17-004055 & 17-004060 v State Farm Mutual Automobile Insurance Company, 2017 CanLII 87159

Dec 22, 2017

Adjudicator: Christopher A. Ferguson

The applicant was involved in two accidents and sought non-earner benefits (NEBs) for both accidents from her insurer. Both claims for benefits were denied. The issue was whether the applicant is barred by s.56 of the Statutory Accident Benefits Schedule – Effective September 1, 2010 from bringing two applications for NEBs.

Adjudicator Ferguson found that the applicant is barred by s.56 from appealing the respondent’s denial of her first accident but not barred from appealing her denial from the second accident.

The Adjudicator held that the applicant issued her claim to appeal the denial for the first accident beyond the limitation period. In contrast, with regards to the second accident, the insurer sent out several denials that were confusing and misleading to the applicant. An insurer cannot raise the limitation period as a bar to an appeal of its denial if its own conduct led the insured person to delay his or her appeal beyond the limitation period.