Sugunaraj Kanaga

The cross-appellant was injured in a motor vehicle accident and sought income replacement benefits (IRBs).

The insurer terminated the IRBs and the cross-appellant applied for mediation.

The arbitrator initially found the claim was not statute-barred, but on appeal, the Director's Delegate found the arbitrator erred in law by failing to determine whether the insurer's refusal was clear and unequivocal.

On cross-appeal, the Director's Delegate held that the insurer's Explanation of Benefits (OCF-9) provided conditional and ambiguous statements regarding the right to a rebuttal examination and the limitation period.

Because the refusal was not clear and unequivocal, the two-year limitation period was never triggered, and the cross-appellant was permitted to proceed to arbitration on the IRB claim.

The appellant insurer appealed an arbitrator's preliminary decision that the respondent's claim for income replacement benefits was not statute-barred.

The arbitrator had found that the two-year limitation period began on the date benefits ended, rather than the date of the insurer's refusal.

The Director's Delegate allowed the appeal, holding that the limitation period under subsection 281.1(1) of the Insurance Act is triggered by a clear and unequivocal refusal to pay benefits, not the date payments cease.

However, the Delegate granted the respondent an extension of time to cross-appeal on the specific issue of whether the insurer's refusal was, in fact, clear and unequivocal.

The applicant was injured in a motor vehicle accident and received statutory accident benefits from the insurer.

The insurer terminated the applicant's income replacement benefits and denied a treatment plan.

The applicant applied for mediation and subsequently arbitration.

The insurer raised a preliminary issue that the applications were filed beyond the two-year limitation period under the Insurance Act and the Statutory Accident Benefits Schedule.

The arbitrator found that the limitation period for the income replacement benefits commenced on the effective date of termination, not the date of the notice, making the application timely.

However, the application regarding the treatment plan was filed beyond the two-year limitation period and was therefore statute-barred.