeking entitlement to NEBs and medical benefits. The insurer argued that the claimant was barred from seeking entitlement to the benefits because he did not dispute the denials within the two-year limitation period. The accident occurred in December 2018, the insurer denied entitlement to NEBs and medical benefits between January and March 2019, and the LAT application was filed in October 2021. The claimant was a minor at the time of the accident. He argued that entitlement to NEBs should be considered discovered when he became eligible on his 18th birthday (September 2020) and, accordingly, the LAT application was within the two-year limitation period. He requested an extension of time with regards to the medical benefits. Adjudicator Kaur held that nothing in s. 36 of the SABS sets out a separate process for applying for NEBs for minors and that nothing in s. 36 makes it a requirement to be 18 to apply for NEBs. Adjudicator Kaur found that the claimant met the eligibility requirement to apply for NEBs under s. 12(1)2i of the SABS at the age of 16 when he was a full-time student (even though an insurer is not required to pay NEBs before an insured is 18 years old). Adjudicator Kaur was not persuaded by the discoverability argument and found that the claimant applied to LAT after the two-year limitation period had expired. Adjudicator Kaur declined to extend the limitation period pursuant to s. 7 of the LAT Act. The application was dismissed.

Full decision here

TGP Analysis

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