Released Date: 11/01/2019
In the matter of an Application pursuant to subsection 280(2) of the Insurance Act, RSO 1990, c I.8., in relation to statutory accident benefits.
Between:
M.N.
Applicant
and
Aviva General Insurance Company
Respondent
DECISION
Adjudicator: Deborah Neilson
APPEARANCES:
For the applicant: Ashu Ismail, Counsel
Andrea Triolo, Counsel
For the respondent: Sophia Chaudri, Counsel
Heard: Written Hearing: August 26, 2019
I. OVERVIEW
1The applicant was involved in an automobile accident on June 17, 2015 and sought benefits pursuant to the Statutory Accident Benefits Schedule - Effective September 1, 2010 (the ''Schedule''). The applicant was denied certain benefits by the respondent insurer and submitted an application to the Licence Appeal Tribunal - Automobile Accident Benefits Service (“Tribunal”) on January 31, 2019.
2This is a preliminary issue hearing to determine whether the applicant is barred from claiming benefits because of the two year limitation period. The respondent claims the applicant failed to apply to the Tribunal within the limitation period for income replacement benefits (“IRBs”) and medical benefits for chiropractic services recommended in four treatment plans. The parties do not agree on when the limitation period for IRBs starts. The applicant denies he missed the limitation period for IRBs. He concedes he missed the limitation period for medical benefits, but asks the Tribunal to exercise a discretion and extend the limitation period for the medical benefits.
3I have determined that the applicant is not barred from proceeding with his claims for IRBs as the respondent has failed to show that he missed the two year limitation period. The applicant is barred from pursuing his claims for medical benefits for chiropractic services in the four treatment plans because he missed the limitation period and I do not have the jurisdiction to extend the limitation period for those claims.
II. PROCEDURAL ISSUES
4In its response to the application and in its submissions, the respondent alleges that the applicant missed the two year limitation period for applying to the Tribunal to dispute the denial of his IRBs. This was not an issue listed in the case conference Adjudicator’s order and it was not addressed in the applicant’s responding submissions. Accordingly, the applicant was provided with an opportunity to respond by filing supplementary submissions. The respondent was provided with an opportunity to file supplementary reply submissions.
5The parties were also asked for supplementary submissions on whether the Tribunal had the jurisdiction under s.7 of the Licence Appeal Tribunal Act to extend the limitation period and in light of my decision in 18-001196 v Certas Home and Auto Insurance, which was released after the parties’ submissions were due.1
III. ISSUES
6The issues I must decide are as follows:
(i) Does the limitation period start on the date of the denial letter, the date it is received, or the date that no further benefits will be paid?
(ii) Is the applicant non-compliant the limitation period under Section 56 of the Schedule for failing to dispute under section 280(2) of the Act, within two years after the insurer’s refusal to pay the following benefits:
a. a medical benefit in the amount of $2,019.24 for chiropractic treatment recommended by Trillium Rehab Physio in a treatment plan (OCF18) submitted on November 5, 2015 and denied on November 7, 2015;
b. a medical benefit in the amount of $1,812.03 for chiropractic treatment recommended by Trillium Rehab Physio in a treatment plan (OCF18) submitted on September 9, 2016 and denied on October 12, 2016;
c. a medical benefit in the amount of $1,677.24 for chiropractic treatment recommended by Trillium Rehab Physio in a treatment plan (OCF18) submitted on February 18, 2016 and denied on February 19, 2016;
d. a medical benefit in the amount of $2,037.65 for chiropractic treatment recommended by Trillium Rehab Physio in a treatment plan (OCF18) submitted on January 7, 2017 and denied on January 9, 2017; and
e. income replacement benefits (“IRBs”) denied by the respondent on January 13, 2017?
7If the applicant missed any of the limitation periods, I must determine whether I have a discretion to extend the limitation period under s.7 of the LAT Act2 and, if so, whether I ought to exercise that discretion.
IV. ANALYSIS
8The onus is on the respondent to show on a balance of probabilities that the applicant missed the limitation period. This includes proving that the two year limitation period started. For a limitation period to start, there must be a valid refusal. A valid refusal is one that is clear, unequivocal, provides the insured person with medical reasons and notifies him of his right to dispute the refusal to pay the benefit.3 The applicant does not dispute that the respondent’s refusals to pay the four treatment plans for chiropractic services were valid refusals. The applicant concedes in his submissions that he missed the limitation period for all four treatment plans. He claims that an extension of the limitation period ought to be granted for those benefits. The respondent and the applicant do not agree on when the limitation period for IRBs starts. My determination of when the limitation period starts will affect whether the applicant missed the limitation period for his IRBs. Accordingly, I have addressed the issues as follows:
a. When does the two year limitation period for IRBs start?
b. Does the Tribunal have the jurisdiction to extend the limitation period?
c. If so, ought the limitation period be extended for the application of any of the benefits in dispute that was not filed in time?
a. The Start of the Limitation Period
9Under s.56 of the Schedule, an application to the Tribunal is required to be commenced within two years after the insurer’s refusal to pay the amount claimed. When an insurer refuses to pay a benefit, it is required to give the insured person written notice under s.54 of the Schedule of his right to dispute the refusal. Section 64 of the Schedule lists the methods that an insurer may use to deliver the notice and when the notice is deemed to have been delivered. This means that the refusal referred to in s.56 of the Schedule that starts the limitation period must be in writing and, for the insured to be notified, the insured must have received the notice or be deemed to have received it under any one of the methods for delivering a notice listed under s.64 of the Schedule.
10The respondent relies on its letter dated January 13, 2017 denying that the applicant was entitled to further IRBs and advising that IRBs would be stopped effective February 1, 2017. The applicant submits that the refusal to pay the amount claimed in this case was February 1, 2017 – the last day that the applicant would receive benefits. The respondent submits that the limitation period started on January 13, 2017 - the date of its denial letter. I find that the limitation period starts when the applicant receives or is deemed to receive the insurer’s refusal to pay the benefit, which is the denial letter. In this case, there is no evidence to indicate when that may have been or from which I may infer when that may have been.
11The applicant relies on the well known rule of statutory interpretation that the words of the Schedule are to be read in their entire context and in their grammatical and ordinary sense harmoniously with the scheme of the Schedule, the object of the Schedule, and the intention of Parliament.4 The applicant submits that the plain meaning of s.56 of the Schedule is that the refusal is the day that the benefits will no longer be paid. I find that the plain meaning of s.56 is that it is the refusal itself that starts the limitation period, not the day that the benefit is stopped for the following reasons.
12The respondent relies on the decision of 17-007103 v Unifund Assurance Company,5 in which the Tribunal determined that the limitation period started with the notice of the denial, not the final day the benefit was paid. 17-007103 v Unifund Assurance Company was upheld on reconsideration by Vice Chair Kershaw.6 She noted that a Court of Appeal decision relied on by the applicant in that case did not actually decide the issue of whether or not the date of the last payment of the benefit can be used. She also noted that other cases cited by the Court of Appeal refer to the date the insured is notified of the denial as the refusal or the date upon which a limitation period begins.
13The applicant submits that s.56 of the Schedule is ambiguous and that an ambiguous statute should be interpreted in favour of the applicant.7 I agree with this principle, but it does not apply in this case as there is no ambiguity in s.56 of the Schedule. If the refusal to pay is not the notice denying the benefit, the Legislature would have referred to the limitation period as the first day the insurer failed to pay the benefit or perform the obligation, just like the start of a limitation period in the Limitations Act, 2002.8 However, the Schedule’s clear use of different terminology shows that the Legislature’s intention was for the date of the notice to the insured that a benefit was denied or reduced - the date of the refusal – to be the start of the limitation period.
14The applicant submits that the date of the denial letter cannot be the date of the refusal unless there is evidence that the denial letter was delivered and received on the day it was sent. The respondent submits that the Tribunal accepted that the date of the denial letter is the date of the refusal and relies on 17-007103 v. Unifund Assurance Company and 17-003105 v. Brant Mutual9 in support of its submission. I agree with the applicant somewhat and find that 17-007103 v Unifund Assurance Company does not assist the respondent. The evidence in 17-007103 v Unifund Assurance Company was that the denial letter was delivered and received on the same day the denial letter was dated. The respondent’s submission ignores s.64 of the Schedule, which discusses the various methods of delivering a notice and when a notice is deemed to have been received. A determination that the date of a denial letter is the start of the limitation period is not consistent with the insurer’s obligation in s.54 of the Schedule to give an insured person written notice of the insured’s right to dispute the denial of a benefit and renders the methods of delivery in s.64 of the Schedule redundant. Because the insurer is required to provide notice to the insured person of his right to dispute the refusal, I find that there can be no refusal unless the insured knows of the refusal or is deemed to know of the refusal.
15In this case there was no evidence that the denial was sent and if it was, how the denial was sent, when the applicant received it or any evidence to support a determination that it was actually or deemed to have been received by the applicant on a particular date. The only evidence before me is that the letter is addressed to the applicant’s address as listed on his application and was carbon copied to L. Minervini Professional Corp., a paralegal. I would have expected a registered letter receipt, email confirmation, fax confirmation, affidavit or even an adjuster’s note indicating how the letter was sent to the applicant or his legal representative. No evidence has been filed despite the issue being raised in the applicant’s submissions and despite the parties being requested by me to provide further submissions on the issue of the limitation period for IRBs.
16The respondent submits that it is clear that the applicant knew that it refused to pay IRBs because he cites the dates of denial and the respondent’s reasons for the denial in his application to the Tribunal. I disagree. I am unable to draw an inference that the denial letter was received or deemed to be received by the applicant as there is nothing in the application, the applicant’s submissions, or either party’s document briefs that would allow me to do so. In his application to the Tribunal, the applicant states that IRBs were denied on February 1, 2017. This may have been information that the applicant obtained from the respondent’s January 13, 2017 denial letter or from the fact that the applicant did not receive any IRBs after February 1, 2017. This is far too speculative to enable me to draw an inference that the January 13, 2017 letter was sent by some means to the applicant such that it was received or deemed to have been received on January 13, 2017. Without some evidence that the January 13, 2017 letter was delivered or something that would allow me to draw an inference that it was delivered, I am unable to find that a limitation period for IRBs started on January 13, 2017. Accordingly, the respondent has not satisfied its onus to prove that the limitation period started on January 13, 2017. Without evidence showing otherwise, I find that the earliest the limitation period started is February 1, 2017, because this is the date the applicant acquiesces to. The application to the Tribunal filed on January 31, 2019 was within the two year limitation period. This means the applicant is not barred by the limitation period under s.56 of the Schedule from proceeding with his claim for IRBs.
b. Jurisdiction to Extend the Limitation Period
17I have found that the applicant is not barred from pursuing her claims for IRBs. However, I must now address her claims for medical benefits. The applicant concedes that she missed the limitation period for the claims for the four chiropractic treatment plans submitted on November 5, 2015, September 9, 2016, February 18, 2016 and January 7, 2017, but asks that the limitation period for those treatment plans be extended. The applicant relies on s.7 of the LAT Act10 and A.F. v. North Blenheim11, a reconsideration decision of the Executive Chair of the Tribunal, as support that the Tribunal has the jurisdiction to extend the limitation period in s.56 of the Schedule. Under s.7 of the LAT Act, the Tribunal “may extend the time for the giving of any notice requiring a hearing by the Tribunal or the appeal of a decision or order of the Tribunal, despite any limitation of time fixed by or under any Act.” In A.F. v. North Blenheim , the Executive Chair determined that s.7 of the LAT Act applies to the two-year limitation period in s.56 of the Schedule.
18The respondent submits that s.7 of the LAT Act does not apply to the limitation period in s.56 of the Schedule and relies on my reconsideration decision of S. v. Certas Home and Auto Insurance Company.12 In S. v. Certas, I determined that s.7 of the LAT Act does not apply because the limitation period in for accident benefit claims is fixed under a regulation – the Schedule – and not “by or under any Act” as the language of s. 7 of the LAT Act dictates. I prefer the determination in S. v. Certas over A.F. v. North Blenheim and find that I do not have the jurisdiction to extend the limitation period for statutory accident benefit claims for the following reasons.
19The applicant submits that the term “by or under any Act” applies to s.56 of the Schedule because the two-year limitation period is in the regulation and the Insurance Act authorizes it. Therefore, the limitation period in the regulation was created “under an Act.” The applicant has provided no authority that shows that the term “by or under any Act” includes provisions in regulations made under an Act, other than the A.F. v. North Blenheim reconsideration decision. The Executive Chair in A.F. v. North Blenheim determined that “by or under any Act” includes regulations because the Legislature’s intention was for s.7 of the LAT Act to apply to statutory accident benefit claims. The reason was because there was nothing in s.7 of the LAT Act excluding Insurance Act matters. However, the Executive Chair was not asked to consider that both “Act” and “regulation” are used in s.3 of the LAT Act, which refers to the duties assigned to the Tribunal “by or under any Act or regulation.” This is very different from s.7 of the LAT Act, where only “Act” is used. If “by or under any Act” is meant to include regulations made under an Act, then the use of “regulation” in s.3 of the LAT Act is redundant. Such an interpretation is contrary to the principles of interpretation adopted by the Supreme Court of Canada in Rizzo & Rizzo Shoes Ltd.
20I also prefer S. v. Certas because the Executive Chair in A.F. v. North Blenheim was not asked to consider the definitions of “Act” and “regulation” in s.87 of the Legislation Act, 2006.13 Under the Legislation Act,2006, the definition for “Act” is different from the definition for “regulation.” Under s.87 of the Legislation Act, 2006, the word “statute” has the same meaning as the definition of “Act.” To read into the definition of “regulation” that it has the same meaning as “Act” or “statute” would result in a change to the legislative process for enacting laws.14 It would mean that the law (under a statute) would not have be subject to repeal, amendment or revocation by the Legislature, but by the Lieutenant Governor in Council, a minister of the Crown, an official of the government or a board or commission. This is contrary to the powers conferred under the Legislative Act.
21The Insurance Act used to have a section that imposed a limitation period for accident benefit claims that was repealed when the dispute resolution process was transferred to the Tribunal.15 If the Legislature had intended to give the Tribunal the discretion to extend the limitation period for appealing a denial of accident benefits, the limitation period in s.281.1 (1) of the Insurance Act would not have been repealed, but would have been amended to state that it was subject to the discretion of the Tribunal in accordance with the LAT Act. Instead, only s.56 of the Schedule imposing a limitation period was amended. Further, s.55 of the Schedule was amended to allow the Tribunal to permit an applicant to apply to the Tribunal, despite the applicant’s failure to submit to an insurer’s examination under s.55(1) 2 of the Schedule or when the dispute relates to an invoice that is under investigation under s.55(1)3 of the Schedule.16 This new power was not extended to the amended s.56 of the Schedule. However, the amendment to s.121(1)26 of the Insurance Act effective April 1, 2016 gives the Lieutenant Governor in Council the power to make regulations governing the proceedings before the Tribunal, including imposing time limits or limitation periods.
22Section 7 of the LAT Act could have been amended to include “regulations,” but was not, even though ss.11(1) and (6) of the LAT Act were amended to include the Insurance Act. If the applicant’s reasoning is accepted, the amendments and repeals would have to be considered oversights or errors by the Legislature, which I do not accept. I find that on a plain reading, the Legislative intent was to remove the limitation period from the jurisdiction of s.7 of the LAT Act, as it is no longer a limitation of time fixed by or under any Act, but rather it is fixed under a regulation.
23The applicant submits that when applying the modern approach to statutory interpretation, attention must be paid to the terms of the enabling statute. The intent of the statute transcends and governs the intent of the regulation.17 The Insurance Act deems that every contract of motor vehicle liability insurance includes the accident benefits in the Schedule, subject to the terms, conditions, provisions, exclusions and limits set out in that Schedule.18 This means that the Insurance Act intends that the Schedule is the contract and the Schedule/contract takes precedence over the Insurance Act.19
24The applicant submits that the two-year limitation period that was in s. 281.1 of the Insurance Act was superseded by the Limitations Act 2002 for all matters brought to court. The applicant submits that the discovery principle in s.4 of the Limitations Act 2002 provides the court with some discretion to consider the circumstances of a case. The applicant submits that discretion was carried over to the Tribunal when the right to pursue accident benefits claims in court was eliminated by the Legislature effective April 1, 2016. If s.7 of the LAT Act does not apply to accident benefits, the applicant submits that the discretion to consider the circumstances previously under s.4 of the Limitations Act 2002 is taken away. I disagree that the court had any discretion to consider the circumstances of an accident benefit claim under the discovery principle for the following reasons. The discovery principle under s.4 of the Limitations Act 2002 did not apply to actions for accident benefits claims. The two-year limitation period in s.281.1 of the Insurance Act that was repealed on April 1, 2016 took precedence over s.4 of the Limitations Act 2002.20 The only circumstances that could be considered by the court were whether there was a waiver of the limitation period or a valid refusal that started the limitation period. Therefore, there can been no loss of a discretion on the limitation period as there was no discretion to begin with.21
25The applicant submits that if the Tribunal does not have a discretion to extend the limitation period, then minors and persons who do not have the requisite mental capacity will lose the right to have the limitation period for their claims suspended until they come of legal age or have the requisite capacity. The applicant submits that the interpretation of s.7 of the LAT Act must be such that the Legislature cannot be seen to have acted in contradiction to the Constitution, which mandates equal access to justice, especially for the otherwise incapable. Despite the applicant’s able argument, I find that the lack of discretion to extend a limitation period does not mean the interests of parties under a disability and minors are not protected for the following reasons.
26If an application is not made for accident benefits in the first place, the fact the person was incapable or is a minor is a “reasonable explanation” under s.34 of the Schedule. This is not dissimilar to the suspension of a limitation period in the Limitations Act 2002. The suspension of the limitation period only applies to minors or incapable persons who do not have a litigation guardian.22
27Assuming an application is submitted on behalf of an incapable person, insurers are prohibited from paying any accident benefits to a minor under s.271 of the Insurance Act unless it is paid into court, paid to the guardian of the property of the minor appointed by the court, or the parent or legal custodian of the child under s.51 of the Children's Law Reform Act.23 If the money is paid into court, the insurer is required to notify the Office of the Public Guardian and Trustee. If the money is paid to a parent or legal custodian under s.51 (4) of the Children’s Law Reform Act, the parent or legal custodian who receives the money has the responsibility of a guardian for the care and management of the money or personal property. What this means is that a minor’s interests are protected because if an accident benefit claim is submitted to an insurer, it must be made by a person who is responsible for the minor and who is therefore liable for ensuring an application to the Tribunal is filed within the limitation period. This is similar to the protections that a litigation guardian provides and why there is no suspension of a limitation period when a minor has a litigation guardian under the Limitations Act 2002.24
28If the insured person is under a disability, the insurer may, under s.141(1) of the Insurance Act, apply to pay the funds into court. The court may make such orders as is appropriate. This means the court is in a position to ensure that the Office of the Public Trustee and Guardian is involved or that a guardian of property is appointed to protect the interests of the person under disability. Accordingly, there are protective measures in place specific to minors and mentally incapable persons other than the extension of the limitation period in the Limitations Act, 2002. Therefore, there is no support for the applicant’s submission that a jurisdiction to extend limitation periods for accident benefits claims under s.7 of the LAT Act is the only way to protect the interests of minors and mentally incapable insureds.
29For the foregoing reasons, I find that I do not have the jurisdiction to extend the limitation period under s.56 of the Schedule.
c. Discretion to Extend the Limitation Period
30The applicant has conceded that he missed the limitation period for filing his application with the Tribunal with respect to the medical benefits. Because I do not have the jurisdiction to extend the two limitation period in s.56 of the Schedule, it is not necessary for me to determine whether the limitation period for the treatment plans should be extended. Accordingly, I find that the applicant is barred from pursuing his claims for the chiropractic treatment set out in the treatment plans submitted on November 5, 2015, September 9, 2016, February 18, 2016 and January 7, 2017.
V. ORDER
31The respondent has failed to show the applicant missed the limitation period for filing his application with the Tribunal for IRBs. The applicant may proceed to a hearing at the Tribunal for his claim for IRBs.
32The applicant’s claims for the following medical benefits are dismissed because he missed the limitation period in s.56 of the Schedule and is therefore barred from proceeding with his application:
a. in the amount of $2,019.24 for chiropractic treatment recommended by Trillium Rehab Physio in a treatment plan (OCF18) submitted on November 5, 2015 and denied on November 7, 2015;
b. in the amount of $1,812.03 for chiropractic treatment recommended by Trillium Rehab Physio in a treatment plan (OCF18) submitted on September 9, 2016 and denied on October 12, 2016;
c. in the amount of $1,677.24 for chiropractic treatment recommended by Trillium Rehab Physio in a treatment plan (OCF18) submitted on February 18, 2016 and denied on February 19, 2016; and
d. in the amount of $2,037.65 for chiropractic treatment recommended by Trillium Rehab Physio in a treatment plan (OCF18) submitted on January 7, 2017 and denied on January 9, 2017.
Released: November 1, 2019
Deborah Neilson
Adjudicator
Footnotes
- S. v. Certas Home and Auto Insurance Company (Tribunal File 18-001196/AABS, September 5, 2019), presently under appeal to the Divisional Court (“S. v. Certas”)
- Licence Appeal Tribunal Act, 1999, SO 1999, c 12, Sch G (“LAT Act”)
- Turner v. State Farm Mutual Automobile Insurance Company, 2005 CanLII 2551 (C.A.) at paragraph 4, s.38(8), s.38(11) and Sietzema v. Economical Mutual Insurance Company, 2014 ONCA 111, the denial does not have to be legally correct to be a valid refusal.
- Re Rizzo & Rizzo Shoes Ltd., 1998 CanLII 837 (SCC), [1998] 1 S.C.R. 27, at para. 21 cited in Zacharias v. Zurich Insurance Company, 2013 ONCA 482, para 37. (“Rizzo & Rizzo Shoes Ltd.”)
- 17-007103 v Unifund Assurance Company, 2018 CanLII 83502 (ON LAT)
- 17-007103 v. Unifund Assurance Company, 2019 CanLII 40291 (ON LAT Reconsideration)
- Consolidated-Bathurst v. Mutual Boiler, [1980] SCC, pages 900 and 901.
- See s.4, s.5(1)(a) and s.5(3) of the Limitations Act, 2002, SO 2002, c 24, Sch B. s. 4. Unless this Act provides otherwise, a proceeding shall not be commenced in respect of a claim after the second anniversary of the day on which the claim was discovered; s..5 5 (1) A claim is discovered on the earlier of, (a) the day on which the person with the claim first knew, (i) that the injury, loss or damage had occurred,…: and s.5(3) For the purposes of subclause (1) (a) (i), the day on which injury, loss or damage occurs in relation to a demand obligation is the first day on which there is a failure to perform the obligation, once a demand for the performance is made.
- 17-003105/AABS v Brant Mutual Insurance Company, 2018 CanLII 8083 (ON LAT) (“17-003105 v Brant Mutual”)
- Licence Appeal Tribunal Act, 1999, SO 1999, c. 12, Sch G (“LAT Act”)
- A.F. v. North Blenheim Mutual Insurance Company, 2017 CanLII 87546 (ON LAT), LAT File 16-002336/AABS (“A.F. v. North Blenheim”)
- S. v. Certas Home and Auto Insurance Company (Tribunal File 18-001196/AABS, September 5, 2019) (“S. v. Certas”)
- Legislation Act, 2006, SO 2006, c 21, Sch F (“Legislation Act 2006”)
- Under s.7 (1) of the Legislation Act, every Act reserves to the Legislature power to repeal or amend it and to revoke or modify any power or advantage that it confers.
- s.281.1 (1) Insurance Act, RSO 1990, c I.8 was repealed on April 1, 2016.
- s.55(2) of the Schedule.
- Bristol-Myers Squibb Co. v. Canada (Attorney General), [2005] 1 SCR 533, 2005 SCC 26, paragraph 38
- See s.244(3) and s.268(1) of the Insurance Act
- Warwick v. Gore Mutual Insurance Co., 1997 CanLII 1732 (ON CA)
- Under s.4 of the Limitations Act 2002, the two year limitation period that starts on the day the cause of action is discovered does not apply if the Limitations Act 2002 provides otherwise. Section s.19 of the Limitations Act 2002 provides otherwise. Under s.19(1), a limitation period in the statutes listed in the Schedule to the Limitations Act 2002 takes precedence over the limitation period in s.4 of the Limitations Act, 2002. Section 281.1 of the Insurance Act was and is still listed in the Schedule to the Limitations Act 2002.
- This also applies with respect to the Courts’ discretion under s.129 of the Courts of Justice Act.
- See s.6 and s.7 of the Limitations Act 2002
- Children's Law Reform Act, RSO 1990, c C.12, s 51(1)
- It is also of note that medical benefits for minors are payable until the age of 28 under s.20(1)

