David Raposo

The applicant insurer sought an order compelling seven respondents to attend examinations under oath regarding their statutory accident benefits claims, specifically attendant care benefits, due to concerns about validity.

The respondents refused, citing insufficient notice of the reasons for examination and their medical conditions.

The court dismissed the motion, holding that the insurer's generic notice ("determining whether State Farm is liable to pay benefits") was inadequate under s. 33(4)3 of the Statutory Accident Benefits Schedule.

The court emphasized that specific reasons for the examination are a condition precedent to the obligation to attend, allowing insureds to prepare adequately.

The applicant insurer appealed an arbitrator’s decision concerning loss transfer reimbursement under s. 275 of the Insurance Act after paying statutory accident benefits to its insured following a motorcycle accident caused by the respondent insurer’s insured.

The arbitrator concluded that the applicant insurer had grossly mishandled the accident benefits file and unreasonably paid substantial benefits, including delayed insurer examinations and excessive settlement amounts.

As a result, the arbitrator reduced the amount recoverable from the respondent insurer.

The court held that the arbitrator’s findings involved mixed fact and law and were entitled to deference unless unreasonable.

Finding ample evidence supporting the arbitrator’s conclusions, the court declined to interfere and upheld the reduced indemnity award.