5 total
Application for accident benefits dismissed as injuries fell within the Minor Injury Guideline.
The applicant was involved in a rear-end motor vehicle accident and sought statutory accident benefits, which the respondent insurer denied on the basis that the injuries fell within the Minor Injury Guideline (MIG).
The applicant argued that a full-thickness tear in his right shoulder, chronic pain, and psychological impairments warranted treatment outside the MIG.
The Tribunal found that the shoulder tear pre-dated the accident and that the applicant did not meet the criteria for chronic pain or a psychological impairment.
Consequently, the applicant's injuries were deemed minor, and the disputed treatment and assessment plans were not reasonable and necessary as they exceeded the $3,500 MIG funding limit.
The application was dismissed.
Applicant found catastrophically impaired due to marked mental and behavioural disorders following a motor vehicle accident.
The applicant was involved in a motor vehicle accident and sought statutory accident benefits, claiming she sustained a catastrophic impairment due to a mental or behavioural disorder.
The Tribunal applied the Pastore test and found that the applicant suffered from class 4 (marked) impairments in activities of daily living, social functioning, and adaptation, meeting the threshold for catastrophic impairment.
The Tribunal also awarded $4,077.72 in attendant care benefits with interest, but dismissed the claim for a special award under s. 10 of Regulation 664, finding the insurer did not unreasonably withhold payments.
Application for accident benefits dismissed; injuries fell within MIG and non-earner test not met.
The applicant sought medical and rehabilitation benefits, as well as a non-earner benefit, following a motor vehicle accident.
The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and that she did not meet the test for a non-earner benefit.
The Tribunal found that the applicant failed to prove her chronic pain was not a sequelae of her soft tissue injuries, and failed to provide compelling evidence of a pre-existing condition that would prevent maximal recovery within the MIG.
The Tribunal also found the applicant did not suffer a complete inability to carry on a normal life, as she continued to engage in many of her pre-accident activities.
Appeal dismissed; claim for non-earner benefits time-barred as limitation period began upon initial refusal.
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.
Accident benefits claim dismissed as statute‑barred under Insurance Act limitation period.
The plaintiff sued her accident benefits insurer for breach of contract and bad faith after the insurer refused to pay non-earner benefits following a motor vehicle accident.
The insurer moved for summary judgment on the basis that the claim was statute‑barred under the two‑year limitation period in the Insurance Act and the Statutory Accident Benefits Schedule.
The court held that the limitation period began when the insurer clearly refused the non‑earner benefit in 2004, or alternatively when income replacement benefits were discontinued in 2006.
A subsequent application for non‑earner benefits years later could not restart the limitation period.
The court also found no evidentiary basis for claims of bad faith or mental distress in the administration of the claim.
