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Claim for hearing aids dismissed as it was submitted beyond the strict 260-week legislative limit.
The applicant sought $7,776.00 for hearing aids following a 2017 motor vehicle accident.
The insurer denied the treatment plan because it was submitted beyond the 260-week limit for medical benefits under section 20(1)(a) of the Statutory Accident Benefits Schedule.
Although the adjudicator found the treatment plan reasonable, necessary, and the result absurd, the Tribunal held it had no authority to set aside the strict 260-week legislative limit.
The application for benefits and interest was dismissed.
Tribunal erred in applying extra-territoriality doctrine to allow injured worker to sue out-of-province employee.
The applicants sought judicial review of a Workplace Safety and Insurance Appeals Tribunal decision that allowed an injured Ontario worker to sue an out-of-province employee and his Schedule 1 employer in Ontario.
The tribunal had held that the statutory bar to civil actions under s. 28 of the Workplace Safety and Insurance Act, 1997 did not apply because the out-of-province employee had no connection to Ontario, relying on the constitutional doctrine of extra-territoriality.
The Divisional Court allowed the application, finding that the tribunal misapplied the constitutional doctrine, as the legislation regulates the property and civil rights of the injured Ontario worker, not the out-of-province defendant.
The matter was remitted to a differently constituted tribunal to interpret s. 28 without the extra-territoriality considerations.
Motions for leave to appeal dismissed with costs.
The moving parties brought motions for leave to appeal an order dated October 31, 2023.
The Divisional Court dismissed the motions for leave to appeal and awarded costs of $5,000 to the responding party.
Motion to strike granted; psychologist and children's aid society owe no duty of care to parents.
The defendants, a treating psychologist and a children's aid society, brought motions under Rule 21 to strike the plaintiffs' statement of claim.
The plaintiffs' action arose from a child protection investigation and criminal charges based on allegations of abuse made by a child previously adopted by the plaintiffs.
The court struck the claim against the psychologist without leave to amend, finding she owed no duty of care to the parents of her patient and was statutorily obligated to report suspected abuse.
The court also struck the adult plaintiffs' claims in negligence and various intentional torts against the children's aid society defendants, finding no duty of care was owed to the parents during a child protection investigation.
Leave to amend was granted for claims of misfeasance in public office and Charter damages.
Human rights application dismissed as it was filed over six years outside the limitation period.
The applicant filed a human rights application alleging discrimination based on race after the respondent denied her insurance benefits following a 2004 car accident.
The respondent requested that the application be dismissed on a preliminary basis because it was filed outside the one-year limitation period.
The Tribunal found that the last alleged incident of discrimination occurred in 2008, making the application over six years late.
As the applicant failed to provide a reasonable explanation for the delay, the Tribunal concluded the delay was not incurred in good faith and dismissed the application.
Arbitrator finds applicant catastrophically impaired where accident-induced blood loss caused brain hypoxia and low GCS score.
The applicant, a five-year-old pedestrian, was struck by a vehicle and sustained severe injuries, including a Glasgow Coma Scale (GCS) score of 9 recorded by paramedics shortly after the accident.
The insurer argued the low GCS score was caused by hemodynamic instability due to blood loss rather than a brain impairment.
The arbitrator found that the applicant suffered a brain impairment as a result of the accident, as the massive blood loss deprived the brain of oxygen, impairing its function and resulting in the GCS score of 9.
The arbitrator concluded the applicant met the definition of catastrophic impairment under subsection 2(1.1)(e)(i) of the Statutory Accident Benefits Schedule.
One co-insured cannot unilaterally cancel automobile insurance coverage affecting another co-insured without notice and consent.
The appellant lessor and the lessee were both named insureds under an automobile insurance policy.
The lessee unilaterally directed the insurer to delete all coverage except fire and theft.
The vehicle was subsequently destroyed in an accident.
The insurer denied the lessor's claim on the basis that coverage had been deleted.
The Court of Appeal allowed the lessor's appeal, holding that the insurance contract provided several, not joint, coverage.
Therefore, one co-insured could not unilaterally cancel the coverage of the other without the insurer providing 15 days' prior notice and obtaining the express or implied consent of the co-insured lessor.
Arbitration dismissed due to applicant's non-attendance; insurer awarded expenses but denied assessment fee award.
The applicant claimed statutory accident benefits following an alleged motor vehicle accident.
Neither the applicant nor her representative attended the scheduled arbitration hearing.
The arbitrator proceeded in their absence and dismissed the applicant's claims for income replacement benefits, interest, and a special award due to a lack of evidence.
The insurer was awarded its expenses of the arbitration.
However, the insurer's claim for an award in respect of its assessment fee under the repealed section 282(11.2) of the Insurance Act was dismissed, as the arbitrator found the new legislative provision to be procedural and applicable retroactively.
Insurer failed to prove applicant wilfully misrepresented accident circumstances; applicant not disentitled to accident benefits.
The applicant claimed statutory accident benefits following a motor vehicle accident.
The insurer denied the claim and argued at a preliminary issue hearing that the applicant was disentitled to benefits under section 48(1) of the Statutory Accident Benefits Schedule because he wilfully misrepresented the circumstances of the accident.
The insurer relied on an accident reconstruction expert who concluded the vehicle damage was inconsistent with the applicant's statements.
The arbitrator found the expert's analysis contained numerous weaknesses, including reliance on an unreliable speed estimate and photographs taken after a subsequent accident.
The arbitrator concluded the insurer failed to discharge its onus of proving wilful misrepresentation and held the applicant was not disentitled to benefits.
Late expert reports admitted and wilful misrepresentation defence allowed to proceed despite initial notice deficiencies.
The insurer denied benefits and raised the preliminary issue of wilful misrepresentation.
The applicant objected to the late service of the insurer's expert reports and argued the insurer failed to provide proper notice of the reasons for denying benefits.
The arbitrator allowed the late expert reports, finding no procedural unfairness or prejudice to the applicant.
The arbitrator also held that the insurer provided sufficient notice of its wilful misrepresentation defence in its Response to the Application for Arbitration, allowing the preliminary issue hearing to proceed.
Insurer may require proof of attendant care services provided beyond Form 1 before paying benefits.
The applicant was injured in a motor vehicle accident and applied for attendant care benefits.
The insurer requested additional information beyond the Assessment of Attendant Care Needs (Form 1) to verify that the services were actually provided and expenses incurred.
The applicant argued that the Form 1 and the Schedule provided a complete code and no further information could be requested.
The arbitrator held that under section 33 of the Statutory Accident Benefits Schedule, the insurer is entitled to request reasonable information, including the identity of the service provider and the dates and approximate times of service, to satisfy itself that the attendant care services were provided and the expenses incurred before paying the benefit.
Insurer's appeal to stay arbitration in favour of its civil proceeding dismissed; insured's choice of forum respected.
The insurer appealed an arbitrator's preliminary order dismissing its motion to stay the insured's arbitration proceeding.
The insurer had commenced a civil proceeding regarding the quantum of income replacement benefits one day before the insured filed for arbitration.
The Director's Delegate rejected the appeal, finding that the insured's right to elect arbitration should be respected, the arbitration was further advanced, and staying the arbitration would cause significant prejudice to the insured.
The arbitration was permitted to proceed.
Insurer's motion to stay FSCO arbitration in favour of its parallel court action dismissed.
The insurer brought a motion to stay the insured's arbitration proceeding at the Financial Services Commission of Ontario (FSCO) pending the outcome of a lawsuit it had filed in the Superior Court of Justice.
The insurer argued that its lawsuit, which sought a determination of the insured's income replacement benefit and repayment of alleged overpayments, was filed two days before the arbitration application.
The arbitrator dismissed the motion, finding that the arbitration had advanced more rapidly than the lawsuit and that a stay would frustrate the goal of avoiding multiple proceedings, as the court lacked jurisdiction to issue a special award.
The arbitrator emphasized that the Insurance Act gives the insured, not the insurer, the right to elect the forum for dispute resolution.
Applicant's claims for accident benefits dismissed for failure to attend; ordered to repay overpaid benefits and costs.
The applicant applied for arbitration seeking statutory accident benefits following a motor vehicle accident.
The applicant failed to attend the hearing or communicate with his counsel, the insurer, or the Commission.
The arbitrator dismissed the applicant's claims in their entirety due to a lack of evidence.
The insurer's claim for repayment of $2,447.72 in overpaid income replacement benefits was granted.
The arbitrator also ordered the applicant to pay the insurer's arbitration expenses of $1,742.00 and an additional $1,000 for abuse of process, finding that the applicant's failure to participate unnecessarily prolonged the proceedings.
