Chamberland, Rancourt, Cotnam
Appeal from a judgment of the Superior Court granting in part an application to dismiss and dismissing the part of the claim with respect to the payment of disability benefits ($69,634) because it was prescribed. Allowed in part.
On April 17, 2012, the appellant insured felt a sharp pain in his lower back that forced him to leave work. He was diagnosed with a dorsal sprain at that time. On September 24, 2012, after an unsuccessful attempt to return to work, the insured was put on leave. That same day, he filed an application for disability insurance benefits with the respondent insurance company under the group insurance contract entered into between that insurance company and his employer. On December 19, 2013, the insurer agreed to pay the disability benefits retroactive to January 6, 2013, but told the insured that the benefits would end on January 17, 2014, because his condition did not correspond to the definition in the contract of [translation] “total disability” for the period beyond the initial 24 months of disability. On January 6, 2014, the insured applied to the Régie des rentes du Québec (RRQ) for total disability benefits, which it denied. On May 29, 2017, the Tribunal administratif du Québec (TAQ) reversed that decision and recognized the insured’s disability. On June 20, 2017, the RRQ agreed to pay the insured a pension retroactively to June 2013. At the same time, the insured, armed with the TAQ and RRQ decisions, communicated with his insurer.. On July 26, 2017, the insurer responded by maintaining its refusal to pay insurance benefits. On May 4, 2018, the insured filed this proceeding. The trial judge concluded that the part of the application regarding the disability benefits had been prescribed since January 17, 2017.
The insured sought to have the insurer perform its obligation to pay him monthly disability benefits as of January 17, 2014, the starting date of the period of total disability beyond the initial 24 months. Since the obligation is performed at several different times, in this case, on the 17th of every month, it is an obligation of successive performance. Prescription for each of the monthly payments therefore starts to run on each due date, when the insurer’s obligation arises and is exigible. Therefore, the claim with respect to the monthly benefits due between January 17, 2014, and May 3, 2015, is prescribed.
Sometimes discussions about insurance coverage continue between an insurer and an insured (or a policyholder). In that case, it is appropriate to push back the starting point of the prescription period until the insurer’s final refusal to pay, given that it is premature to resort to the courts when the parties are still in discussion. In this case, the judge did not err in concluding that the insurer’s refusal occurred on December 19, 2013, and not on July 26, 2017 (after the steps taken by the insured appellant following the TAQ’s May 29, 2017, decision). Therefore, the prescription period’s starting point cannot be pushed back to that date.
*Summary by SOQUIJ
Text of the decision: Http://citoyens.soquij.qc.ca