Eric K. Grossman

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 appellant was injured in an all-terrain vehicle accident and sought statutory accident benefits.

The Licence Appeal Tribunal adjudicator found the vehicle was not an automobile and denied benefits.

The Executive Chair reconsidered the decision, cancelled it, and ordered a rehearing.

Both parties appealed the reconsideration decision to the Divisional Court.

The court dismissed both appeals, finding the Executive Chair's decision to order a rehearing was reasonable given the complexity of the case and the need to resolve factual disputes regarding the vehicle's status.

The court also held that an appeal does not stay a request for reconsideration under the Statutory Powers Procedure Act.

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.

The applicant and respondent insurers were engaged in a priority dispute regarding statutory accident benefits.

Following the death of the original arbitrator, the parties could not agree on a substitute.

The applicant brought an application under the Arbitration Act, 1991 to appoint a new arbitrator.

The court appointed the applicant's proposed choice, the Honourable Douglas Cunningham, finding that the dispute involved novel legal arguments and issues of deflection, making an arbitrator with extensive judicial experience preferable to one with specialized insurance adjusting experience.

The applicant insurer sought judicial review of a FSCO Director's Delegate decision that allowed an insured's appeal in part regarding statutory accident benefits.

The insurer had denied claims for an in-home assessment and form preparation, alleging the clinics were engaged in a fraudulent scheme.

The Divisional Court held that the Director's Delegate exceeded his jurisdiction by interfering with the Arbitrator's findings of fact regarding the in-home assessment, as appeals are limited to questions of law.

However, the court upheld the decision requiring the insurer to pay for form preparation because the insurer failed to object to the application within the statutory timeframe.

The applicant, an Ontario resident, was injured in an ATV accident in British Columbia.

He applied for statutory accident benefits in Ontario.

The insurer denied the claim on the basis that the ATV was not an 'automobile' under the Statutory Accident Benefits Schedule because it was not required to be insured in British Columbia.

The applicant sought judicial review of the FSCO Director's Delegate's decision upholding the denial.

The Divisional Court dismissed the application, finding it was reasonable to apply British Columbia legislation to determine whether the ATV required insurance, and thus the ATV did not meet the definition of an automobile.

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 appellant appealed a summary judgment dismissing her action against her insurer for terminating her Income Replacement Benefits.

The motion judge found the action was barred by the two-year limitation period under the Insurance Act.

The Court of Appeal dismissed the appeal, holding that the termination notice was clear and unequivocal, and affirming that the limitation period is triggered by a single event—the refusal to pay the benefits claimed—rather than operating as a rolling limitation period.

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 insurer brought a summary judgment motion seeking repayment of over $100,000 in income replacement benefits (IRBs) paid to the defendant insured.

The overpayments occurred because the insured received retroactive long-term disability and Canada Pension Plan benefits that should have been deducted from the IRBs.

The court found that the insurer failed to provide proper statutory notice for most of the overpayments, limiting its recovery to a 12-month period.

The court also held that while it had jurisdiction to order repayment of the overpayments, it lacked jurisdiction to vary the existing Financial Services Commission of Ontario (FSCO) consent order governing the ongoing IRB payments.

The insurer was awarded $11,150 without costs.

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.

Two appeals were heard together regarding whether the equitable doctrine of laches can defeat a first party insurer's loss-transfer claim under s. 275 of the Insurance Act.

In both cases, the first party insurers delayed several years before requesting indemnification from the second party insurers.

The Court of Appeal held that the defence of laches cannot be invoked against a statutory loss-transfer claim, as it is a claim for legal relief subject to the Limitations Act, 2002, which no longer contains a laches-saving provision.

Furthermore, even if laches were available, the second party insurers failed to demonstrate acquiescence or actual prejudice.

Lombard's appeal was dismissed and TD's appeal was allowed.

The appellant insurer appealed an arbitral award determining it was the priority insurer required to pay statutory accident benefits to a claimant.

The arbitrator found the claimant was principally dependent on her mother and stepfather, triggering coverage under the mother's policy.

The appellant argued the arbitrator erred in calculating the claimant's means and needs, specifically regarding earning capacity, the value of housekeeping services, and the use of government statistics versus individualized assessments.

The Superior Court of Justice dismissed the appeal, finding the arbitrator made no reviewable errors and correctly applied the dependency test.

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 respondent was injured in a motor vehicle accident and applied for statutory accident benefits.

After the insurer denied certain benefits, the respondent applied for mediation but commenced a civil action just days later, before the 60-day statutory mediation period expired.

The insurer brought a motion to stay or dismiss the action under s. 281(2) of the Insurance Act, which the motion judge dismissed.

On appeal, the Court of Appeal allowed the appeal and quashed the action, holding that the statute clearly bars the commencement of a proceeding until mediation has failed or the 60-day period has expired.