Catherine Taylor

The applicant sought attendant care benefits following a motor vehicle accident.

The insurer stopped payment after the applicant failed to attend a scheduled insurer examination and argued the subsequent application was statute-barred under section 56 of the Schedule as it was filed more than two years after the refusal.

The Tribunal found that the examination was not properly constituted because the notice did not specify it was for attendant care benefits.

Furthermore, the refusal letter was not clear and unequivocal because it stated the benefit was suspended and would be reconsidered if the applicant attended a rescheduled examination.

The preliminary issue was resolved in favour of the applicant, allowing the claim to proceed.

The applicant sought attendant care benefits following a motor vehicle accident.

The insurer suspended the benefits after the applicant failed to attend an insurer examination and argued the subsequent application was statute-barred under section 56 of the Schedule as it was filed more than two years after the refusal.

The Tribunal found that the insurer's denial letter was not clear and unequivocal because it stated the benefit was suspended and would be reconsidered if the applicant attended a rescheduled examination.

As the denial merely suspended rather than terminated the benefit, the limitation period was not triggered, and the claim was allowed to proceed.