In 2003, Deborah Stuckless, was involved in a car accident. She was a pedestrian stuck by a vehicle. Deborah Stuckless’ own automobile insurance policy responded to her claim for accident benefits. Her son, Timothy Watkins, was fifteen years old at the time and was not directly involved in the accident.

Timothy Watkins brought two separate actions against his mother’s accident benefits insurer, Western Assurance Company: one for non earner benefits and a second action for damages arising out of alleged bad faith handling of Deborah Stuckless’ accident benefits claim.

Despite commencing an action for non earner benefits in 2012, Timothy Watkins never submitted an application for accident benefits or any medical documents to Western. Western first found out about Timothy Watkins’ intention to apply for non earner benefit by way of a letter from his lawyer, Lou Ferro, in 2010. On a motion for summary judgment, Justice Braid found that Timothy Watkins had not provided any medical evidence to support that, as a result of and within 104 weeks of the accident, he suffered a complete inability to carry on a normal life as a result of the injuries suffered by his mother in her car accident.

Timothy Watkins’ action for non earner benefits also sought damages for wrongful infliction of mental distress by the use of unlawful claims practices; bad faith for unreasonable conduct in the claims process; and aggravated, punitive and exemplary damages.

Timothy Watkins argued that Western failed to comply with section 32 (2) of the SABS, and therefore he was not required to notify the insurance company that he intended to apply for benefits within thirty days; to file an application for benefits within thirty days; and/or to commence a claim within two years. Timothy Watkins argued that Western knew Deborah Stuckless had a dependant son living with her, and that should have been enough notice for Western to provide him with an accident benefits package and information pursuant to 32 (2) of the SABS. However, Justice Braid found that there was no evidence that

Western was told of any harm suffered by Watkins, or that he needed benefits. Justice Braid commented:

It is a rare case when a minor dependent, who was not present at the time of an accident, suffers harm as a result of that accident, which makes him eligible for statutory accident benefits. In these circumstances, the informational requirement is only triggered when the insurer is told that the minor dependent has suffered harm as a result of an accident and/or that the minor dependent intends to apply for accident benefits. It is an absurd interpretation of the legislation to suggest that an insurer must provide an explanation of benefits to every dependent of a policyholder when the dependent was not present at the accident.

Justice Braid relied on the Court of Appeal decisions in Sietzema v. Economical Mutual Insurance Company and Haldenby v. Dominion of Canada General Insurance Co., in finding that if Timothy Watkins’ were to succeed in his argument, it would mean that the time requirements for filing an application for benefits and the limitation period in the action never began to run. This would defeat one of the primary purposes of the statutory accidents benefits regime, namely, to ensure the timely submission and resolution of claims for accident benefits. Justice Braid further commented:

Statutory time requirements and limitation periods cannot be extended indefinitely. There must be some finality to the process. To suggest that failure to provide a description of all benefits creates an unfettered right to bring a claim at any time, defeats the mandate of facilitating the quick resolution of claims and the need for finality, certainty and the principle of diligence.

In finding that Timothy Watkins failed submit an application for non-earner benefits, together with a disability certificate, Justice Braid found that Timothy Watkins failed to notify Western of the circumstances giving rise to the claim and failed to comply with section 35 (2) of the SABS. Justice Braid also found that the action for non earner benefits was brought outside of the two-year limitation period, where the limitation period began to run when Watkins reached the age of majority and expired on July 14, 2007.

Justice Braid found that Timothy Watkins did not provide a sufficient explanation for having never filed an application for benefits, pursuant to section 31 of the SABS. Justice Braid considered the fact that Watkins’ lack of notice prejudiced Western’s ability to adequately defend and investigate the claim. Further, Justice Braid found that Timothy Watkins’s conduct did not entitle him to relief from forfeiture.

This decision echoes the message imparted by the Ontario Court of Appeal in Sagan v. Dominion of Canada General Insurance Co., Sietzema v. Economical Mutual Insurance Company, and Haldenby v. Dominion of Canada General Insurance Co., that an insured person’s failure to provide a disability certificate, an application for accident benefits, or commence an action within two years, is fatal.

To read part two of this blog, please click here.