LTD Denials – When Does The 2-Yr Limitation Period Start?

Article by Gabe Flatt

Limitation periods continue to be a hot topic in the context of disability benefits. A recently released Divisional Court decision seems to have shed a little light on this matter. In Western Life Assurance Company v. Penttila, the insurer brought a summary judgment motion to dismiss the plaintiff’s claim due to being statute barred and out of time. The motion was denied. The insurer appealed the motion judge’s decision.

The relevant dates in this matter are as follows:

  • May 16, 2012 – the plaintiff was approved for long term disability benefits due to back problems.
  • February 19, 2013 – the insurer advised the plaintiff that her benefits would be denied as of March 7, 2013 due to a change in the definition of her disability. The insurer’s correspondence advised that she could appeal its decision by providing a written request for review along with supportive medical documentation.
  • April 8, 2013 – the plaintiff advised the insurer that she wished to appeal the denial, and provided further medical information.
  • November 13, 2013 – the insurer requested reports from two doctors from the plaintiff and advised: “upon receipt of all of the above requested information, we will complete our review of your appeal and advise you of the decision.”
  • The plaintiff provided the requested documentation. On October 21, 2014, the insurer advised that the file had been reviewed and that its position “remained unchanged.”
  • May 25, 2015 – the plaintiff requested a letter from the insurer that outlined its decision from its review of her file.
  • June 18, 2015 – the insurer sent a letter advising that it could not conclude on the basis of the information available that she was unable to perform her occupation and that benefits beyond March 6, 2013 remain declined.
  • June 6, 2016 – the plaintiff issued a Statement of Claim.

At the summary judgment motion, the insurer argued that the Statement of Claim was issued outside of the two year limitation period, which should have commenced as of either February 19, 2013 (the date of the denial letter) or March 7, 2013 (the initial termination date). The motion judge held that either October 21, 2014 (the date the insurer denied the plaintiff’s appeal) or June 18, 2015 (the date of the insurer’s final letter) were the applicable dates on which a reasonable person would have understood that a proceeding was a legally appropriate means to seek a remedy.

On appeal, the Divisional Court found that the motion judge was correct in holding that the triggering event for the commencement of the two-year limitation period was the date upon which it would be legally appropriate to commence legal proceedings to seek payment of disability benefits that the insurer refused to pay. Given that there was an agreed upon right to appeal the insurer’s denial directly to the insurer, it would be premature to commence legal proceedings until that process ran its course.

As a result, the Divisional Court upheld the Motion Judge’s decision, dismissed the summary judgment motion and awarded costs to the plaintiff.

Takeaway

This decision supports the idea that the limitation period for commencing a claim at Court in the disability context only begins to run once there is a final, clear, unequivocal denial of benefits. It also supports the idea that the limitation period only commences once it becomes “legally appropriate” to commence a Court proceeding. If there is another method of appeal that is either agreed upon or should reasonably be concluded prior to commencing a Court proceeding, the limitation period will likely commence only after that appeal process is completed.

This means that insurers should be very wary about providing open-ended rights to insureds to appeal the denial of disability benefits. The insurer should be able to demonstrate that a final decision was made and that the decision was communicated to the insured in a way that makes the denial clear and unequivocal.

See Western Life Assurance Company v. Penttila, 2019 ONSC 14 (CanLII)

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

Source: Mondaq

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Desjardins invests in Canada with Better Things Community Grants program

AURORA, ON, Aug. 1, 2018 /CNW/ – Desjardins Group today announced the winners of the Better Things Community Grants program. Three large grants of between $20,000 and $50,000 and 17 community grants of $5,000 will go to deserving initiatives in Ontario, Alberta and New Brunswick.

Earlier this year, Desjardins asked its State Farm® branded agents to nominate local charities or government organizations that work to address safety issues, promote healthy lifestyles, improve financial well-being or support education and youth for grant consideration. A total of 137 nominations were received with 20 chosen as grant recipients.

As part of the ongoing State Farm Canada brand transition to Desjardins Insurance, Desjardins and its exclusive Agents are giving back to their communities, helping people in need and letting clients know that Desjardins Insurance will always be connected, committed and investing in where our customers live, work and play.

“Being involved in communities is part of who we are at Desjardins, and no one understands the needs of our customers better than our local Agents who work and live where their clients do,” says Barbara Bellissimo, Senior Vice President, Desjardins Agent Network. “The Better Things Community Grant program is an opportunity for Desjardins Insurance Agents to connect with the issues that matter in their communities and to provide support to help these groups continue the great work they do every day.”

Grant Recipients

Three grants totaling $105,000 were awarded to the following charities:

  • Pathstone Foundation (St. Catharines, ON) received a grant of $50,000 towards the development of 10,000 square feet of greenspace for mental health disorder patients. The Natural Playground and Healing Garden will be the first of its kind to be created at a children’s mental health agency.
  • Connect Society (Edmonton, AB) received a grant of $35,000 to support their mission to help meet the needs of families affected by hearing loss, allowing them to fully participate and thrive in daily activities. Connect Society will be equipping a preschool in Edmonton with a sensory room to help young children impacted by deafness learn and grow.
  • P.R.O. Kids (Saint John, NB) received a grant of $20,000 towards matching children and teens in financial need with organized, registered recreation activities. Positive Recreation Opportunities for Kids provides youth the ability to become involved in the Sport, Music, Art or Cultural program of their choosing; regardless of financial barriers.

An additional 17 grants totaling $85,000 ($5,000 each) were awarded to the following:

  • Bellwood Public School (Whitby, ON)
  • Brockville and Area Food Bank (Brockville, ON)
  • Chatham-Kent Student Breakfast Programs (Chatham, ON)
  • Distress Centre Calgary (Calgary, AB)
  • Eden Food for Change (Mississauga, ON)
  • Essex County Community Living (Essex, ON)
  • Food4Kids (St. Catharines, ON)
  • Girls Inc. of Durham (Ajax, ON)
  • Holland Bloorview Kids Rehabilitation Hospital Foundation (Toronto, ON)
  • Hong Fook (Scarborough, ON)
  • Kimberly Jr. Public School (Toronto, ON)
  • Linking Generations (Sherwood, AB)
  • London Cross Cultural Learner Centre (London, ON)
  • Port Perry Hospital Foundation (Port Perry, ON)
  • Sir Edgar Bauer Catholic Elementary School (Waterloo, ON)
  • Sussex Vale Transition House (Sussex, NB)
  • The Carson Foundation (Palgrave, ON)

Quotes

“It’s fantastic that Desjardins recognized Pathstone’s Natural Playground and Healing Garden, which will be the this first of its kind in Canada, as a project they wanted to support. This will be a unique, innovative and transformative initiative for the Niagara community. Research has long supported that for young people dealing with mental health issues, time spent in a natural environment is calming, reduces feelings of stress, fear, anger and aggression and improves functionality, attention, focus and self-esteem.”
Shaun Baylis – CEO Pathstone

“As a non-profit, Connect Society has financial limitations and must make difficult decisions about how to use the government funds we receive. It’s encouraging that corporations like Desjardins have a heightened sense of social responsibility, and are willing to champion the good work of charitable organizations to effect positive change. Not only has Desjardins validated our hard work, but their financial support will provide an environment that promotes learning for the children currently in our program and for future generations.”
Cheryl Redhead – CEO/Executive Director Connect Society

“Working at an inner-city school in Saint John I have seen the challenges that youth are faced with every day. We are extremely happy that Desjardins recognizes PRO Kids as a catalyst of change for youth in our community. It provides children an enriching experience while helping to tackle barriers and allow them to break the cycle of poverty.”
Jen Brown – Vice Chair P.R.O. Kids Advisory Committee

Grant Presentations

Each grant recipient will be hosting a cheque presentation event where executives and representatives of each organization will be on hand to discuss their grant, what program or initiative the money will be supporting, and the impact it will have.  Local media, dignitaries and Desjardins Insurance Agents will also be invited to attend.

Once dates, times and locations are confirmed a detailed media invitation will be sent to local outlets prior to each cheque presentation event.

State Farm Canada is becoming Desjardins Insurance

In 2015, Desjardins Group completed the purchase of State Farm Canadian property and casualty and life insurance operations, as well as its mutual fund, loan and living benefits companies. More than 470 State Farm Agents in Canadaare becoming Desjardins Insurance Agents. They continue to offer the strength of their relationships and serve their clients’ insurance and financial needs. The brand transition will be completed by December 31, 2019. Details here – https://www.statefarm.ca/about-us/newsroom/2017/11/21/state-farm-brand-in-canada

About Desjardins
Desjardins Group is the leading cooperative financial group in Canada and the fifth largest cooperative financial group in the world, with assets of $276.3 billion. It has been rated one of the Best Employers in Canada by Aon Hewitt. To meet the diverse needs of its members and clients, Desjardins offers a full range of products and services to individuals and businesses through its extensive distribution network, online platforms and subsidiaries across Canada. Ranked among the world’s strongest banks according to The Banker magazine, Desjardins has one of the highest capital ratios and credit ratings in the industry.

Desjardins Insurance and related trademarks are trademarks of the Fédération des caisses Desjardins du Québec, used under licence.

State Farm and related trademarks and logos are registered trademarks owned by State Farm Mutual Automobile Insurance Company, used under licence by Certas Home and Auto Insurance Company and certain of its affiliates.

SOURCE Desjardins Group

 

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