A Claimant's Delays in providing required Information and filing a Claim to his Insurer result in denied Long-term Disability Benefits

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On November 17, 2006, Cecil Richards was injured in a motor vehicle accident and consequently, he notified his insurer, Sun Life Assurance Company of Canada, of his intention to pursue a claim for disability benefits issued under a group insurance policy. The insurer approved short-term disability benefits for Mr. Richards from November to January. However, before providing long-term disability (LTD) payments, they requested additional information from the plaintiff. After failing to receive a response, Sun Life proceeded to close his case and informed Mr. Richards of this fact in a letter, dated May 1, 2007. " The letter also communicated that Mr. Richards had until August 1, 2007 (i.e. three months) to appeal the decision, which he did not do. However, between August and September, the plaintiff called the insurer three times to inquire about the status of his claim and was informed every time that the case was closed.

On November 17, 2008, Mr. Richards issued a statement of claim in relation to " a negligence claim that he was also pursuing as a result of the accident. However, he did not file a claim for payment of the LTD benefits he felt he was owed by Sun Life until October 2012, which is the current matter being decided. In" Richards v. Sun Life Assurance Company of Canada," Sun Life filed a motion for summary judgement, stating that the claim should be dismissed because, per the" Limitations Act, the two-year limitation period had passed which meant the claim was statute-barred. Therefore, the key two issues in deciding this case are:
  1. Was the plaintiff's claim discovered before October 30, 2010 and thus past the two-year limitation period?

  2. If the claim was indeed discovered before October 30, 2010, is the plaintiff entitled to claim benefits from that date forward, based on the concept of a rolling limitation period?

Relying on the Court of Appeal decision in" Kassburg v. Sun Life, the plaintiff argued that in the case of disability benefits, the limitation period does not begin until the person with the claim receives a "clear and unequivocal denial", which he argued he did not receive from Sun Life. The judge disagreed with the plaintiff's argument, noting that in" Kassburg, the letter to the plaintiff did not inform her that her claim was denied; it simply advised her that she could appeal the decision by submitting further medical information, which she did. In" Kassburg, the motion judge ruled that the limitation period began only when the plaintiff was told that her appeal was denied. On the matter of whether or not the plaintiff discovered he had a claim before October 30, 2010, Mr. Richards stated that he initially thought he had submitted all required information to the insurer. He also stated that he was confused and misled, and did not understand that "closing his file" meant that his claim for LTD benefits had been denied, particularly as his file had been closed and reopened in the past. He simply assumed his claim was being delayed, and he pointed to his calls to Sun Life in August and September to inquire about the status as evidence that he did not realize the claim was denied. However, the judge noted that none of the plaintiff's explanations adequately explained why he waited from September 2008 until October 2012 to commence his action. The judge acknowledged that the plaintiff may have been confused in 2007 and 2008, despite being told his file was closed; nevertheless, at some point before October 10, 2010, he should have recognized that he was being denied benefits to which he felt he was entitled. This is particularly true when the benefits are income replacement benefits, which are presumably needed for ongoing expenses. In essence, the judge believed that the plaintiff had to have realized something was wrong. The judge also asserted that when the plaintiff retained counsel and began a negligence action in November 2008, he knew he had grounds to file a personal injury claim at that time. Therefore, the judge concluded that the plaintiff must also have known he had grounds for a claim before October 30, 2010. Therefore, when the claim for disability benefits was filed on October 30, 2012, the limitation period had expired and the claim is thus statute-barred. On the matter of a rolling limitation period, the judge noted that it applies to cases where, at issue, is whether payments to which the plaintiff is entitled have already been made. It does not apply to cases where the issue is whether the plaintiff is entitled to such payments in the first place. In" Richards," the issue is the latter, which is whether the plaintiff is actually entitled to disability benefits. Consequently, the judge ruled that the concept of a rolling limitation period does not apply in this case. For all of the above reasons, the judge dismissed the plaintiff's claim. Certainly, the aftermath of an accident can be a very difficult period for victims and their families, both emotionally and in terms of physical recovery. " Injury compensation and income replacement through disability benefits can ease the financial burden that is brought on by medical treatments, an inability to work, and other expenses. " However, the legal requirements of the claims process can add to the stress and challenges during the recovery period, particularly without the help and guidance of a qualified personal injury lawyer. At Rastin & Associates, we offer years of experience in helping individuals like you in successfully filing claims after being injured in an accident caused by another person's negligence. Our knowledgeable lawyers can advise you on the optimum approach for obtaining favourable compensation given the unique circumstances of your case. " If you or someone you love has been the victim of personal injury and/or require representation in a dispute for long-term disability benefits, please do not hesitate to call or visit us today. You can call us at " 844-RASTIN1 or " email Rastinlaw.com


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