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Claims for income replacement and attendant care benefits dismissed due to lack of credible evidence.
The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs) and attendant care benefits from his insurer.
The insurer paid IRBs at a rate of $11.00 per week based on a forensic accounting report, which the applicant disputed, claiming $246.40 per week.
The arbitrator found the applicant's testimony regarding his business income and return to work dates lacked credibility and accepted the insurer's expert accounting evidence.
The claim for attendant care benefits was also dismissed, as the applicant's injuries fell within the Minor Injury Guideline and his testimony regarding his need for care was inconsistent and not credible.
Claims for interest and a special award were consequently dismissed, and the insurer was awarded its expenses.
Appeal dismissed; arbitrator's finding of broker negligence in cancelling insurance policy supported by record.
The appellant appealed an arbitrator's decision regarding the effective date of an automobile insurance policy cancellation.
The parties agreed that if the broker was negligent in cancelling the policy effective July 26, the appellant was bound.
The arbitrator preferred the insured's evidence that she wanted full coverage until she left, and found the broker negligent in telling the insurer to cancel coverage effective July 26.
The Court of Appeal dismissed the appeal, holding that the arbitrator's finding was supported by the record.
Economic loss requirement is only a threshold for attendant care expenses under SABS.
The applicant, catastrophically injured in a motor vehicle accident, sought determination of the amount of attendant care benefits payable under the Statutory Accident Benefits Schedule, O. Reg. 34/10.
The insurer limited payments based on the number of hours of economic loss sustained by the family member providing care, rather than the full amount assessed in the Form 1.
The court interpreted the definition of “incurred” expense under s. 3(7)(e) of the SABS and held that proof of economic loss is only a threshold requirement to establish that the expense was incurred.
Once that threshold is met and the insured is obligated to pay the caregiver, the insurer must pay the reasonable and necessary attendant care expenses up to the statutory maximum.
The insurer’s proportional calculation based on lost hours was rejected.
Declaratory action for accident benefits struck as premature without mediation or dispute.
The defendant insurer brought a motion to strike the plaintiff’s statement of claim seeking a declaration that she met the disability test for income replacement benefits under the Statutory Accident Benefits Schedule.
The insurer had already accepted the plaintiff’s disability and was paying benefits, and no mediation had been sought under the Insurance Act dispute resolution scheme.
The court held that declaratory relief could not be used to bypass the mandatory mediation provisions governing disputes over statutory accident benefits.
As there was no existing dispute and the claim sought pre‑emptive relief, the action was premature and disclosed no reasonable cause of action.
The statement of claim was struck.
