Nigel G. Gilby

The applicant sought reconsideration of a Tribunal decision dismissing his application for attendant care and housekeeping benefits as statute-barred.

The applicant argued the insurer's denial letter was ambiguous, that subsequent payments negated the denial, and raised Charter and discoverability arguments.

The Tribunal dismissed the reconsideration request, finding the adjudicator made no significant errors of law.

The denial letter was clear and unequivocal, subsequent payments after the limitation period expired did not revive the claim, and the adjudicator properly declined the Charter argument due to lack of required notice.

The applicant sought attendant care and housekeeping benefits following a 2009 motor vehicle accident.

The respondent denied the benefits in October 2011.

The applicant later sought the benefits at a higher tier after being determined catastrophically impaired, arguing the limitation period did not apply or was negated by subsequent payments.

The Tribunal found the 2011 denial letter was clear and unequivocal, triggering the two-year limitation period under the Insurance Act.

The Tribunal held that discoverability does not apply to the statutory accident benefits scheme and that a subsequent catastrophic impairment determination does not trigger a new limitation period.

The application was dismissed as statute-barred.

The applicant was injured in a rear-end motor vehicle accident and received statutory accident benefits until the insurer terminated them.

She applied for arbitration, seeking ongoing weekly income benefits and medical/rehabilitation benefits.

The arbitrator found that the applicant suffered from chronic pain syndrome and remained disabled from her pre-accident job as an in-store demonstrator, entitling her to weekly benefits up to the 156-week mark.

However, the arbitrator concluded that the applicant was not continuously prevented from engaging in any suitable employment thereafter, and dismissed the claim for post-156 week benefits and further medical/rehabilitation benefits.