38 total
Non-earner benefit claim dismissed as statute-barred; 5.5-year delay prejudiced insurer, precluding limitation period extension.
The applicant sought a non-earner benefit following a 2014 motor vehicle accident.
The insurer denied the benefit in July 2014.
The applicant applied to the Licence Appeal Tribunal in December 2019, over five years later.
The insurer brought a preliminary motion arguing the claim was barred by the two-year limitation period under the Insurance Act and the Statutory Accident Benefits Schedule.
The applicant argued the denial was equivocal, the discoverability principle applied, and alternatively sought an extension under s. 7 of the Licence Appeal Tribunal Act.
The Tribunal found the July 2014 denial was clear and unequivocal, the discoverability principle did not apply as the applicant had all necessary facts, and declined to extend the limitation period due to the lengthy delay and resulting prejudice to the insurer.
The appeal was dismissed.
Applicant with catastrophic brain injury awarded attendant care and housekeeping benefits due to motivational limitations.
The applicant was involved in a severe motor vehicle accident resulting in catastrophic impairment, including a brain injury.
He sought attendant care benefits and housekeeping and home maintenance benefits, which the respondent insurer denied.
The Licence Appeal Tribunal found that while the applicant was physically capable of performing tasks, his brain injury caused significant emotional and motivational limitations.
The Tribunal concluded that the applicant was entitled to attendant care benefits for comfort, safety, and security, calculated at 240 minutes per week, as well as housekeeping and home maintenance benefits of $100 per week, plus interest on overdue amounts.
Trial adjourned and costs thrown away awarded to defendants due to plaintiff's eve-of-trial production of a laptop.
At the opening of a scheduled trial, the defendants requested an adjournment because the plaintiff produced a laptop computer containing over 14,000 files the day before trial.
The plaintiff's claim included $1.8 million for past and future income loss, making the newly disclosed work documents highly material.
The court granted the adjournment, finding that trial fairness required the defendants to have an opportunity to inspect the new productions and conduct further examination for discovery.
The defendants were awarded costs thrown away, with the amount to be determined by the trial judge.
Procedural directions issued for the conduct of an 11-day virtual trial using Zoom and CaseLines.
The court issued a Trial Management Endorsement providing procedural directions for an upcoming 11-day virtual trial to be conducted via Zoom and CaseLines due to the COVID-19 pandemic.
The endorsement outlined requirements for the electronic trial record, witness management, document uploading, exhibit marking, and the preparation of a Joint Document Book in accordance with appellate guidance.
Private disability benefits are deductible from IRBs as an income continuation benefit plan.
The applicant was injured in a motor vehicle accident and applied for income replacement benefits (IRBs).
The respondent deducted a $700 weekly disability benefit the applicant received from a private Industrial Alliance policy, arguing it was an 'income continuation benefit plan' under s. 3(7)(d) of the Schedule.
The Tribunal agreed, finding the private policy was tied to employment and calculated based on gross weekly earnings, making it deductible.
The Tribunal also found the respondent provided proper notice of overpayment and was entitled to repayment for a specific 12-month period.
The applicant's request for costs was denied.
Motion to exclude jurors who pay auto insurance premiums denied; no statutory basis for challenge for cause.
The plaintiff in a motor vehicle accident case brought a motion to exclude potential jurors who pay auto insurance premiums, arguing they have an inherent conflict of interest.
The plaintiff sought to introduce survey evidence suggesting residents would limit damages to lower their premiums.
The court excluded the survey evidence as inadmissible hearsay that failed the threshold test for expert evidence.
The court dismissed the motion, finding no statutory basis in the Juries Act to exclude such jurors or permit a broad challenge for cause, and no evidence of widespread bias to justify striking the jury notice.
Insurer's request for reconsideration of non-earner benefits entitlement dismissed; Tribunal made no errors.
The insurer requested a reconsideration of a Licence Appeal Tribunal decision that found the applicant entitled to Non-Earner Benefits (NEBs) following a motor vehicle accident.
The insurer argued that the Tribunal failed to consider evidence of the applicant's ability to participate in pre-accident activities, improperly focused on only two areas of her life, and ignored her pre-existing psychological trauma.
The Executive Chair dismissed the request, finding that the Tribunal properly applied the legal test, weighed the evidence, and provided sufficient reasons for its conclusion that the applicant suffered a complete inability to carry on a normal life.
Application for accident benefits dismissed and expenses awarded after applicant failed to attend arbitration hearing.
The applicant sought statutory accident benefits following a motor vehicle accident.
After her representatives were removed from the record due to a breakdown in the solicitor-client relationship, the applicant failed to attend the scheduled arbitration hearing despite receiving proper notice.
The arbitrator proceeded in her absence pursuant to Rule 37.9 of the Dispute Resolution Practice Code.
As the applicant bore the onus of proving entitlement and presented no evidence, the application was dismissed.
The insurer was awarded $1,000 in expenses for the preparation and attendance required.
Application for arbitration dismissed with $1,500 in expenses due to applicant's failure to participate.
The applicant was injured in a motor vehicle accident and sought accident benefits from the insurer.
After his counsel was removed from the record due to a lack of instructions, the applicant failed to participate in the arbitration process or respond to communications from ADR Chambers.
The arbitrator dismissed the application for arbitration due to the applicant's failure to participate and ordered the applicant to pay the insurer's expenses fixed at $1,500.
Arbitration application dismissed with costs after applicant failed to attend the hearing.
Prior to the scheduled arbitration hearing, the applicant's counsel requested to be removed from the record due to a breakdown in the solicitor-client relationship.
The arbitrator granted the request.
The applicant failed to attend the hearing despite having notice.
Consequently, the arbitrator dismissed the application for arbitration, finding the applicant failed to meet her onus of proof, and awarded the insurer $1,000 in expenses.
Jury award for pecuniary losses properly reduced to nil to prevent double recovery from statutory benefits.
The appellant was injured in a motor vehicle accident and awarded damages by a jury.
The jury questions lumped together damages for medical/rehabilitation, attendant care, and housekeeping.
The trial judge reduced these awards to nil under s. 267.8 of the Insurance Act because the appellant had already received statutory accident benefits exceeding the jury's award.
The appellant appealed, arguing the reduction was improper without a benefit-by-benefit breakdown.
The Court of Appeal dismissed the appeal, holding that the trial judge reasonably reduced the award to prevent double recovery, despite the poorly structured jury questions.
Interlocutory appeal of preliminary settlement decision rejected; stay of arbitration hearing refused.
The appellant sought to appeal an arbitrator's preliminary decision finding that the parties had not reached a settlement, and requested a stay of the upcoming arbitration hearing.
The Director's Delegate declined to exercise discretion to hear the interlocutory appeal, finding that it did not finally decide all issues in dispute and that hearing it would not facilitate the most cost-effective resolution.
The Delegate also refused to stay the arbitration hearing, noting the absence of special circumstances to take control of the process away from the hearing arbitrator.
The appeal was rejected without prejudice to renewing it after all issues are finally determined.
Applicant awarded $10,000 in arbitration expenses due to mixed success and a reasonable settlement offer.
The applicant sought her expenses of the arbitration hearing following a mixed result where she was successful on her claims for income replacement and attendant care benefits, but unsuccessful on the issue of catastrophic impairment.
The insurer also sought its expenses.
The arbitrator considered the criteria under section 12(2) of Ontario Regulation 664, noting that while success was mixed, the applicant had made a reasonable offer to settle the income replacement and attendant care claims which the insurer rejected.
The applicant achieved greater success on those issues at the hearing than her offer.
The arbitrator awarded the applicant a portion of her expenses, fixed at $10,000.00, and dismissed the insurer's claim for expenses.
Accident materially contributed to delayed disc herniations and conversion disorder, but applicant not catastrophically impaired.
The applicant was injured in a motor vehicle accident in August 2005.
Nine months later, she suffered severe disc herniations resulting in a cauda equina-like syndrome and a conversion disorder.
The insurer denied ongoing income replacement and attendant care benefits, arguing the disc herniations were not causally related to the accident.
The arbitrator found that the accident materially contributed to the disc herniations and the subsequent conversion disorder.
However, the arbitrator concluded the applicant was not catastrophically impaired, as her combined physical (21%) and mental/behavioural (28%) whole person impairment rating was 43%, falling short of the 55% threshold.
The applicant was awarded an ongoing income replacement benefit and attendant care benefits capped at $3,000 per month for the 104-week period following the accident.
Default set aside where defendants reasonably relied on insurer to defend claim.
The defendants moved to set aside a noting in default in a tort action arising from a motor vehicle accident after the insurer settled the injured plaintiffs’ claims, obtained an assignment of their cause of action, and sought judgment against the insured defendants for the settlement amount.
The court held that the insurer could not rely on s. 258(13) of the Insurance Act because no judgment had been obtained by the original plaintiffs against the insured defendants.
The non‑waiver agreement also did not permit recovery in the existing action, as the proceeding did not determine coverage obligations between insurer and insured.
Applying the discretionary test under Rule 19.03(1), the court found the defendants had demonstrated a continuing intention to defend and reasonably relied on their insurer to do so.
The noting in default was set aside, also independently invalid because the statement of claim had been served outside the six‑month limit in Rule 14.08 without an extension.
CPP child's benefit is not deductible from statutory income replacement benefits.
The Applicant sought an adjournment of an arbitration hearing regarding statutory accident benefits, which the Insurer initially opposed but later conceded.
The Arbitrator granted the adjournment to allow the catastrophic impairment issue to be heard together with other issues.
On a preliminary issue regarding the quantum of income replacement benefits, the Arbitrator ruled that the Canada Pension Plan (CPP) child's benefit is not a 'disability pension benefit' under subsection 2(9) of the Schedule and therefore cannot be deducted from the Applicant's income replacement benefits.
The Arbitrator awarded the Applicant $11,960 in expenses due to the Insurer's failure to consent to the adjournment earlier.
Arbitrator awards $21,490.38 in expenses but denies disbursements for witness travel time.
Following the settlement of a dispute over non-earner benefits, the parties disagreed on the quantum of expenses payable to the applicant.
The arbitrator awarded $21,490.38 in fees and disbursements, applying the maximum hourly rates permitted under the Expense Regulation.
The arbitrator denied the applicant's claim for disbursements related to witness travel time, finding no provision in the Expense Regulation or jurisprudence to support such compensation.
Appeal dismissed; appellant had no recourse against the Motor Vehicle Accident Claims Fund.
The appellant appealed an order dismissing her claim against the Motor Vehicle Accident Claims Fund.
The Court of Appeal dismissed the appeal, finding that because the appellant was not involved in the accident and did not have first party insurance, she was not entitled to statutory benefits and had no recourse against the Fund under s. 6 of the Motor Vehicle Accident Claims Act.