Statutory Accident Benefits Schedule matters (SABS)

State Farm paid statutory accident benefits to its insured motorcyclist who was injured after swerving to avoid a left-turning vehicle insured by Aviva.

State Farm sought indemnification from Aviva under the loss transfer provisions of the Insurance Act.

The arbitrator found the Aviva-insured driver 100% at fault under rule 5(1) of the Fault Determination Rules, concluding that 'ordinary rules of law' does not mean pure tort law and must be informed by Rule 3.

The application judge set aside the award and apportioned fault 50/50 based on tort law.

The Court of Appeal allowed the appeal and restored the arbitrator's award, holding that rule 5(1) does not require a pure tort law analysis and that Rule 3 applies to all fault determinations under the Rules.

A heavy commercial vehicle insured by the appellant rear-ended a stopped vehicle, causing it to rear-end a third vehicle insured by the respondent.

The respondent paid statutory accident benefits to its insured and sought indemnification from the appellant under the loss transfer provisions of the Insurance Act.

The arbitrator and the Superior Court judge held that the appellant was 100 per cent responsible for the entire chain reaction under section 9(4) of the Fault Determination Rules.

The Court of Appeal allowed the appeal, holding that the word 'incident' in section 9(4) refers only to the specific collision between two vehicles, meaning the appellant was only at fault for the collision with the middle vehicle and not required to indemnify the respondent.

The appellant insurer appealed a Divisional Court judgment dismissing its application for judicial review of a decision by the Director's Delegate.

The Director's Delegate had found that the two-year limitation period for the respondent to apply for mediation regarding a denied non-earner benefit did not begin to run until the insurer provided the medical report it relied upon in its denial.

The Court of Appeal dismissed the appeal, finding the Director's Delegate's interpretation of the home statute was reasonable and entitled to deference.

The appellant was injured in a motor vehicle accident and applied for statutory accident benefits.

The insurer paid income replacement benefits but denied non-earner benefits in 2004.

After income replacement benefits were terminated in 2006, the appellant sought non-earner benefits in 2009 and commenced an action in 2012.

The motion judge granted summary judgment dismissing the action as time-barred.

The Court of Appeal upheld the decision, confirming that the two-year limitation period for non-earner benefits began to run when the insurer initially refused them in 2004, even while the appellant was receiving income replacement benefits.

The insurer moved for summary judgment dismissing an action for non-earner benefits brought by an insured who had previously elected and received income replacement benefits after a motor vehicle accident.

The court held that s. 36 of the Statutory Accident Benefits Schedule barred recovery of non-earner benefits for any period during which income replacement benefits had already been paid.

However, the legislation did not preclude concurrent actions seeking income replacement benefits and non-earner benefits for the period after the insurer terminated the income replacement benefits, with the ultimate entitlement to be determined at trial.

Partial summary judgment was therefore granted only for the period when income replacement benefits were actually paid.

On a summary judgment motion arising from a motor vehicle accident involving an uninsured son driving his father's vehicle, the moving defendant sought dismissal of the plaintiff's claim and an insurer's crossclaim on the basis that the vehicle had been taken without consent.

Applying the post-Hryniak summary judgment framework, the court held there was no genuine issue requiring a trial on consent to possession.

The court found that although the father had forbidden operation of the vehicle and the son had signed an excluded driver form, the son retained legal possession because the vehicle and keys remained available to him and had been entrusted for his use.

The owner was therefore potentially vicariously liable under s. 192 of the Highway Traffic Act, with negligence and damages left for trial.

The appellant insurer appealed a jury trial judgment, arguing the trial judge erred in dismissing two motions for a mistrial due to plaintiff's counsel's conduct during cross-examination and closing address.

The appellant also challenged the award of 2% per month interest on overdue payments.

The Court of Appeal dismissed the appeal, finding the trial judge gave clear and appropriate instructions to the jury to cure any prejudice.

The Court also upheld the 2% interest rate, noting that the 2010 Statutory Accident Benefits Schedule preserved the substantive right to the former interest rate for accidents occurring before its effective date.

The appellant insurance company appealed a Superior Court judgment that set aside an arbitrator's award regarding insurance coverage.

The issue was whether an 81-year-old man was principally financially dependent on his son at the time of a motor vehicle accident, which would determine which insurer was liable to pay.

The arbitrator found that the man was dependent, applying the Safeco test.

The appeal judge overturned this, finding the arbitrator failed to account for the voluntary nature of the dependency.

The Court of Appeal allowed the appeal, holding that the arbitrator's factual determination of dependency was reasonable and entitled to deference, and restored the arbitrator's award.

The appellant was injured in a motor vehicle accident and submitted an application for accident benefits without a disability certificate.

The respondent insurer denied the claim.

More than two years later, the appellant sought mediation and subsequently commenced an action, which was dismissed on summary judgment as statute-barred.

On appeal, the appellant argued the limitation period did not begin until a valid claim, including a disability certificate, was denied.

The Court of Appeal dismissed the appeal, holding that the application was valid without the certificate and that allowing a claimant to delay the limitation period indefinitely by withholding a certificate would undermine the statutory regime's purpose of timely resolution.

The respondent farmer was injured when his uninsured all-terrain vehicle (ATV) was struck from behind by a truck on a public road.

He sued the truck driver, the truck owner, and his own insurer for damages and statutory accident benefits.

The motion judge found the ATV was a 'self-propelled implement of husbandry' exempt from compulsory insurance.

The Court of Appeal reversed, holding that the ATV was an off-road vehicle that required insurance when operated on a public road.

Consequently, the respondent's action was statute-barred and his claim for statutory accident benefits was foreclosed.

The driver was injured in a single-vehicle accident while driving a rental vehicle insured by the respondent.

The rental company also held an optional death and dismemberment policy with the appellant, which the driver did not purchase.

The driver submitted a claim for statutory accident benefits to the appellant, who refused to pay.

The respondent began paying the benefits and initiated a priority dispute arbitration.

The arbitrator ruled the appellant was not an 'insurer' under the statutory regime because there was no sufficient nexus.

The application judge overturned this, finding the appellant was an insurer.

On appeal, the Court of Appeal allowed the appeal, holding that the appellant's policy was not a 'motor vehicle liability policy' and therefore the appellant was not required to pay first and dispute later under O. Reg. 283/95.

The appellant appealed an order adding it as a party to the proceeding.

The Court of Appeal questioned its jurisdiction to hear the appeal, considering whether the order was final or interlocutory.

The appellant argued the order was final due to preconditions in the Insurance Act regarding mediation and arbitration for statutory accident benefits.

The Court held that the order adding the party was interlocutory, as it did not finally determine the questions of law raised by the appellant.

Consequently, the appeal was quashed for lack of jurisdiction, with costs awarded to the respondents.

The appellant appealed the dismissal of her action against her motor vehicle insurer for income replacement benefits.

She argued the trial judge erred by excluding the medical reports of her deceased family physician and by misinterpreting the Statutory Accident Benefits Schedule (SABS).

The Court of Appeal upheld the trial judge's decision to exclude the reports under section 52(2) of the Evidence Act, as they lacked necessity and reliability and would prejudice the respondent.

The Court also affirmed that under sections 4(1) and 5 of the SABS, an insured must establish eligibility for income replacement benefits within the first 104 weeks after the accident to qualify for benefits beyond that period.

The appeal was dismissed.

The respondent sought weekly benefits from the appellant insurer pursuant to the Statutory Accident Benefits Schedule 1990.

The insurer terminated benefits, and the respondent sued for past and ongoing benefits, including interest on overdue amounts under s. 24(4).

The insurer brought a motion to determine whether s. 24(4) provides for simple or compound interest.

The motion judge found it provides for compound interest, and the insurer appealed.

The Court of Appeal dismissed the appeal, holding that s. 24(4) unambiguously provides for compound interest when read in its entire context and harmoniously with the legislative scheme.

The respondent was rendered paraplegic in a motor vehicle accident.

His mother took an unpaid leave of absence to provide 24-hour care.

The insurer argued that under SABS-2010, it was only required to pay attendant care benefits for the 40 hours per week of paid employment the mother forgone, as that was the extent of her 'economic loss'.

The Court of Appeal held that economic loss serves as a threshold for entitlement to attendant care benefits, not as a measure of the quantum.

Once the threshold is met, the insurer must pay for all reasonable and necessary care provided, subject to statutory maximums.

The appeal was dismissed.

The appellant insurer appealed the trial judge's findings that the respondent qualified for non-earner benefits following a motor vehicle accident and that the benefits were payable for four years.

The respondent cross-appealed, claiming ongoing entitlement.

The Court of Appeal upheld the finding of entitlement, noting that post-accident employment does not disqualify a claimant but serves as a point of comparison under the Heath test.

However, the Court allowed the appeal regarding the duration of benefits, reducing the payment period to approximately two years and three months based on medical assessments showing significant improvement.

The respondent was assaulted by two unknown men in a parking lot, forced into his vehicle, and assaulted further before being abandoned.

As the assailants drove away, they ran over his foot.

The respondent claimed statutory accident benefits and indemnity coverage from his automobile insurer.

The insurer denied the claims, arguing the injuries were caused by the assaults, not the use or operation of the vehicle.

The motion judge dismissed the insurer's motion for summary judgment.

On appeal, the Court of Appeal allowed the appeal in part, holding that the assaults were intervening acts independent of the vehicle's use, breaking the chain of causation.

Summary judgment was granted to the insurer for all claims except those relating to the foot injury, which required a trial.

A cyclist was injured by an unidentified motorist and applied to the Motor Vehicle Accident Claims Fund for statutory accident benefits.

The application lacked a police report.

The Fund later learned of a 911 call but delayed seeking a court order to obtain the call records for over seven months.

Once obtained, the records identified the motorist and their insurer, Pilot Insurance Company.

The Fund then notified Pilot of its intent to dispute priority.

The Court of Appeal held that while the application became functionally adequate when the 911 records were obtained, the Fund's lack of diligence in pursuing the records meant it should be treated as having received a completed application months earlier.

Consequently, the Fund failed to meet the 90-day notice requirement under s. 3 of O. Reg. 283/95 and remains responsible for paying the benefits.