Appeal dismissed; insurer's denial of income replacement benefits was clear and unequivocal, triggering the limitation period.
The appellant was injured in a motor vehicle accident and claimed income replacement benefits (IRBs).
The insurer denied the claim on the basis that the appellant had not worked the required 26 weeks in the 52 weeks prior to the accident.
The appellant applied for mediation more than two years after the denial, arguing the denial was not clear and unequivocal because it invited further information.
The Arbitrator found the denial was clear and unequivocal, and dismissed the IRB claim as statute-barred.
On appeal, the Director's Delegate upheld the Arbitrator's decision, finding no error of law in the conclusion that the refusal was valid and not premature.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesOct 13, 2016