The Personal Insurance Company v. Tagoe, 2024 ONCA 894
By: Chris MacDonald
In a significant decision, the Ontario Court of Appeal confirmed that the principle of “discoverability” applies when determining whether an insured person’s claim for Income Replacement Benefits (“IRBs”) under the Statutory Accident Benefits Schedule (“SABS”) is time-barred. This ruling makes it clear that an accident victim’s two-year window to apply to the Licence Appeal Tribunal (“LAT”) may not begin until they actually discover their entitlement to IRBs.
Brief Facts
The claimant, Mr. Tagoe, was injured in an automobile accident but returned to work shortly afterward. Initially, he did not see himself as disabled and thus did not view himself as seeking IRBs. The insurer, in a pre-emptive move, issued a broad denial indicating no IRBs would be paid. Several years later, when he was no longer able to work, Mr. Tagoe filed a LAT application. The insurer argued this claim was time-barred because more than two years had passed from the original denial.
Applicable Law
The dispute centered on section 56 of the SABS, which generally imposes a two-year limitation period to challenge an insurer’s refusal to pay accident benefits. The Court of Appeal applied the discoverability doctrine, clarifying that the clock starts running only once a claimant knows (or ought reasonably to know) they are entitled to apply for those benefits.
The Income Replacement Benefit (IRB)
IRBs are designed to partially replace lost income when an individual’s injuries prevent them from performing the essential tasks of their employment. However, the relevant coverage shifts after 104 weeks, requiring the claimant to show a “complete inability” to do any work for which they are reasonably suited.
The Court’s Decision and Its Impact
The Court affirmed the Divisional Court’s finding that if a claimant returns to work or is otherwise unaware of an inability to work, the limitation period to apply for IRBs does not automatically start just because the insurer pre-emptively denies the claim. This outcome helps protect individuals who reasonably discover their entitlement only when they are truly unable to return to work. For accident victims, this decision ensures they are not unjustly barred from receiving benefits when the severity of their injuries—or their impact on employment—emerges later.
If you or a loved one is facing similar challenges with an automobile insurer regarding statutory accident benefits, do not hesitate to call MacDonald Injury Lawyers. Our experienced legal team understands the nuances of limitation periods, discoverability principles, and the SABS. We are committed to advocating for your rights and helping you secure the benefits you deserve.