3 total
Catastrophic impairment claim dismissed; insurer's claim for repayment of income replacement benefits also dismissed.
The applicant sought a determination of catastrophic impairment and entitlement to various statutory accident benefits following a 2013 motor vehicle accident.
The respondent denied the benefits and sought repayment of income replacement benefits, alleging willful misrepresentation.
The Tribunal found that the applicant did not sustain a catastrophic impairment, as he failed to establish a 55% Whole Person Impairment or a Class 4 marked psychological impairment, preferring the respondent's medical experts over the applicant's.
Consequently, the claims for medical, attendant care, and housekeeping benefits were dismissed.
The Tribunal also dismissed the respondent's claim for repayment, finding insufficient evidence of fraud or willful misrepresentation by the applicant regarding his employment status.
Application for non-earner and medical benefits dismissed as applicant resumed pre-accident activities and reached treatment plateau.
The applicant sought a non-earner benefit and a medical benefit for chiropractic services following a motor vehicle accident.
The adjudicator found that the applicant did not meet the test for a non-earner benefit, as video surveillance and medical assessments demonstrated she had resumed most of her pre-accident activities, including caring for her children, driving, and household chores.
The adjudicator also denied the medical benefit for chiropractic services, finding it was not reasonable and necessary because the applicant had reached a plateau in her recovery and was successfully participating in an independent exercise program.
Claims for an award under Ontario Regulation 664 and interest were consequently dismissed.
Unapproved minor settlement invalid; entire global settlement set aside.
The plaintiffs brought a motion to sever a minor’s claim from a global $700,000 motor vehicle accident settlement and to set aside the settlement on the basis that the minor later developed catastrophic psychological impairments after witnessing the accident.
The settlement had been concluded in 2010 but court approval for the minor’s claim was never obtained as required by Rule 7.08 of the Rules of Civil Procedure.
The court held that settlements involving minors are not binding without judicial approval and that the evidentiary record did not support severing the minor’s portion from the global settlement.
Given the lack of court approval, absence of apportionment of the settlement funds, and the disbursement of most of the funds by former counsel, the court set aside the entire settlement.
The defendant’s request to order the return of the funds was declined because former counsel was not a party to the proceeding.