Quite often, we do not know all the factors that may affect the process of filing a claim. When someone is injured, the main focus is usually rehabilitation, and the required paperwork/documentation tends to be lower on the list of priorities, especially if it is a serious injury. This is a very critical error that many make, and the outcome of your case can be severely affected.
Time limitations are usually imposed on certain legal matters and they aim to serve as a guideline to justice. As potential claimants, it is important to know how we can help ourselves in this situation.
A case from which we can draw reference on time constraints in filing a claim is that of Kassburg vs Sun Life Assurance Company of Canada. Here, the insurance company claims the right to void a claim based on the contractual statute of limitations of the policy and the plaintiff disputes this, claiming rightful compensation due to deliberate ambiguity and time delays on the part of the defendant.
The plaintiff in this case was employed with the North Bay Police Services at the time and applied for long term disabilities benefits in May of 2008, being disabled from October of 2007. The particular policy contained a clause where her short term benefits could be covered by her employer.
The insurance representative sent notification in the middle of May 2008 to notify the client that the claim was under review and pending. The notification also explained that coupled with the clause that pertained to the short term disability payments that were being made by the employer, the time period would end on September 2008 and that payments under the policy would begin immediately on the following day.
Early December 2008, another letter informed the plaintiff that her claim was denied and for the next twenty six months documentation was exchanged and her appeals were again denied, a further three times.
The claimant sought legal representation and a suit was filed in February of 2012.
There is a time limitation period of two years when filing for compensation for disability (contained in section 4 of the Limitations Act 2002) and the insurance company cited this and claimed that the time limitations set forth in both the contract and the Limitations Act had long since passed and should not be admissible.
The glaring bone of contention here is ascertaining when the time limit of the litigation should have begun and what compensation if any is due.
Within the Limitations Act there are a few exemptions within Section 22 and the plaintiff cited one as grounds of support for her claim. The law states that the time period can be varied or excluded on dates before the first day of 2004. Aside from this she claims ambiguity within the law itself.
Having met the first requirement, she claims ambiguity on the grounds that between the booklet provided and the group contract made available to her, there was an obvious disconnect. The terms do not definitively explain the changes that were taking place within the contract.
The defendant’s rebuttal was based on ruling before where the onus was on the insured to both know when their “out of pocket” costs began as well as a case where an insurance company was not held liable to the time limit during the period of reviewing a client’s appeal. If the statute of limitations was supposed to be agreed upon, it should begin from Dec 2008-2010.
The judgment was found in favor of the claimant partly because there was no clear cut reason as to why the beginning and ending period of the time limitation was not brought up by the insurance company at all during the initial extensive correspondence.
Hiring a lawyer from Rastin & Associates is the first step to ensuring that you will be properly represented and that your rights will be protected. As seen in this case, time is very important, so do not hesitate to contact us as soon as possible if you or a loved one has been injured. Call us for your free initial consultation now.