Ontario: In an accident benefit claim, a denial triggers the limitation period

Time begins to run for the mediation of a denied accident benefit claim from the date of the denial.  A party can’t stop the commencement of the limitation period by sneakily (or inadvertently) omitting certain documents from the accident benefits application.

The appellant in Sagan v. Dominion of Canada General Insurance Company was in a car accident in March 2008. In the same month, he advised his insurer of his claim. The insurance company sent him a package that included the OCF 1 application for accident benefits form and the OCF 3 disability certificate. The appellant filed the OCF 1 form but not the OCF 3 certificate.

The respondent denied the claim in April 2008. In April 2011, the appellant applied for mediation of the denial. The respondent took the position that the two-year limitation period had expired. The appellant commenced an action, which the Court dismissed on a motion for summary judgment.

The appellant argued that the limitation period begins to run not from the date of just any claim, but a valid claim. The appellant’s claim was invalid because it didn’t include a disability certificate. A claim for accident benefits requires a disability certificate pursuant to section 35(2) of the Regulations under the Insurance Act governing claims for accident benefits.

The Court rejected this position:

 1.         A plain reading of section 35(2) provides that the disability certificate is to be filed with the application for benefits.  It is not the application.  In addition, section 35(6) provides for claims to be considered in cases where there is no disability certificate filed at all.

2.         The statutory regime is designed to ensure timely submission and resolution of accident benefits.  It is not in keeping with this overall purpose to suggest that a claimant can delay the start of the limitation period – perhaps indefinitely – by not submitting a disability certificate.

And so sound judicial resoning triumphed over a cute, but improbable argument.

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