Machaj v. RBC General Insurance Co., 2016 ONCA 257

• Judge: Sharpe, Juriansz and Roberts, JJ.A.
• Court: Court of Appeal (Ontario)
• Case Date: April 05, 2016
• Jurisdiction: Ontario
• Citations: 2016 ONCA 257;(2016), 348 O.A.C. 230 (CA)

Machaj v. RBC Ins. (2016), 348 O.A.C. 230 (CA)

MLB headnote and full text

Temp. Cite: [2016] O.A.C. TBEd. AP.019

Zofia Machaj (plaintiff/appellant) v. RBC General Insurance Company (defendant/respondent)

(C60814; 2016 ONCA 257)

Indexed As: Machaj v. RBC General Insurance Co.

Ontario Court of Appeal

Sharpe, Juriansz and Roberts, JJ.A.

April 8, 2016.

Summary:

The appellant's action for catastrophic injury Statutory Accident Benefits was dismissed on the ground that it was statute barred by virtue of s. 281.1(1) of the Insurance Act because a mediation proceeding had not been commenced "within two years after the insurer's refusal to pay the benefits claimed". The appellant appealed.

The Ontario Court of Appeal allowed the appeal, and set aside the motion judge's order.

Insurance - Topic 5062.2

Automobile insurance - Compulsory government schemes - Bodily injury and death benefits - Catastrophic impairment - [See Insurance - Topic 5077 ].

Insurance - Topic 5076

Automobile insurance - Compulsory government schemes - Bodily injury and death benefits - Limitation period - [See Insurance - Topic 5077 ].

Insurance - Topic 5077

Automobile insurance - Compulsory government schemes - Bodily injury and death benefits - Notice of refusal or termination of benefits - The motion judge found that the appellant's action for catastrophic injury Statutory Accident Benefits was statute barred by virtue of s. 281.1(1) of the Insurance Act because a mediation proceeding had not been commenced "within two years after the insurer's refusal to pay the benefits claimed" - The motion judge concluded that the decision in Do v. Guarantee Insurance Co. (Ont. Div. Ct.) did not apply - Do held that an insurer's denial of the existence of the status of catastrophic impairment did not in itself amount to a denial of a benefit and that it was only where a specific benefit was denied that the limitation period commenced to run against the claimant - In this case, the insurer gave the following reason for the denial of the request for catastrophic impairment status: "... the assessors have formed the consensus opinion that you have not sustained a Catastrophic Impairment and therefore you do not qualify for the increased benefits" - The motion judge found that by adding the words "and therefore you do not qualify for the increased benefits", the insurer did deny benefits within the meaning of s. 281.1(1) - The appellant appealed - The Ontario Court of Appeal allowed the appeal and set aside the motion judge's order - There was no difference in substance between the denial in this case and the denial that was made in Do - The additional words did not convert what was, in substance, a denial of a catastrophic determination into a denial of the specific benefits that would trigger the commencement of the two year limitation period.

Cases Noticed:

Guarantee Co. of North America v. Do et al. (2015), 333 O.A.C. 247; 2015 ONSC 1891, appld. [para. 2].

Statutes Noticed:

Insurance Act, R.S.O. 1990, c. I-8, sect. 281.1(1) [para. 1].

Counsel:

Sandi J. Smith, for the appellant;

Harry P. Brown, for the respondent.

This appeal was heard on April 5, 2016, before Sharpe, Juriansz and Roberts, JJ.A., of the Ontario Court of Appeal. The Court of Appeal delivered the following endorsement on April 8, 2016.