COURT OF APPEAL FOR ONTARIO
CITATION: Sagan v. Dominion of Canada General Insurance Company, 2014 ONCA 720
DATE: 20141021
DOCKET: C58299
Epstein, van Rensburg and Benotto JJ.A.
BETWEEN
Daniel Sagan
Plaintiff (Appellant)
and
Dominion of Canada General Insurance Company
Defendant (Respondent)
Sean Oostdyk, for the appellant
Joyce Tam, for the respondent
Heard: September 25, 2014
On appeal from the judgment of Justice Thomas R. Lofchik of the Superior Court of Justice, dated December 31, 2013.
ENDORSEMENT
[1] The appellant appeals the summary judgment, which dismissed his claim against the respondent insurance company for accident benefits on the basis that the action was barred by the two-year limitation period.
[2] The appellant was in a car accident in March 2008. The same month he advised his insurer of his claim. The insurance company sent him a package that included an application form known as OCF 1. The package also included a disability certificate known as OCF 3.
[3] The appellant filed the application (OCF 1) for accident benefits (that included a claim for non-earner benefits) but did not file a disability certificate (OCF 3). The respondent sent the appellant a denial of the claim in April 2008.
[4] In April 2011 the appellant sought to apply for mediation with respect to the denial of his claim submitted in 2008. The respondent took the position that the two-year limitation period had expired.
[5] An action was commenced but was dismissed on a motion for summary judgment.
[6] The appellant relies on the Regulations under the Insurance Act governing claims for accident benefits (the SABS regime) that requires that a claim for non-earner benefits be accompanied by a disability certificate. Section 35(2) of the Regulation provides:
An insured person who applies for a specified benefit shall submit with the application a disability certificate completed no later than 10 business days before the date the application is submitted.
[7] The appellant alleges that the motion judge erred by determining that the limitation period started to run from the time that the claim was denied. The appellant argues that the time does not start to run until there is a denial of a valid claim; namely, one that includes a disability certificate. Since the appellant’s claim did not include a disability certificate, it was not valid. It therefore did not trigger the two-year limitation period that starts to run upon the denial of a claim.
[8] We do not agree. In our view the Regulation cannot be interpreted in this manner for two reasons:
1. A plain reading of section 35(2) provides that the disability certificate is to be filed with the application for benefits. It is not the application. In addition, section 35(6) provides for claims to be considered in cases where there is no disability certificate filed at all.
2. The statutory regime is designed to ensure timely submission and resolution of accident benefits. It is not in keeping with this overall purpose to suggest that a claimant can delay the start of the limitation period – perhaps indefinitely – by not submitting a disability certificate.
[9] For these reasons, the appeal is dismissed with costs payable by the appellant fixed at $5,000 including disbursements and applicable taxes.
“Gloria Epstein J.A.”
“K. van Rensburg J.A.”
“M.L. Benotto J.A.”