Case Commentary – Time Limits for Disputing Accident Benefits Coverage Decisions

A recent decision by the Ontario Licence Appeal Tribunal (“LAT”) confirms that there is a strict two-year time limit for disputing a denial of accident benefits coverage. Claimants should consult with an accident benefits lawyer as soon as possible to avoid losing out on potential benefits.

The same two year limitation period does not apply to accident benefits coverage disputes

In a series of earlier posts, we discussed the Limitations Act, and the two year limitation period that begins to run when a potential legal claim is discovered.

When it comes to accident benefits, however, the Limitations Act does not apply. Instead, the Insurance Act sets out the scheme for resolving any disputes over entitlement to benefits. This establishes a two-year time limit for any individual to dispute a denial of benefits, which begins to run from the date that the insurer provided “clear and unequivocal” notice of their denial.

S.T. and Economical Mutual Insurance Company

This case involved a catastrophically injured applicant seeking ongoing attendant care, housekeeping and home maintenance benefits. She was injured in 2008, and she was found to be catastrophically impaired in 2015.

In August 2010, the applicant’s insurer had sent notice that her attendant care, housekeeping and home maintenance benefits would be terminated the following month. This was written in straightforward, clear language and explained her options for disputing the decision, including the two year time limit.

The applicant had not begun her claim until 2016, and was therefore outside of the two year limit. She attempted to argue that her catastrophic impairment was not determined until 2015, which increased her eligibility for benefits and should therefore trigger entitlement from that point. The LAT disagreed, finding that the proper limit was two years from the denial of benefits. Her application was denied.

Toronto personal injury lawyers offering accident benefits advice

At Jasmine Daya & Co., our experienced personal injury lawyers exclusively represent accident victims. When we are handling your accident benefits claim, we will stay on top of your file and keep your long term needs in mind, to ensure you don’t miss any potential opportunities for compensation.

We offer free consultations to all new clients. Contact us today to discuss your accident benefits claim, either online, or by calling our office at 416-967-9100.