An insured's application for benefits under a policy issued to his employer, submitted two and a half years after the deadline, was considered timely because the insured had not been provided with the policy or claims documents by his employer.

[2014] O.J. No. 5253

2014 ONSC 6405

Ontario Superior Court of Justice

P.M. Perell J.

November 4, 2014

The insurer sought to dismiss the insured's claim for long term disability benefits under a group policy issued to the insured’s employer on the basis that his claim was barred by the expiration of time.

The insured began work with his employer in 2009. He could not read or write English and had limited ability understanding spoken English. The insured may not have been provided with a copy of the group policy of insurance or any benefit brochure setting out the group insurance policy’s terms and conditions. The insured was injured in a motor vehicle accident in March 2010. The insured told his employer he was injured and unable to return to work. His employer did not advise him to make a claim for benefits or provide him with any documents to do so.

Under the terms of the policy, the insured’s claim for benefits was due no later than September 2010. The insured became aware of the benefits available under the policy in January 2013 after he was asked about it while being examined for discovery. In April 2013, the insured applied for benefits which the insurer ultimately denied.

The court dismissed the insurer’s motion and made a binding determination that the insured’s application was timely because the insured showed he was unable to submit an application earlier. The insured could not submit a claim earlier because his employer did not provide him, as it was obligated to do, with the documents required to exercise his rights under the group policy. The court went on to say that, even if the application was not timely, the insured would have been entitled to relief from forfeiture.