Eric K. Grossman

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits (IRBs) and two treatment plans.

The respondent insurer denied the benefits, arguing the applicant did not meet the test for IRBs and failed to attend scheduled independent medical examinations (IEs).

The Tribunal found the applicant's credibility lacking due to her failure to produce documents explaining her non-attendance at the IEs and drew an adverse inference.

However, relying on the applicant's psychological expert, the Tribunal concluded she suffered severe psychological impairments rendering her substantially unable to perform the essential tasks of her pre-accident employment as a personal support worker.

The Tribunal awarded ongoing IRBs, excluding the period of non-attendance at the IEs, but denied the disputed treatment plans as duplicative or unproven.

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, an Ontario resident, was injured when he fell off an ATV in British Columbia.

The ATV was owned by a BC resident and was not insured or required to be insured in BC.

The appellant claimed statutory accident benefits under his Ontario automobile policy, arguing the ATV should be considered an automobile under Ontario law.

The Director's Delegate dismissed the appeal, applying the territoriality principle to find that Ontario law regarding mandatory insurance does not apply to a vehicle owned and operated in British Columbia.

Therefore, the ATV did not meet the extended definition of an automobile, and the appellant was not involved in an 'accident' under the Statutory Accident Benefits Schedule.

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 applicant was injured in an ATV accident in British Columbia and sought statutory accident benefits under his Ontario automobile insurance policy.

The insurer denied the claim on the basis that an ATV is not an 'automobile' under the SABS.

The arbitrator applied the lex loci delicti principle, finding that British Columbia law governed the incident.

Under British Columbia law, the ATV was not required to be insured under a motor vehicle liability policy.

Consequently, the ATV did not meet the definition of an automobile under the ordinary parlance test, and the incident was not an 'accident' under the SABS.

The application was dismissed.

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.

The insured was injured in a motor vehicle accident and submitted an Application for Accident Benefits (OCF-1) indicating she was retired.

The insurer denied income replacement benefits (IRBs) and non-earner benefits based on the application.

Over two years later, the insured sought mediation for IRBs, arguing the initial denial was invalid because she had not explicitly claimed IRBs.

The Director's Delegate allowed the insurer's appeal, holding that an OCF-1 constitutes a claim for all weekly benefits.

The insurer's denial was valid and triggered the two-year limitation period, rendering the insured's claim statute-barred.

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 insurer appealed an arbitrator's decision allowing the insured to proceed to arbitration regarding the stoppage of income replacement benefits despite the expiry of the two-year limitation period.

The Director's Delegate upheld the arbitrator's finding that the Notice of Stoppage (OCF-17) was invalid because it misleadingly indicated that requesting a Designated Assessment Centre (DAC) assessment was a mandatory prerequisite to disputing the stoppage.

Because the notice failed to properly inform the insured of the dispute resolution process, it did not constitute a clear and unequivocal refusal, and the limitation period was never triggered.

The appellant insurers sought to stay 15 individual arbitrations pending the resolution of a Superior Court action and FSCO charges alleging systemic fraud by the clinics providing the respondents' assessments and treatments.

The Arbitrator dismissed the stay motions, applying the RJR-MacDonald test for interlocutory injunctions.

On appeal, the insurers argued the Arbitrator should have applied the less stringent Armstrong criteria and erred in finding no irreparable harm.

The Director's Delegate dismissed the appeal, holding that the Armstrong criteria apply only to appellate stays under s. 283(6) of the Insurance Act, not to first-instance stays.

The Delegate found no error in the Arbitrator's application of RJR-MacDonald, noting the public interest in a timely and efficient dispute resolution system outweighed the insurers' desire to avoid duplicating evidence across multiple arbitrations.

The plaintiffs were injured in motor vehicle accidents and sought statutory accident benefits from their insurers.

After disputes arose, the plaintiffs applied to the Financial Services Commission of Ontario (FSCO) for mediation.

When 60 days passed without a mediator being appointed, the plaintiffs commenced civil actions.

The insurers moved to strike or stay the actions, arguing that under s. 281(2) of the Insurance Act, mediation must actually be attempted and fail before an action can be brought.

The Court of Appeal dismissed the insurers' appeals, holding that the 60-day time limit in the legislation is mandatory, and mediation is deemed to have failed if not concluded within that period, freeing the insured to commence a court action.

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.