Sagan v. Dominion of Canada General Insurance Company

[Indexed as: Sagan v. Dominion of Canada General Insurance Co.]

Ontario Reports

Court of Appeal for Ontario,

Epstein, van Rensburg and Benotto JJ.A.

October 21, 2014

123 O.R. (3d) 314 | 2014 ONCA 720

Case Summary

Insurance — Limitations — Insured filing application for accident benefits in 2008 but not filing disability certificate — Claim valid despite failure to include disability certificate — Two-year limitation period starting to run from date that claim was denied. [page315]

The insured filed an application for accident benefits, but did not file a disability certificate as required by the Statutory Accident Benefits Schedule Regulations. The claim was denied in April 2008. In April 2011, the insured sought to apply for mediation with respect to the denial of his claim. The insurer took the position that the two-year limitation period had expired. The insured commenced an action, which was dismissed on a motion for summary judgment. The insured appealed, arguing that the limitation period did not start to run until there was a denial of a valid claim, and that a valid claim must include a disability certificate.

Held, the appeal should be dismissed.

The claim was valid despite the failure to file a disability certificate.

Statutes referred to

Insurance Act, R.S.O. 1990, c. I.8 [as am.]

Rules and regulations referred to

Statutory Accident Benefits Schedule — Accidents on or after November 1, O. Reg. 403/96, s. 35(2), (6)

APPEAL from the judgment of Lofchik J., [2013] O.J. No. 6022, 2013 ONSC 7886 (S.C.J.) dismissing an action.

Sean Oostdyk, for appellant.

Joyce Tam, for respondent.

[1] Endorsement BY THE COURT: -- The appellant appeals the summary judgment, which dismissed his claim against the respondent insurance company for accident benefits on the basis that the action was barred by the two-year limitation period.

[2] The appellant was in a car accident in March 2008. The same month he advised his insurer of his claim. The insurance company sent him a package that included an application form known as OCF-1. The package also included a disability certificate known as OCF-3.

[3] The appellant filed the application (OCF-1) for accident benefits (that included a claim for non-earner benefits) but did not file a disability certificate (OCF-3). The respondent sent the appellant a denial of the claim in April 2008.

[4] In April 2011, the appellant sought to apply for mediation with respect to the denial of his claim submitted in 2008. The respondent took the position that the two-year limitation period had expired.

[5] An action was commenced but was dismissed on a motion for summary judgment.

[6] The appellant relies on the Regulations under the Insurance Act, R.S.O. 1990, c. I.8 governing claims for accident benefits (the "SABS" [Statutory Accident Benefits Schedule] regime) [page316] that requires that a claim for non-earner benefits be accompanied by a disability certificate. Section 35(2) of the Statutory Accident Benefits Schedule -- Accidents on or after November 1, O. Reg. 403/96 (the "Regulation") provides:

35(2) An insured person who applies for a specified benefit shall submit with the application a disability certificate completed no later than 10 business days before the date the application is submitted.

[7] The appellant alleges that the motion judge erred by determining that the limitation period started to run from the time that the claim was denied. The appellant argues that the time does not start to run until there is a denial of a valid claim, namely, one that includes a disability certificate. Since the appellant's claim did not include a disability certificate, it was not valid. It therefore did not trigger the two-year limitation period that starts to run upon the denial of a claim.

[8] We do not agree. In our view, the Regulation cannot be interpreted in this manner for two reasons:

(1) A plain reading of s. 35(2) provides that the disability certificate is to be filed with the application for benefits. It is not the application. In addition, s. 35(6) provides for claims to be considered in cases where there is no disability certificate filed at all.

(2) The statutory regime is designed to ensure timely submission and resolution of accident benefits. It is not in keeping with this overall purpose to suggest that a claimant can delay the start of the limitation period -- perhaps indefinitely -- by not submitting a disability certificate.

[9] For these reasons, the appeal is dismissed with costs payable by the appellant fixed at $5,000, including disbursements and applicable taxes.

Appeal dismissed.

End of Document