A Further Re-Application For Benefits Does Not Restart The Limitation Period

Blake v. Dominion of Canada General Insurance Company (2015 ONCA 165 (CanLII)) is a recent decision of the Ontario Court of Appeal which discusses a number of issues pertinent to the advancement of a claim for Statutory Accident Benefits as well as trial procedure in general.

The Blake decision was an Appeal from the trial decision dismissing Ms. Blake's claim for caregiver benefits and extra-contractual damages.

Following a 10-day trial, the trial judge dismissed Ms. Blake's claim, held that her claim was statute-barred, and ruled that, in any event, she had not established her entitlement to caregiver benefits beyond the initial 104-week eligibility period. In addition, the trial judge dismissed Ms. Blake's claims for damages for breach of the contractual duty of good faith, aggravated damages, and mental distress.

On Appeal, the Applicant, Ms. Blake raised four grounds. She submitted that the trial judge erred in (1) finding that her claim was statute barred, (2) refusing to read all the evidence she proffered at trial, (3) holding that she failed to meet her evidentiary burden in relation to entitlement to the caregiver benefit and by applying the wrong legal causation test and (4) dismissing her claims for extra-contractual damages.

The Court of Appeal however dismissed her appeal and ordered costs payable by Ms. Blake.

Background

The facts of this case are briefly as follows. Ms. Blake submitted an Application for Accident Benefits on December 30, 2002. Dominion paid Ms. Blake caregiver benefits until her entitlement to the benefit was eventually terminated. Dominion subsequently sent Ms. Blake an Explanation of Benefits (OCF-9) advising her that she no longer qualified for caregiver benefits effective January 31, 2004.

Ms. Blake did not seek Mediation with respect to this denial and throughout 2004 and early 2005, submitted three more applications for caregiver benefits as well as expenses.

On November 26, 2004, Dominion sent another OCF-9 denying Ms. Blake's November 2004 Application for caregiver expenses which led Ms. Blake, through her Counsel, to file an Application for Mediation dated December 23, 2004, with the Financial Services Commission of Ontario.

Dominion issued a further OCF-9 on January 16, 2005 addressing Ms. Blake's claim for caregiver benefits for the period from November 12, 2004 until January 11, 2005, which stated:

Please be advised effective Jan 31 2004, your caregiving benefit was reduced to $0.00.... We have...