Deanna Samantha Gilbert

The respondent was seriously injured in a motor vehicle accident in the United States Virgin Islands.

She applied to her insurer for statutory accident benefits and underinsurance coverage.

The insurer brought an application to deny coverage, arguing the accident occurred outside the territorial limits of the Insurance Act and the policy, which cover the 'United States of America'.

The court found the term ambiguous and applied the doctrine of contra proferentem, concluding that the term includes the United States Virgin Islands for the purposes of coverage.

The insurer's application was dismissed.

The applicant brought a motion for an order declaring that the in-person medical examinations proposed by the insurer to determine catastrophic impairment were not reasonably necessary.

The applicant argued that the insurer already had sufficient medical information from recent assessments for post 104-week income replacement benefits.

The arbitrator found that the tests for catastrophic impairment differ from those for post 104-week benefits, and the insurer reasonably required the new examinations.

The motion was dismissed, and the proceedings were stayed until the applicant attends the scheduled examinations.

The applicant was injured while riding a rented all-terrain vehicle (ATV) in British Columbia and applied for statutory accident benefits from her mother's Ontario automobile insurer.

The insurer denied the claim on the basis that the ATV was not an 'automobile' under the Statutory Accident Benefits Schedule.

The arbitrator held that the definition of 'automobile' under subsection 224(1) of the Ontario Insurance Act, which includes vehicles required to be insured under 'any Act', refers exclusively to Acts of the Ontario Legislature.

Because the ATV was not required to be insured under Ontario law, it was not an automobile, and the applicant was not involved in an 'accident' within the meaning of the Schedule.

The appellant insurer sought leave to appeal a preliminary order of an arbitrator that directed it to proceed with a determination of catastrophic impairment based on a paper review by a previously retained psychiatrist, rather than requiring the respondent to attend four new in-person examinations.

The respondent had refused to attend the new examinations based on her treating psychologist's opinion that they posed a significant risk of harm and increased suicide risk.

The Director's Delegate refused to admit fresh evidence, denied leave to appeal the preliminary order, and denied a stay of the arbitrator's order.

The Delegate found that the insurer's right to choose its assessors under section 42 of the Schedule is qualified by reasonableness, and that the appeal did not raise novel issues or demonstrate sufficient prejudice to warrant an exception to the general rule against appealing preliminary orders.

Costs of $5,539.68 were awarded to the respondent.

The applicant, who developed a major depressive disorder with psychotic features following a motor vehicle accident, applied for a catastrophic impairment designation.

The insurer scheduled further in-person psychiatric and medical assessments.

The applicant refused to attend, relying on her treating psychologist's opinion that further assessments posed a serious risk of triggering suicidal ideation.

The arbitrator held that the insurer's discretion to order section 42 examinations is not unfettered and must be exercised in a manner that does not harm the insured.

Given the uncontroverted evidence of suicide risk, the arbitrator ordered the insurer to make its catastrophic impairment determination based on a paper review and supplementary questions to previous assessors, rather than requiring further in-person examinations.