"What's in a Word?"
Accident & Injury Car Accident
Summary: Very recent Court of Appeal decision dealing with an alleged missed 2-year deadline to apply to the LAT [Ontario Licence Appeal Tribunal] for a denied IRB [income replacement benefit].
What’s in a word? A lot - especially if a limitation period is at stake.
Per very recent Court of Appeal decision dealing with an alleged missed 2-year deadline to apply to the LAT [Ontario Licence Appeal Tribunal] for a denied IRB [income replacement benefit]:
[1] …On December 30, 2015, Allstate notified Mr. Varriano that his IRBs would stop… because Mr. Varriano had returned to full-time work…
[2] On September 28, 2018, Mr. Varriano filed an application before the Licence Appeal Tribunal (“LAT”)…Allstate took the position that Mr. Varriano’s application was time-barred…The LAT adjudicator…found that Allstate’s Benefits Letter met the legislative requirements…and accordingly, the limitation period was triggered on December 30, 2015.
[3] The Divisional Court overturned…held that s. 37(4) required Allstate to provide medical reasons in the Benefits Letter…
[5] …I would allow the appeal. Respectfully, the Divisional Court’s interpretation of s. 37(4) is incorrect…
[10] Under the SABS...
37. (2) An insurer shall not discontinue paying a specified benefit…unless,
…
(e) the insured person has resumed his or her pre-accident employment duties;
[11] …
37. (4) If the insurer determines that an insured person…is no longer entitled to receive a specified benefit on any one or more grounds set out in subsection (2), the insurer shall advise…of its determination and the medical and any other reasons for its determination. [bolding mine]
[17] The Divisional Court…concluded that a plain reading of s. 37(4) supported the interpretation of the word “and” in the phrase “medical and any other reasons” as bearing a conjunctive meaning…
[28] …[However] s. 37(4) states that the insurer may rely on “any one or more grounds set out in [s. 37(2)]” (emphasis added) in terminating benefits. By explicitly including those words…an insurer may rely on a single non-medical reason for termination of benefits…Put differently, interpreting “and” in the joint sense conflicts with the joint and several nature of the grounds for termination.
[31] …s. 37(4) requires provision of the insurer’s actual reasons for determination. If the insurer relies on a medical and a non-medical reason to deny benefits, the insurer must advise the insured person of both. However, if the insurer is relying on a non-medical ground under s. 37(2), the provision requires only that the insurer provide notice of the cancellation of the benefits and to provide the insured with the non-medical reason for that determination.
[32] …In Smith, Gonthier J. concluded that insurance notice provisions serve a consumer protection purpose by requiring insurers to completely and clearly provide insured persons with the information they need…to enable them to challenge a refusal…
[34] …requiring the addition of a line stating, “there are no medical reasons for this denial”, would not further assist an insured in deciding whether to challenge the denial of benefits.
Varriano v. Allstate Insurance Company of Canada, 2023 ONCA 78 (CanLII), <https://canlii.ca/t/jvbhh>