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Insurer cannot initiate court action to dispute catastrophic impairment; Insurance Act forms complete dispute resolution code.
The insured was injured in a motor vehicle accident and was determined by a Designated Assessment Centre to have suffered a catastrophic impairment.
The insurer disputed this finding, initiated mediation, and after mediation failed, commenced a court action for a declaration that the insured was not catastrophically impaired.
The motion judge struck the insurer's claim, finding that the Insurance Act provides a complete code for dispute resolution that does not permit an insurer to initiate a court proceeding.
The Court of Appeal dismissed the insurer's appeal, confirming that the statutory scheme requires the insured to initiate court or arbitration proceedings to enforce a disputed catastrophic impairment finding, while protecting the insurer by allowing it to pay only its last settlement offer pending resolution.
Appeal allowed and matter remitted; arbitrator erred by presuming common-law cohabitation continues after separation for parents.
The insurer appealed an arbitration decision awarding spousal death benefits to the natural father of the deceased's child.
The couple had separated and were living apart at the time of the fatal motor vehicle accident.
The Director's Delegate found that the arbitrator erred in law by applying a rebuttable presumption that common-law cohabitation continues despite separation when the couple has a child, until concrete steps are taken to terminate the relationship.
The appeal was allowed, the arbitration order revoked, and the matter remitted for a new hearing.
Insurer's appeal dismissed; early GCS scores validly established catastrophic impairment without being confounded by other injuries.
The insurer appealed an arbitrator's decision finding that the claimant suffered a catastrophic impairment under the Statutory Accident Benefits Schedule following a motor vehicle accident.
The arbitrator relied on Glasgow Coma Scale (GCS) scores of 9 or less taken within the first hour of the accident.
The insurer argued the scores were confounded by intubation, seizures, and facial injuries, and were not taken within a 'reasonable period of time'.
The Director's Delegate dismissed the appeal, finding no palpable and overriding error in the arbitrator's factual findings that the early scores validly reflected brain impairment and were taken within a reasonable time.
Subsequent contribution claim allowed but apportionment must respect findings from the initial tort action.
The respondents settled a personal injury claim arising from a bar fight and subsequently brought an action against the appellant for contribution and indemnity under the Negligence Act.
The trial judge found the appellant 80% liable and ordered him to pay $380,000.
On appeal, the Court of Appeal upheld the finding of liability but held that the trial judge erred in apportioning fault without regard to the findings in the first trial.
The Court reduced the appellant's contribution to $162,555.50 to ensure the respondents did not obtain a better result in the second action than they could have in the first.
