Eric K. Grossman

The appellant sought income replacement benefits (IRBs) under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The central issue was the correct interpretation of the test for post-104-week IRBs under section 6(2)(b) of the Schedule.

The appellant argued that the test requires consideration of employment in a competitive, real-world setting comparable in nature, status, and remuneration to the insured's former employment.

The respondent insurer argued that the statutory test does not include such requirements.

The Court of Appeal upheld the lower courts' decisions, holding that while factors such as competitive real-world setting, status, and remuneration are relevant considerations in the evidence-based analysis, they are not stand-alone requirements of the test.

The appellant failed to prove a complete inability to engage in any employment for which she was reasonably suited by education, training, or experience, particularly given evidence that wedding planning remained a viable option.

The appellant, Chubb Insurance Company of Canada, appealed an arbitration decision that held it solely liable for Statutory Accident Benefits (SABS) payments to an injured person, despite Zurich Insurance Company being the actual primary insurer.

The Supreme Court of Canada had previously ruled that Chubb, as the first insurer to receive a misdirected SABS application, was deemed an insurer for the claim.

The Superior Court found that the arbitrator erred by not fully analyzing the interplay between the Insurance Act and O. Reg. 283/95.

The court concluded that both Chubb and Zurich were insurers of equal priority due to the unique circumstances and must share liability 50/50, with each responsible for 2% compound interest for delays attributable to them.

Allstate paid Michigan-level personal injury protection (PIP) benefits to an insured following a motor vehicle accident in Michigan.

TD Home accepted priority as the proper insurer but only reimbursed Allstate for Ontario-level benefits, arguing it was not obligated to pay Michigan-level benefits because it had not signed Michigan's Certification List.

An arbitrator ordered TD Home to reimburse the full amount.

TD Home appealed.

The Superior Court of Justice dismissed the appeal, finding the arbitrator's decision was reasonable and within his authority under the Arbitration Act to decide the dispute in accordance with law and equity.

Two Ontario residents injured in separate accidents outside Ontario involving an all-terrain vehicle (ATV) and a dirt bike sought statutory accident benefits (SABs) under their Ontario automobile insurance policies.

Both insurers denied coverage, arguing that the definition of "automobile" under Ontario law should be determined by the law of the jurisdiction where the accidents occurred (lex loci delicti).

The Court of Appeal held that Ontario law applies to the interpretation of Ontario contracts and statutes, and that the definition of "automobile" in the Insurance Act and Off-Road Vehicles Act applies uniformly regardless of where the accident occurs.

Both vehicles qualified as automobiles under the extended definition because they would have required insurance if operated in Ontario under the Off-Road Vehicles Act.

The court allowed the appeal of the insured and dismissed the appeal of the insurer.

The defendant, Irina Campos, brought a motion under Rule 21.01(1)(a) of the Rules of Civil Procedure to dismiss the plaintiff's action as statute-barred, arguing the limitation period had expired.

The plaintiff, Miano, was injured in a hit-and-run in May 2015 and only identified Campos as the probable owner of the truck in February 2018 after obtaining police records.

The court dismissed the defendant's motion, holding that a limitation period defence based on discoverability is a question of mixed fact and law, not suitable for determination under Rule 21.01(1)(a) unless facts are undisputed.

The court further clarified that a claim for damages from an automobile accident is not discovered until the plaintiff knows or ought to know the identity of the owner or operator of the automobile, rendering it unnecessary to commence an action against "Jane Doe" to preserve a limitation period.

An insurance priority dispute concerning whether an automobile insurance policy issued by Elite remained in force at the time of an accident.

Elite sent a purported notice of non-renewal in August 2010 for a policy ending September 20, 2010, based on the claimant's failure to register for a data-transmitting device within 12 months.

The arbitrator found the notice premature and that the policy had been terminated by mutual agreement of the parties despite the statutory continuation provision in section 236(5) of the Insurance Act.

The Superior Court appeal judge reversed, finding section 236(5) required the policy to remain in force.

The Court of Appeal allowed the appeal, finding the arbitrator's decision reasonable on both issues: the notice was premature and the policy was effectively terminated by the parties' conduct.

The Motor Vehicle Accident Claims Fund appealed a trial judgment in which it successfully sued an automobile insurer for restitution based on unjust enrichment.

The insurer had purported to terminate an automobile insurance policy for non-payment of premiums by sending notice only to the named insured (the vehicle owner's wife) rather than to the actual owner.

The policy remained in force when a catastrophic accident occurred.

The injured passenger obtained a judgment against the vehicle owner and assigned it to the fund, which paid the judgment and then sued the insurer for restitution.

The Court of Appeal upheld the trial judgment, finding that the notice of termination was ineffective because it was not sent to the actual owner as required by statutory condition 11(1) of Ontario Regulation 777/93, that the fund was not bound by the Insurance Act's limitation period because the Crown enjoyed immunity from the Act's provisions, and that the fund was entitled to bring a claim in unjust enrichment rather than being restricted to the statutory remedy under section 258 of the Insurance Act.

This appeal concerns a dispute between two insurers regarding the payment of statutory accident benefits (SABS) to an injured claimant.

The central issue is whether an insurer's failure to notify the claimant of a priority dispute between insurers within 90 days of receiving the SABS application precluded the insurer from pursuing the dispute.

The arbitrator determined that while notice to the claimant was mandatory, no specific time limit was prescribed by regulation.

The Superior Court reversed this decision, applying a correctness standard of review.

The Court of Appeal allowed the appeal, holding that the reasonableness standard of review applies to arbitrator decisions on SABS priority disputes, even where questions of law are engaged.

The arbitrator's interpretation that late notice did not bar the priority dispute was reasonable.

The appellant insurer appealed a decision dismissing its application for a declaration that it was not required to provide a justification for requesting examinations under oath of statutory accident benefits claimants.

The application judge had found that section 33(4)3 of the Statutory Accident Benefits Schedule required insurers to provide a specific justification or reason for requesting such examinations.

The Court of Appeal allowed the appeal, holding that section 33(4)3 does not require an insurer to provide a justification for its request that an applicant attend an examination under oath.

A general statement of the purpose of the examination that gives the applicant notice of the general type of questions that will be asked is sufficient.

The applicant insurer sought an order compelling six statutory accident benefits (SABS) claimants to attend examinations under oath (EUOs) as a test case on whether a justification is required under s. 33(2) of the SABS.

The court held that s. 33(4)3 mandates the insurer to provide a specific reason or reasons for the EUO, beyond a general statement of purpose or scope.

The court found that the insurer failed to provide such meaningful reasons to any of the respondents, thus they were not obligated to attend the examinations.

The application was dismissed.

This appeal concerned the interpretation of Regulation 283/95 under the Insurance Act, specifically whether an insurer disputing liability for statutory accident benefits must provide notice of its dispute to the insured person within the same 90-day period it provides notice to the other insurer.

The arbitrator had found that late notice to the insured was permissible.

The court, applying a purposive approach to statutory interpretation, held that the 90-day period for notifying other insurers also applies to notifying the insured, as indicated by the word "also" in the Regulation and to ensure the insured's rights to participate in the dispute are not nullified.

The court also confirmed that relief from forfeiture is not available for statutory time limits under this regulatory scheme.

The appeal was allowed, and the respondent's dispute was barred due to late notice to the insured.

The defendant, The Personal Insurance Company of Canada, sought to have the same judge who granted its initial summary judgment motion hear a subsequent 'further motion' to dismiss the balance of the plaintiff's action.

The plaintiff opposed this request, arguing the relief was inappropriate for summary judgment and citing concerns about the judge's prior favourable ruling.

The court, referencing Hryniak v. Mauldin, declined to seize itself of the further motion, clarifying that the obligation to craft a trial process arises when summary judgment motions are dismissed, not granted.

However, the court offered to case manage the interim issues related to the second motion.

The plaintiff was injured in a motor vehicle accident and received Income Replacement Benefits (IRBs) from her insurer until they were terminated in 2003.

She commenced an action against the insurer for other benefits in 2005, but did not claim IRBs.

In 2007, she commenced a new action against the insurer for IRBs and against her former lawyer for negligence.

The insurer brought a motion for summary judgment to dismiss the IRB claim as statute-barred.

The court granted the motion, finding that the insurer's 2003 notice of termination was clear and unequivocal, triggering the two-year limitation period, which had long expired.

The plaintiff, catastrophically injured in a motor vehicle accident, sought statutory accident benefits in the form of retrospective attendant care benefits for a period between 2001 and 2006.

The motion asked the court to determine the date from which interest should accrue if those benefits were ultimately found to be payable.

The insurer argued interest could only begin after it received a Form 1 assessment of attendant care needs, relying on appellate authority interpreting the Statutory Accident Benefits Schedule.

The court held that under the applicable 2001 version of the Schedule, interest begins when the insurer had sufficient information to assess entitlement to the benefit, even absent a formal Form 1.

On the facts, the insurer had early knowledge of the claimant’s catastrophic impairments and attendant care needs.

This appeal concerns priority for statutory accident benefits under Ontario's no-fault automobile insurance regime after a claimant declined optional rental-counter coverage and was injured in a single-vehicle accident.

The core issue was whether the insurer had a sufficient nexus to the claimant to qualify as an insurer obliged to respond under s. 268 of the Insurance Act and the inter-insurer priority framework.

The Court accepted the appellate reasons below that the arbitrator erred in excluding the insurer from the statutory scheme.

The appeal was allowed and costs were awarded to the appellant.

An insurer appealed an arbitrator’s refusal to dismiss a statutory loss transfer application brought approximately 11 years after a motor vehicle accident.

The court held that the application was not barred by the two‑year limitation period under s. 5(1)(b) of the Limitations Act, 2002 because the limitation period runs from the day after a first‑party insurer requests indemnity from the second‑party insurer.

However, the court found that the equitable doctrine of laches can apply to delayed statutory loss transfer claims where the scheme possesses an equitable character.

The court further held that acquiescence constitutes a stand‑alone branch of laches and does not require proof of prejudice.

The first‑party insurer’s lengthy and unexplained delay, combined with knowledge of its claim, amounted to acquiescence and barred the loss transfer claim.

The defendant insurer brought a motion for the determination of a question of law prior to trial regarding whether the plaintiff was entitled to simple or compound interest on arrears of weekly income benefits under s. 24(4) of the Statutory Accident Benefits Schedule (OMPP legislation).

Applying the modern principle of statutory interpretation and reviewing legislative history, including the Kruger Report, the court found that the legislature intended to impose a penalty on insurers for late payments.

The court concluded that interest payable under s. 24(4) is compound interest.