Released April 8, 2016 | Full Decision [CanLII]
This recent Court of Appeal decision examined the applicable limitation periods for CAT claims under the SABS. The appellant completed an OCF-19 form seeking CAT determination. No claim was made for specific benefits. RBC denied the request for CAT status. The OCF-9 Explanation of Benefits stated the insurer’s assessors had formed a consensus opinion that the appellant was not CAT and did not qualify for increased benefits. The list of benefits on the OCF-9 form was left blank. The motions judge found that the appellant’s claim for CAT status was barred because a mediation was not commenced within two years of the insurer’s refusal to pay the benefits claimed. The motion judge agreed with RBC that the words “and therefore you do not qualify for the increased benefits” constituted a proper denial pursuant to section 281.1(1) of the Insurance Act. Meanwhile, the appellant argued that her claim was not barred given the Divisional Court’s reasoning in Do v. Guarantee Insurance Co., 2015 ONSC 1891 (hereinafter “Do”), which found that CAT impairment status was not itself a benefit, but rather a designation that entitles a claimant to request extended medical, rehabilitation, and/or attendant care benefits and other expenses. At issue, was whether the motion judge erred by concluding that Do did not apply.
The Court of Appeal found that there was no difference in substance between the denial that was made in the appellant’s case and the denial made in Do. The Court found that by adding the words “and therefore you do not qualify for the increased benefits”, RBC was doing nothing more than telling the appellant that she lacked status to claim increased benefits. It further asserted that the additional words in the denial letter did not convert the denial of CAT status into a denial of the specific benefits that would trigger the commencement of the two-year limitation period. The Court ultimately decided to allow the appeal and set aside the motion judge’s order dismissing the appellant’s claim as statute barred.
