Anju Sharma

The appellant sought his legal expenses following a successful appeal regarding interim legal expenses for catastrophic impairment reports.

The respondent agreed the appellant was entitled to expenses but disputed the amount claimed.

The Director's Delegate found that the novelty and importance of the issues justified an increased hourly rate of $150 for the appellant's counsel.

Taking into account the overriding consideration of reasonableness and proportionality, the Delegate fixed the appellant's legal expenses of the appeal at $7,900.42, inclusive of fees, disbursements, and HST.

The applicant was injured in a motor vehicle accident and exhausted her medical and rehabilitation benefits.

She applied for funding for a Catastrophic Impairment Assessment to access the next tier of benefits.

The insurer denied the request, arguing that the assessment costs were subject to the exhausted $50,000 limit under section 18 of the Statutory Accident Benefits Schedule.

The Arbitrator held that a catastrophic impairment determination is a process, not a benefit, and the assessment expenses are payable under section 25 of the Schedule, independent of the section 18 limits.

The insurer was ordered to pay the $9,492 assessment expense.

The appellant was injured in a motor vehicle accident and sought $12,960 in interim expenses to fund a catastrophic impairment rebuttal assessment.

The arbitrator dismissed the motion, finding that while the criteria for interim expenses were met, the $50,000 monetary cap for medical and rehabilitation benefits under section 18 of the 2010 Schedule had been exhausted.

On appeal, the Director's Delegate held that the arbitrator erred in applying the section 18 monetary cap to an award of interim legal expenses under subsection 282(11.1) of the Insurance Act.

The appeal was allowed in part, and the insurer was ordered to pay $6,780 for four expert reports, conditional upon catastrophic impairment being formally added as an issue in the arbitration.

The appellant sought to appeal an arbitrator's preliminary order denying his request for interim legal expenses to fund a rebuttal catastrophic impairment assessment.

The arbitrator had found that while the appellant met the test for interim legal expenses, the $50,000 limit on medical and rehabilitation benefits under section 18 of the 2010 Schedule precluded the award.

The Director's Delegate exercised discretion to accept the appeal, finding that it raised a novel and broadly important issue of whether the statutory benefit maximums apply to interim expense awards under the Insurance Act.

The applicant, who was injured in a motor vehicle accident, sought an interim order requiring the insurer to fund a rebuttal catastrophic impairment assessment.

The insurer had already paid the $50,000 maximum in medical and rehabilitation benefits for non-catastrophic injuries.

The arbitrator found that while the applicant met the criteria for an interim expense award—raising a bona fide issue, demonstrating the expense was reasonable and necessary, and showing financial inability to pay—the request was barred by the statutory limits.

Because the cost of assessments is included in the medical and rehabilitation benefits limit under the Schedule, the arbitrator could not order the insurer to exceed the $50,000 cap.

The motion was dismissed with no order as to expenses.