Landriault v. Sun Life, 2015 ONSC 3196

This is a summary judgment motion brought by the Defendant for a determination that the Plaintiff is statute barred from commencing an action beyond the two year period from the date of denial.  Here, the Plaintiff applied for LTD benefits from the Defendant and received monthly payments from September 2008 through October 2010.  The Plaintiff was denied benefits in October 2010 following obtaining the results of a Functional Abilities Evaluation arranged by the Defendant.  The FAE assessors concluded that the Plaintiff was not “totally disabled” within the meaning of the policy post 24 months.

On November 11, 2010, the Plaintiff appealed the decision and provided additional medical documents.  On December 20, 2010, the Defendant maintained its denial citing insufficient medial documentation.  On February 15, 2011, the Plaintiff made a complaint to the Financial Service Commission of Ontario and on February 18, 2011, the Defendant sent a response.  The response used language indicating that the insurer would be willing to review additional medical documentation.  The Plaintiff had further communication with the Defendant via telephone.  The insurer’s notes indicated that on June 1, 2011, the Plaintiff had called requesting the status of her appeal.

The Plaintiff issued a statement of claim on April 29, 2014.  The Defendant brought a summary judgment motion stating that the Plaintiff’s action is statute barred by virtue of the Limitations Act, 2002, S.O. c.24 Sch. B.

The Plaintiffs argued firstly that the limitation period was not discoverable because the insurer had not provided a “final determination” on her case and that the language used by the Defendant in the letter to the Plaintiff was not clear.  In the alterative, it was argued that there is a “rolling limitation period” meaning that because the benefits are payable on a monthly basis, a separate cause of action arises when each monthly benefit becomes payable.

Based on the Plaintiff’s own evidence that she did not take any steps, did not file any additional information after being advised of the denials in December 2010, February and June 2011, the Court concluded that the Plaintiff was statute barred from commencing an action.

With respect to the “rolling limitation period” the Court concluded that LTD payments cannot be considered a new cause of action on its own.  The Plaintiff’s potential claim arises when the insurer denies the claim and advises the Plaintiff of the same.

Kaitlyn MacDonell
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