Watkins v. Western Assurance Co., 2016 ONSC 2574

Accident Benefits Insurer’s failure to provide an Explanation of Benefits to a dependant of a policyholder who may have been entitled to accident benefits does not stop the time requirement of that dependant to apply for accident benefits within the statutory timelines and commence an action within the two-year limitation period

Released August 31, 2016 | Full Decision [CanLII]

The plaintiff’s mother was involved in a car accident in 2003. The plaintiff was not involved in the accident and was a minor at the time of accident. The plaintiff’s mother had applied for and received accident benefits from Western Assurance Co. Her accident benefits file was settled in 2007.

The plaintiff reached the age of majority in July 2005. In May 2010, his lawyer sent a letter to the accident benefits insurer, stating that as a result of the insurer’s failure to pay non-earner benefits to his mother, the plaintiff was unable to succeed in school. The plaintiff’s counsel stated that they will start an application for accident benefits shortly. This application was never submitted to the insurer.

The insurer brought this summary judgment motion to strike the action on the basis that it is statute barred, among others.

One of the issues before the court was whether the insurer’s failure to provide a written explanation of benefits to the plaintiff stops the time requirement for submitting an application for accident benefits and/or the two-year limitation period to commence an action.

The plaintiff argued that the insurer did not comply with its obligation to provide a written explanation of benefits available to the plaintiff, and therefore he was not required to notify the insurer that he had intended to apply for benefits within 30 days; to file an application for benefits within 30 days; and/or to commence an action within two years.

Braid J. called it an “absurd interpretation of the legislation to suggest that an insurer must provide an explanation of benefits to every dependent of a policyholder when the dependent was not present at the accident.”

The court held that accepting the plaintiff’s argument would mean that the time requirements for filing an application for benefits and the limitation period to commence an action never began to run. This would defeat one of the important purposes of the statutory accident benefits regime – namely to ensure the timely submission and resolution of accident benefits claims.

The court concluded that the limitation period to commence an action and the statutory requirement to notify the insurer of his intention to apply for benefits and/or make an application for benefits within 30 days began to run when the plaintiff reached the age of majority in July 2005. He was therefore required to notify the insurer by August 2005, and commence an action by July 2007. Having failed to do so, Braid J. dismissed the plaintiff’s claim.

Read the full decision on CanLII
Ben Irantalab
Written by

Ben enjoys the complexities of personal injury litigation. But what attracts him most to represent seriously injured people is the satisfaction that he receives from helping clients achieve the best possible outcome during their most difficult times. Ben’s practice is exclusively devoted to motor vehicle collisions, occupiers’ liability, accident benefits, product liability, medical malpractice, and wrongful death. For Ben, the cases that require special creativity and thinking outside the box are most gratifying.

In his spare time, Ben enjoys travelling, playing soccer, swimming, and playing backgammon. Ben also speaks Farsi.