A preliminary issue hearing was held to determine whether the claimant was barred from appealing a denial of benefits claimed for MIG determination, IRBs, ACBs, housekeeping, medical benefit expense claims, a CAT determination and a special award. Vice-Chair Boyce held the claimant was statue-barred from appealing the denials due to the claimant’s failure to dispute the insurer’s valid denials within the two year limitation period and that the claimant had failed to demonstrate an extension of time under section 7 of the LAT Act was warranted. Vice-Chair Boyce made reference to Smith v. Co-Operators General Insurance Company in which the Supreme Court of Canada set out the requirements to satisfy there is a proper denial of benefits. Vice-Chair Boyce found the insurer’s denials to have easily met the notice requirements in Smith. The Vice-Chair indicated that the explanation of benefit letters of the insurer in this case were some of the most detailed and specific denials he had seen and went beyond the minimum notice requirements. In regard to exercising the Tribunal’s discretion to extend the limitation period under section 7 of the LAT Act, Vice-Chair Boyce did not find the claimant had bona fide intention to appeal the denials within the two year limitation period prescribed under the SABS. The Vice-Chair noted the claimant had been represented by counsel since the accident in November 2015 and the claimant’s application had not been submitted until August 21, 2019 after he obtained his third representative. The claimant failed to show any evidence of extenuating circumstances that prevented him from filing his application or from instructing his counsel to do so over the past five years. In addition, there was an absence of routine documentation and correspondence related to certain claims that might have indicated an intent by the claimant to dispute the insurer’s appeals that also demonstrated the claimant did not have the intention from the beginning to appeal. The Vice-Chair rejected the claimant’s submission that the delay in appeal did not prejudice the insurer. The Vice-Chair found the delay caused prejudice to the insurer because it had not been able to contemporaneously assess the claimant’s impairments and adjust the file accordingly for several years as the claimant remained in the MIG. Vice-Chair Boyce found the justice of the case did not warrant what would amount to a significant extension of the limitation period.
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