Introduction
The Court of Appeal decision in Kumarasamy v. Western Life[1] is a significant decision for both claimants and disability insurers. It provides much-needed clarity regarding commencing an action for long-term disability (“LTD”) benefits and what is required to start the limitations clock pursuant to sections 5(1) and (2) of the Limitations Act[2] (“Limitations Act”), particularly in cases where benefits are not paid from onset. The Court of Appeal in Kumarasamy held that there does not need to be a “clear and unequivocal” denial of a claim for the limitations clock to start. This article provides a high-level overview and summary of the court’s balanced approach in determining how the limitations period is triggered in the context of a claimant’s application for LTD benefits.
Timeline of the Main Facts
On August 25, 2014, the insured, Kumarasamy, was involved in a motor vehicle accident (“MVA”). Kumarasamy did not return to work after his MVA, alleging several injuries. On August 26, 2014, Kumarasamy retained a lawyer to represent him in his MVA claim and accident benefits claim. He did not retain the lawyer for his LTD benefits claim, and his MVA retainer made it clear that the lawyer was not pursuing the LTD benefits.
February 26, 2015 was the group policy deadline for Kumarasamy to provide a Notice of Claim and the first date that LTD benefits would become payable, should he qualify for LTD benefits.
On March 9, 2015, Kumarasamy submitted his Notice of Claim form to Western Life, the LTD insurer. On June 2, 2015, Western Life sent a letter to Kumarasamy, advising that it had closed his file because he had not provided completed LTD claim forms. On October 13, 2016, lawyers for Kumarasamy – although still not retained on his LTD claim – requested his LTD file from Western Life. On November 8, 2016, Western Life advised Kumarasamy’s lawyer that Kumarasamy’s LTD file had been closed on June 2, 2015, as he had not submitted the required LTD forms.
On or about February 10, 2017, Kumarasamy discussed his LTD claim and signed a retainer with his lawyers to represent him on his LTD claim. On May 10, 2017, Western Life and Kumarasamy’s lawyers discussed Kumarasamy’s LTD claim together and, thereafter, Western Life provided the lawyers a letter dated April 19th, 2017 (which Kumarasamy had not previously received), advising Kumarasamy of additional information necessary to evaluate his claim and advising that “we are not waiving our right to rely on any statutory or Policy provision including any time limitations.”
On June 28, 2017, Western Life wrote Kumarasamy advising that his claim was denied. On June 28, 2019, Kumarasamy commenced an action against Western Life (and his employer).
Please log in to read the full article.