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Once removed from the Minor Injury Guideline for psychological reasons, the $3,500 cap no longer applies to physical treatments.
The applicant was injured in a motor vehicle accident and sought statutory accident benefits for physiotherapy.
The respondent insurer initially limited her physical treatment to the Minor Injury Guideline (MIG) cap of $3,500.
The applicant was later removed from the MIG due to a psychological impairment.
The adjudicator held that once an insured is removed from the MIG for any reason, the $3,500 limit no longer applies to physical injuries, and the sole test is whether the proposed treatment is reasonable and necessary.
Relying on the recommendation of the respondent's own medical assessor, the adjudicator found the disputed physiotherapy treatment plans were reasonable and necessary.
The adjudicator declined to order an award for unreasonable delay, finding the insurer's incorrect interpretation of the MIG limits did not amount to bad faith.
Arbitration application for statutory accident benefits dismissed due to the applicant's failure to attend the hearing.
The applicant applied for arbitration at the Financial Services Commission of Ontario after the insurer terminated his statutory accident benefits.
The applicant's counsel was permitted to withdraw due to a complete breakdown in communications.
The applicant failed to attend the scheduled hearing despite receiving notice.
As the applicant bore the burden of proof and presented no evidence, the application was dismissed.
Costs of $5,000 awarded to successful appellant who beat its pre-appeal offer to settle.
The appellant, having successfully reduced the trial damages award on appeal to an amount lower than its pre-appeal offer to settle, sought costs of $11,347.53.
The respondents argued for no costs due to divided success.
Applying the principles from Boucher, the court rejected a purely mechanical calculation of hours and fixed costs at $5,000 plus disbursements and GST, finding this amount to be fair, reasonable, and within the reasonable expectations of the parties.
Small Claims damages award for goods damaged in transit reduced to account for depreciation and unjust enrichment.
The appellant appealed a Small Claims Court judgment awarding the respondents damages for goods damaged during a move using a rented truck.
The Divisional Court upheld the finding of liability and the sufficiency of evidence for the damages.
However, the court found the trial judge erred by failing to account for depreciation of the damaged items and by awarding the cost of the truck rental and mileage, which amounted to unjust enrichment.
The damages award was reduced accordingly.
Power of Attorney and Undertaking does not extend Ontario accident benefits to out-of-province accidents.
The appellant, a resident of Colorado, was injured in a motor vehicle accident in New York State while a passenger in a vehicle insured by the respondent under an Ontario policy.
The appellant claimed entitlement to Ontario-level statutory accident benefits, arguing that the Power of Attorney and Undertaking (PAU) filed by the respondent required it to pay such benefits.
The Director of Arbitrations dismissed the appeal, confirming the arbitrator's decision that the PAU only applies to actions or proceedings arising out of a motor vehicle accident in Ontario.
As the accident occurred in New York, the PAU did not extend Ontario coverage to the appellant.
