Daniel Strigberger

Belair Insurance Company appealed an arbitrator's decision that found it 100% at fault for indemnifying State Farm Mutual Automobile Insurance Company for statutory accident benefits under a loss transfer dispute.

The Superior Court of Justice reviewed the arbitrator's interpretation of the Fault Determination Rules, specifically rules 12(5) and 13(2), under a reasonableness standard.

The arbitrator had concluded that Rule 13(2) did not apply to incidents involving vehicles travelling in opposite directions in adjacent lanes at an uncontrolled intersection, as such scenarios were covered by Rule 12(5).

The court upheld the arbitrator's interpretation, finding it reasonable and consistent with the legislative scheme's purpose of providing an expedient method for fault determination among insurers.

The appeal was dismissed.

The appellant insurer appealed a decision dismissing its application for a preliminary determination of whether the respondent was involved in an 'accident' under the Statutory Accident Benefits Schedule.

The insurer argued this was a coverage issue that had to be determined by a court before the mandatory dispute resolution scheme under s. 279 of the Insurance Act applied.

The Court of Appeal dismissed the appeal, holding that the s. 279 scheme is a comprehensive alternative dispute resolution process that governs all disputes concerning entitlement to statutory accident benefits, including whether a claimant qualifies as an insured person involved in an accident.

The respondent was injured when he tripped over a motorcycle parked on a walkway between trailers at a campsite.

The appellant insurer denied statutory accident benefits, arguing the incident did not meet the definition of an 'accident' under the Statutory Accident Benefits Schedule.

The application judge found that the temporary parking of the motorcycle constituted an ordinary or well-known use of the vehicle, satisfying the purpose test.

The Court of Appeal upheld the decision, confirming that parking a vehicle is an ordinary and well-known activity to which vehicles are put, and dismissed the appeal.

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 insurer brought an application seeking a determination that the respondent was not involved in an "accident" within the meaning of s. 3(1) of the Statutory Accident Benefits Schedule and therefore not entitled to accident benefits.

The court held that disputes concerning entitlement to benefits, including whether an accident occurred, must proceed through the statutory dispute resolution process under the Insurance Act.

Allowing an insurer to unilaterally seek a court determination would undermine the legislative scheme and expose insured persons to premature cost consequences.

The court also found that the application procedure was inappropriate where material facts were disputed and no agreed statement of facts existed.

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.

An insurer brought an application seeking a declaration that the respondent’s injuries did not arise from an “accident” within the meaning of s. 3(1) of the Statutory Accident Benefits Schedule.

The respondent had tripped over a motorcycle that had been temporarily parked in a pedestrian walkway at a campsite and sustained serious spinal injuries.

Applying the two‑part purpose and causation test from Amos and subsequent Ontario Court of Appeal jurisprudence, the court held that the temporary parking of the motorcycle constituted the use or operation of an automobile.

The motorcycle’s placement in the walkway was found to be the dominant feature causing the injuries and created an unbroken chain of causation.

The court declared that the incident was an “accident” under the SABs.

A heavy commercial vehicle insured by the appellant initiated a chain reaction collision by rear-ending a stopped vehicle, which in turn rear-ended a vehicle insured by the respondent.

The respondent paid statutory accident benefits to its insured and sought loss transfer indemnification from the appellant.

The arbitrator held that under Rule 9(4) of the Fault Determination Rules, the appellant was 100 per cent at fault for the incident and liable to indemnify the respondent, despite the absence of a direct collision between their respective vehicles.

The Superior Court of Justice dismissed the appeal, finding that the plain meaning of Rule 9(4) imposes liability for the entire incident on the moving vehicle that initiates the chain reaction.

The appeal concerned a preliminary arbitration decision arising from a statutory accident benefits priority dispute under s. 268 of the Insurance Act and O. Reg. 283/95.

The appellant argued that the insurer initiating the dispute was required to conduct a reasonable investigation and give notice to all insurers potentially higher in priority before serving the Motor Vehicle Accident Claims Fund.

The court held that the wording of s. 3 of the Regulation did not impose a general duty to investigate before giving notice and required notice only to insurers the initiating insurer claims are liable.

The court agreed with the arbitrator’s interpretation that the Regulation does not obligate the first insurer to notify every potentially higher-priority insurer or conduct a full investigation prior to issuing a priority dispute notice.

The arbitrator’s decision was upheld.

The Motor Vehicle Accident Claims Fund appealed an arbitrator’s decision finding that an injured motorcyclist was not principally dependent on his parents for financial support under the Statutory Accident Benefits Schedule.

The arbitrator had concluded that during the 12 months preceding the accident the claimant’s employment income exceeded 51% of his financial needs, applying the dependency framework from Miller v. Safeco and subsequent arbitral jurisprudence.

The appellant argued the arbitrator misapplied the dependency factors and improperly confined the analysis to the year preceding the accident.

The court held that the determination of dependency involved mixed fact and law and was reviewable on a reasonableness standard.

Finding the arbitrator’s use of the 12‑month timeframe and the 51% dependency test reasonable and consistent with established jurisprudence, the court dismissed the appeal.

Two first party insurers paid statutory accident benefits to their insureds and made requests for loss transfer from second party insurers.

The second party insurers refused to pay, and the first party insurers initiated arbitration proceedings.

The second party insurers argued the claims were barred by the Limitations Act, 2002.

The Court of Appeal held that the two-year limitation period for loss transfer claims begins to run the day after the first party insurer makes a demand for loss transfer, not from the date the second party insurer definitively refuses to indemnify.

The appeals by the first party insurers were dismissed.

The Applicant sought expenses following a successful arbitration for statutory accident benefits.

The insurer conceded general entitlement but disputed the quantum of legal fees and certain disbursements.

The arbitrator applied the criteria under section 12(2) of Regulation 664 and determined that a 2:1 ratio of preparation time to hearing time was appropriate given the modest complexity of the issues.

The arbitrator allowed the law clerk's time at $45 per hour and counsel's time at $150 per hour.

The Applicant was awarded total arbitration expenses of $21,268.41, including legal fees, disbursements, and the costs of the expense hearing.

The applicant applied for a death benefit under section 25 of the Statutory Accident Benefits Schedule following the death of her father in a motorcycle accident.

The insurer denied the benefit, arguing she was not principally dependent on him for financial support.

The arbitrator found that the applicant was principally dependent on her father in the year prior to the accident, as he contributed substantially to her expenses and intended to pay off her student loan.

The applicant was therefore entitled to the death benefit.

The Applicant was injured in a motor vehicle accident and applied for statutory accident benefits, including caregiver, housekeeping, and medical benefits.

The Insurer denied the claims, arguing in part that the Applicant failed to attend an in-home assessment.

The Arbitrator found that the Insurer's notice of examination was procedurally defective and that the Applicant had a reasonable excuse for refusing the in-home assessment.

On the substantive issues, the Arbitrator concluded that the accident materially contributed to the Applicant's physical and psychological impairments, including fibromyalgia and psychosis.

The Arbitrator awarded caregiver and housekeeping benefits for specific periods, as well as the costs of a dental assessment and a physiotherapy treatment plan, but denied the cost of a neurological examination.

Interest was awarded on the overdue benefits.

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

An arbitrator found the appellant was the first insurer to receive the application and ordered it to pay benefits pending the resolution of a priority dispute, despite the appellant's claim that it was a victim of a fraudulent pink slip and had no real nexus to the respondent.

The appellant appealed and sought a stay of the arbitrator's order pending the appeal.

The Director's Delegate denied the stay request, finding that granting a stay would thwart the clear legislative intent of O. Reg. 283/95, which is to ensure that the payment of accident benefits to claimants is not delayed due to disputes between insurers over who is liable to pay.

The appellant insurer sought to appeal a preliminary arbitration order determining it was responsible for paying statutory accident benefits to the respondent.

The appellant also requested a stay of the order.

Two other entities, another insurer and an industry association, sought intervenor status.

The Director's Delegate accepted the appeal from the preliminary order but declined to grant a stay, emphasizing the need for seamless receipt of benefits pending dispute resolution.

Both requested intervenors were granted status on specific terms to make submissions on issues of law.

The applicant sought death benefits from the insurer following her father's death in a motor vehicle accident, claiming she was a dependant.

The insurer denied the claim.

In the course of arbitration, the applicant brought a motion for a third-party production order against her brother to obtain their late father's financial records.

The brother did not respond to the motion.

The arbitrator granted the motion, finding the documents relevant to the dependency issue and satisfying the requirements for third-party production under the Dispute Resolution Practice Code and the Insurance Act.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits from Unifund Assurance Company based on a fraudulent pink insurance slip provided by the owner of the vehicle he was driving.

Unifund refused to respond, arguing there was no nexus between it and the applicant.

The arbitrator held that the applicant's choice of insurer was not arbitrary or random, as he relied on the police report which listed Unifund based on the fraudulent slip.

Therefore, a sufficient nexus existed, and Unifund was the first insurer required to pay benefits pending any priority dispute.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits from the Motor Vehicle Accident Claims Fund, despite a police report indicating the vehicle he was in was insured by Wawanesa.

The Fund refused to pay, arguing the application was incomplete without the police report and there was an insufficient nexus.

The arbitrator found the application was complete but agreed there was an insufficient nexus because the applicant's choice to apply to the Fund was arbitrary, as he took no steps to determine if other insurance was available.

The Director's Delegate dismissed the appeals by the applicant and Wawanesa, confirming that an applicant must have some basis for believing coverage is unavailable elsewhere before applying to the Fund as the insurer of last resort.