3 total
Insurer ordered to pay increased attendant care benefits and a special award for unreasonable denials.
The applicant was injured in a motor vehicle accident and sought attendant care benefits (ACB) and a special award from her insurer.
The insurer had previously conceded catastrophic impairment and entitlement to some benefits but disputed the quantum of ACB and the special award.
The arbitrator found the applicant's occupational therapist's evidence to be reasonable and holistic, awarding ACB of $1,728.19 and $2,593.67 per month for the respective periods.
The arbitrator also found the insurer's conduct in relying on flawed assessments and ignoring cognitive issues to be unreasonable, thereby meeting the threshold for a special award.
Insurer's denial of catastrophic impairment status does not trigger the limitation period for claiming statutory benefits.
The applicant insurer sought judicial review of a director's delegate's decision upholding an arbitrator's finding that the insurer's refusal to designate the respondent as catastrophically impaired did not trigger the two-year limitation period under s. 281.1(1) of the Insurance Act.
The Divisional Court held that the standard of review was reasonableness, rejecting the insurer's argument for correctness.
The Court found the director's delegate reasonably concluded that a catastrophic impairment determination is not a benefit itself, and the insurer's denial letter did not constitute a clear and unequivocal refusal of a benefit.
The application for judicial review was dismissed.
Appeal of preliminary decision on catastrophic impairment limitation period accepted; stay of arbitration denied.
The appellant insurer sought to appeal a preliminary arbitration decision which found that its denial of a catastrophic impairment designation did not trigger the two-year limitation period under the Insurance Act.
The Director's Delegate accepted the appeal, noting it raised a substantive and novel issue of law that could determine the entire arbitration.
However, the request for a stay of the arbitrator's order was denied, as the parties had already consented to adjourn the arbitration hearing, rendering a stay of little practical effect.
