5 total
Insurer's summary judgment motion dismissed; genuine issue for trial regarding deductibility of employer settlement from LTD benefits.
The plaintiff sued his disability insurer for long-term disability benefits.
The insurer brought a motion for summary judgment to dismiss the action, arguing that a $314,843 settlement the plaintiff received from his former employer upon termination was fully deductible from his LTD benefits under the policy.
The court dismissed the motion, finding that the nature and component parts of the settlement package were unclear from the documentary record.
The court concluded there was a genuine issue requiring a trial to determine whether the settlement funds constituted income replacement or disability payments subject to deduction.
Appellant ordered to pay $5,000 in costs following unsuccessful and unnecessarily complicated appeal.
Following the dismissal of the appellant's appeal, both parties sought their legal expenses.
The Director's Delegate found that the respondent was entirely successful on the appeal, which was unnecessarily complicated by the appellant.
The appellant was ordered to pay the respondent's legal expenses fixed at $5,000 inclusive of HST.
Appeal of accident benefits denial dismissed; arbitrator made no errors of law regarding IRBs or treatment.
The Appellant, who sustained a catastrophic impairment in a 2009 motor vehicle accident, appealed an arbitrator's decision denying his claims for ongoing income replacement benefits (IRBs) and a $56,600 treatment plan at the Sierra Tucson facility.
The Director's Delegate dismissed the appeal, refusing to admit fresh medical evidence because it could have been obtained earlier with due diligence or was inappropriate for an appeal restricted to questions of law.
The Delegate found no error of law in the arbitrator's conclusions that the Appellant failed to meet his onus to prove post-accident income for IRB quantum, failed to meet the post-104 week complete inability test, and required updated neuropsychological testing before the intensive treatment plan could be approved.
Motion to compel appellant to pay for arbitration transcripts dismissed; respondent may order them itself.
The Respondent brought a motion during a preliminary appeal conference to compel the Appellant to order and pay for the transcript of his own testimony from the arbitration hearing.
The Appellant argued he could not afford the transcripts and did not intend to rely on them.
The Director's Delegate dismissed the motion, finding that the onus is on the moving party to establish that further portions of the transcript should be ordered, and that there is nothing preventing the Respondent from ordering the transcripts itself if it believes they are necessary for a full and fair appeal hearing.
Insurer ordered to pay extensive accident benefits and a special award for unreasonably withholding payments.
The applicant, who had a pre-existing severe disability in her right arm, suffered a rotator cuff tear to her left shoulder and a low back injury in a motor vehicle accident.
She applied for statutory accident benefits for housekeeping, attendant care, various assistive devices, and a weight reduction program.
The insurer denied or ignored many of the claims, arguing the applicant failed to mitigate her damages by refusing shoulder surgery and that her mobility issues were unrelated to the accident.
The arbitrator found the applicant's refusal of surgery was reasonable given the high risks.
The arbitrator awarded past and ongoing housekeeping and care benefits, funding for an electrically operated bed, a scooter, a chair lift, a residential weight reduction program, and rehabilitation assessments.
Finding that the insurer had unreasonably withheld payments and failed to properly adjust the claim, the arbitrator ordered a special award ranging from 30% to 50% on the withheld benefits, along with interest.
