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Ontario Court of Appeal Overturns "Unreasonable" LAT Decision

Is an injured person required to make a claim for benefits that he or she would not be entitled to receive, just to preserve their rights to claims these benefits at some point in the future? Prior to the Ontario Court of Appeal’s recent decision in Tomec v. Economical Mutual Insurance Company on November 8, 2019, that was the requirement, as ludicrous that may be.

Under Ontario’s no-fault accident benefits regime, certain benefits, namely attendant care benefits and (possibly) housekeeping and home maintenance benefits cannot be claimed beyond the two-year anniversary of an accident, unless an injured person is deemed “catastrophically impaired.” However, it may take years following that anniversary date to be declared catastrophic.

Originally, a LAT adjudicator ruled that an injured person must appeal these benefits within two-years of the two-year anniversary of the accident, even if that person would not be entitled to those benefits at the time. Consequently, injured persons would be forced to bring LAT applications for benefits that they would not be entitled to receive.

In noting the “absurd” outcomes that would inevitably arise, the Ontario Court of Appeal fortunately ruled that the two-year limitation period for enhanced benefits does not start until an injured person is declared catastrophically impaired.   


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