Articles Posted in Limitation Periods

On August 10, 2021 the Honourable Justice Grace ordered that “all civil jury trials scheduled to commence in London, Ontario during September, October, November and December 2021 and all civil jury trials scheduled to commence in London, Ontario during September and October 2021” are adjourned. There will be a special civil assignment court to be conducted by teleconference on September 16, 2021 at which time new trial and potentially new pre-trial dates will be set.

The reason for the blanket adjournment of all of these civil trials? COVID-19.

His Honour cited “the impact of COVID-19 on the operations of the Superior Court of Justice and the significant backlog of criminal and family cases”.

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So where does that leave your personal injury or long term disability case?

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If you read the last instalment of the Toronto Injury Lawyer Blog, you would have read all about the confusing world of Long Term Disability policies, how they work; how they don’t work; and how ordinary people find them confusing. If you didn’t catch the last instalment of the Toronto Injury Lawyer Blog; don’t fret! You can read up on it here. Brian Goldfinger thinks that you will find it interesting and informative.

What makes our long term disability lawyers mad or frustrated, is when we see what appear to be otherwise meritorious cases, fail on account of a technicality not caught by the innocent disability claimant who doesn’t know any better.

Enter the recent decision out of Kitchener of Wiles v. Sun Life Assurance Company; released February 15, 2018 by the Honourable Justice G. E. Taylor.

In this case, the Plaintiff commenced an action against Sun Life Insurance for Long Term Disability Benefits. Prior to her disability, she worked at a company called Spaenaur.

The plaintiff states that she became fully disabled as of October 15, 2015, she continued to work full time and perform her employment duties until the date of termination of her employment at the beginning of November 2015. Prior to the termination of her employment, the plaintiff did not request of anyone at Spaenaur to be placed on disability.

In the Attending Physician’s Statement Salary Continuance Services, the plaintiff’s primary diagnosis was stated as “major anxiety disorder”. In the Attending Physician’s Statement Claim for Long-Term Disability benefits, the plaintiff’s symptoms were described as severe anxiety and depression which first appeared on November 3, 2015. The form also described the plaintiff’s symptoms as the result of being dismissed from her employment.

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What does it take to be found disabled under your Long Term Disability Policy? A kind adjuster? A lenient policy? Good handwriting on the LTD application? A good LTD lawyer? Or is it just dumb luck?

Our lawyers wish we had the answer to get you approved right away. A good lawyer will certainly help, but a good lawyer can only play the hand that s/he has been dealt.

Even winning claims can take time to win as the insurer has to be satisfied that the applicant’s disability is not only legitimate, but also meets the definition of “disability” contained in the policy of insurance.

The tricky thing for adjusters is that every LTD policy is different. They all contain different definitions of disability, different time lines to consider, along with different benefit amounts.

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My law firm gets calls from people all across Ontario with respect to Long Term Disability claims. The questions cover a wide range of topics from:

• Am I entitled to LTD benefits?
• What can I do if the LTD insurer denies my claim?
• How can I apply for LTD benefits?
• Is it too late to sue?
• Should I appeal the LTD insurer’s decision not to pay LTD benefits?
• How many times should I appeal the insurer’s LTD denial?
• How much is my LTD case worth?
• How do LTD benefits work?
• Where can I get my LTD application paper work and how do I fill it in?

One of the reasons people have so many questions when it comes to their LTD claim, is because few people have ever read their LTD policies; LTD claims are the exception for employees; not the norm; and people simply don’t understand how these benefits work.

In fact, we even have people calling our office for completely different reasons (car accident, slip and fall, motorcycle accident), only to find out months, or sometimes years later that they have long term disability coverage through their employer! Some people don’t even know they’re covered!!!

As an aside, this awareness of your rights dovetails in to personal injury lawyer advertising. Insurers don’t want to see lawyers advertise. To be fair, some well connected personal injury law firms don’t want to see other personal injury law firms advertise either (but that’s a different topic).One of the reasons which insurers don’t want to see personal injury lawyers advertise, is so that the general public is kept in the dark when it comes to understanding their rights. The later an injured accident victim, or LTD claimant understands their rights, the better for an insurer.

Case in point: The recent Ontario Court of Appeal decision in Usanovic v. Penncorp Life Assurance Company also known as La Capitale Financial Security Insurance Company 2017 ON CA 395 (CanLII). This Ontario Court of Appeal decision was released on May 18, 2017.

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I would like to begin this Toronto Injury Lawyer Blog Post by discussing our law firm’s experience reporting a case of auto fraud to the Financial Services Commission of Ontario (FSCO). I will get in to what exactly the auto fraud was in a later post, as I simply don’t have the space this week to get in to the story.

FSCO is the government body which takes care of car accident and accident benefit fraud in Ontario. This was our first time reporting an incident.

When you wish to report a fraud, there is a Fraud Hotline, 1-855-5TIP-NOW or 1-855-584-7669. There is also an online form you can complete on the FSCO website. Accident Benefit and Car Accident Fraud has been made to be a big deal with all of the huffing and puffing which insurers do about this “epidemic“. You would think that reporting a fraud would be simple, and that the fraud team at FSCO would know what they’re dealing with, and get right on it seeing as it’s such a big deal.

I was passed on to four separate people at the FSCO Fraud Hotline (plus a hang up altogether)  before they even took down any of the fraud victim’s information to investigate the matter. It seemed like nobody knew what to do, nobody knew what to look for, and nobody wanted to deal with our report. I was being passed, from person to person without getting any answers. I had to advance a theory of the fraud which made them say “AH-HA! That’s it!” before they even understood the cause/root of the alleged fraud. It was like they hadn’t even dealt with car accidents or accident benefit cases before.

After much pressing and energy, the fraud has now been reported. What happens now is beyond our law firm’s control. Whether or not we get a progress report from FSCO regarding their investigation is uncertain. I’m doubtful they’ll get back to our office or to the fraud victims. Reporting car accident and accident benefit fraud should NOT be an exercise of jumping through hoops. It should be a clear and easy process with responsive, knowledgeable and accountable staff who get results. Results matter and I got the feeling in dealing with the FSCO fraud team that didn’t know what they were doing. Just our opinion based on our experience.

Now, on to the remainder of the Toronto Injury Lawyer Blog which focuses on Long Term Disability Claims and their tricky limitation periods…..

If there’s one thing which causes Plaintiff side injury lawyers to panic or lose sleep, it’s the fear of missing a limitation period. Conversely for defence counsel and their insurer clients, the prospect of getting a clear cut win on summary judgment motion because a Plaintiff missed their limitation period is exciting; along with a fast and cost effective way to close a file.

Determining when a limitation period begins to run has always been a challenge in certain types of cases. For motor vehicle accident claims, establishing the date of loss is rather simple. Most of the time, with certain exceptions, all the Court needs to do is look at the date of loss. But the same approach does not apply in the context of long term disability claims where there can be multiple denials, multiple levels of appeal, or the denial is not clear and unequivocal. There can be heated debate between Plaintiff and Defence Counsel as to when a limitation period should begin to run. Continue reading →

Not too long ago, the Toronto Injury Lawyer Blog focused on limitation periods in the context of Long Term Disability Claims, and how insurers will delay, delay, delay such that enough time has passed that they could ask the Court to dismiss your claim. Delay is the enemy of a Plaintiff and the friend of an insurer.

The longer a denied claim goes without litigation, the greater the chance that the delay argument will swing in the favour of the LTD insurer. It’s clear that time is NOT on the claimant’s side when it comes to filing an LTD claim, and then litigating it at Court.

One of the larger LTD Insurers, RBC Life Insurance Company recently brought their delay argument to the Ontario Court of Appeal in the hopes of having a claimant’s case dismissed completely.

The case is Dube v. RBC Life Insurance Company and the initial decision at the Superior Court level can be found in the above noted link.

In this case Mr. Dube was a full time employee of the Windsor Essex Housing Corporation. He began working there in around November 2008. He was entitled to benefits under a group disability policy with RBC. One of those benefits was Long Term Disability Benefits. These benefits were supposed to pay for a percentage of Mr. Dube’s salary, in the event of serious injury, illness and/or disability. Basically, if you’re too hurt to work, RBC will pay you a portion of your salary to help make ends meet. In theory, this sounds like a great thing. Almost too good to be true…

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