Limitation period for attendant care benefits is only triggered by a clear and unequivocal refusal.
The appellant, who was catastrophically injured in a motor vehicle accident, sought retroactive attendant care benefits.
The insurer argued the claim was statute-barred because the appellant failed to mediate within two years of the insurer's determinations of the amounts it would pay.
The arbitrator agreed, finding the appellant had a positive obligation to dispute the insurer's assessments in a timely manner.
On appeal, the Director's Delegate rescinded the arbitrator's decision, holding that the limitation period under the Insurance Act is only triggered by a clear and unequivocal refusal to pay the benefit claimed.
The insurer's explanations of benefits and letters stating what it would pay did not constitute a proper refusal.
The appellant was permitted to proceed to arbitration on the merits of his claim.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesJan 6, 2016
