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.