32 total
Applicant removed from Minor Injury Guideline due to chronic pain but denied Non-Earner Benefit.
The applicant sought statutory accident benefits following a motor vehicle accident, including removal from the Minor Injury Guideline (MIG), a Non-Earner Benefit (NEB), and funding for a psychological assessment.
The Tribunal found that the applicant's chronic pain warranted removal from the MIG and approved the psychological assessment as reasonable and necessary to investigate the pain symptomology.
However, the claim for an NEB was dismissed because the medical evidence and the applicant's post-accident activities, including returning to part-time work, did not demonstrate a complete inability to carry on a normal life.
Application for accident benefits dismissed as applicant failed to prove treatment plans were reasonable and necessary.
The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including treatment plans for massage therapy, physiotherapy, psychological services, and an in-home attendant care assessment.
The respondent denied the treatment plans.
The Licence Appeal Tribunal found that the applicant failed to prove on a balance of probabilities that the disputed treatment plans were reasonable and necessary, noting a lack of objective medical evidence supporting the requests.
The Tribunal awarded interest on two previously approved and incurred expenses but declined to deem other approved but unincurred expenses as incurred under s. 3(8) of the Schedule, finding the respondent did not unreasonably withhold payment.
The applicant's claims for a special award and costs were dismissed.
A tort action in Ontario by a worker receiving Alberta workers' compensation benefits is statute-barred and an abuse of process.
The plaintiff, an Ontario resident, was injured in British Columbia while driving for an Alberta-based company.
He elected to receive Alberta workers' compensation benefits and subsequently initiated a tort action in Ontario against the defendant, the truck's owner and also an Ontario resident, alleging improper maintenance.
The defendant moved to stay or dismiss the action, arguing it was statute-barred by the plaintiff's election to receive workers' compensation benefits and constituted an abuse of process.
The Ontario Superior Court of Justice allowed the motion, finding the tort action was statute-barred based on principles of inter-provincial comity and that it represented an abuse of process, as it sought to relitigate a matter covered by the workers' compensation scheme and allowed for potential double recovery, thereby circumventing the 'historic trade-off' inherent in such legislation.
Summary judgment Motion dismissed
The defendants, having successfully dismissed the plaintiff's $5 million conspiracy claim on summary judgment, sought substantial indemnity costs.
The plaintiff argued against costs, citing no reprehensible conduct and challenging the defendants' bill of costs.
The court awarded the defendants $250,000 in substantial indemnity costs, finding the plaintiff's unsubstantiated allegations of dishonesty, illegality, and conspiracy to be reprehensible and deserving of sanction, particularly given the potential impact on the defendants' reputation and the complexity and duration of the litigation.
Summary judgment granted dismissing conspiracy claim against insurer and employees for lack of evidence.
The plaintiff, a medical and rehabilitation services provider, sued the defendant insurance company and its employees for conspiracy to cause economic harm, alleging they conspired to deny claims and care plans without due regard to their merits.
The defendants brought a motion for summary judgment, and the plaintiff brought a cross-motion.
The court found no evidence of an agreement between the defendants to harm the plaintiff, noting that the employees were acting within the scope of their employment and could not conspire with their employer.
The court granted the defendants' motion for summary judgment and dismissed the action.
Costs of the appeal awarded to the respondent fixed at $60,000.
The Court of Appeal for Ontario issued a costs endorsement following the appeals in Westerhof v. Gee Estate and McCallum v. Baker.
The court ordered that the costs of the appeal in McCallum v. Baker be awarded to the respondent, fixed in the amount of $60,000 inclusive of disbursements and applicable taxes.
Insurer ordered to produce 33 former employees for discovery before summary judgment motion proceeds.
The plaintiff, a trustee in bankruptcy for a healthcare provider, brought a motion seeking to compel the defendant insurer to produce 33 former employees for examination for discovery prior to the determination of the defendant's summary judgment motion.
The plaintiff also sought the return of $350,000 paid into court as security for costs and an order prohibiting the defendant from bringing further motions.
The court granted the request for discoveries, finding that the parties had previously agreed to them in Minutes of Settlement and that the plaintiff needed the evidence to put its best foot forward on the summary judgment motion.
The requests to reduce security for costs and prohibit further motions were dismissed.
Successful defendants received reduced partial indemnity costs after summary judgment.
This was a costs endorsement following a successful summary judgment motion in favour of two defendants.
The court held the successful defendants were entitled to costs on a partial indemnity basis, but reduced the amounts claimed for file review, pleadings, document discovery, motion preparation, and certain disbursements.
The court found the claimed hourly rate reasonable while emphasizing that recoverable costs are not determined solely by hours multiplied by rate and must reflect what a reasonable losing party might expect to pay.
Costs were fixed at $22,274.10 inclusive of fees, disbursements, and H.S.T.
Appeal dismissed; trial judge made no error in finding appellant failed to prove causation.
The appellant was seriously injured in a motor scooter accident and suffered brain injuries.
At trial, 16 years later, she provided a different account of the accident than in her statement of claim.
The trial judge dismissed the action, finding she had not proven the respondent caused or contributed to the accident, relying in part on defence expert evidence regarding retrograde amnesia.
On appeal, the appellant argued the trial judge erred in admitting the expert evidence, assessing reliability, and applying the standard of proof.
The Court of Appeal dismissed the appeal, finding no error in the trial judge's reliance on the expert evidence, assessment of reliability, or application of the balance of probabilities standard.
Rule 53.03 does not apply to participant experts or non-party experts giving opinion evidence.
Two personal injury appeals were heard together to determine the scope of Rule 53.03 of the Rules of Civil Procedure regarding expert witnesses.
The Court of Appeal held that Rule 53.03 does not apply to 'participant experts' (such as treating physicians) or 'non-party experts' who form opinions based on their observation of or participation in the events at issue, rather than being engaged by a party for the litigation.
In Westerhof, the trial judge's erroneous exclusion of such evidence warranted a new trial.
In McCallum, the trial judge correctly admitted the treating practitioners' opinion evidence.
Appeal of jury verdict and threshold motion dismissal denied; causation not established for chronic pain.
The appellant appealed a jury verdict and a trial judge's decision dismissing her action for damages arising from a motor vehicle accident.
The jury found that the appellant had recovered from her injuries and awarded $58,000 for loss of competitive advantage, while the trial judge ruled she did not meet the statutory threshold under the Insurance Act.
The Court of Appeal dismissed the appeal, finding that the jury's conclusion on causation was supported by the evidence and not internally inconsistent, and that the trial judge properly dismissed the action because the appellant failed to establish that her ongoing medical issues were caused by the accident.
Appeal abandoned; costs of $7,500 awarded to the respondent.
The appellant filed a Notice of Abandonment for the appeal.
The Court of Appeal ordered costs of the abandoned appeal to the respondent, fixed at $7,500 inclusive of disbursements and taxes.
Wrong reasons did not stop a clear benefits denial from triggering limitations.
The appellant challenged summary judgment dismissing her statutory accident benefits action for non-earner benefits as out of time.
The court held that a clear and unequivocal denial of benefits triggered the two-year limitation period, even though the insurer gave an incorrect legal reason for ineligibility.
The limitation period ran from the initial refusal of non-earner benefits, not from the later termination of income replacement benefits.
The court further held that neither the Insurance Act nor the SABS required the insurer to give renewed notice of a possible entitlement to a previously denied benefit upon termination of another benefit.
The appeal was dismissed with costs.
Leave to appeal denied; not plain and obvious that bankruptcy trustee lacks capacity to claim punitive damages.
The defendant sought leave to appeal a decision dismissing its motion to strike the plaintiff's claims for punitive and aggravated damages.
The defendant argued that the bankruptcy trustee lacked the legal capacity to advance these in personam claims on behalf of the bankrupt company.
The Divisional Court dismissed the motion for leave to appeal, finding no conflicting decisions and no good reason to doubt the correctness of the motion judge's conclusion that it was not plain and obvious the trustee lacked capacity.
Appeal dismissed; group disability insurers have no common law duty to inform insureds of potential claims.
The appellant appealed a summary judgment decision denying her claim against her group disability insurer for benefits.
She argued the insurer had a common law duty to inform her directly of a potential claim, and that the limitation period should not run until they did so.
The Court of Appeal dismissed the appeal, finding no such common law duty exists for group disability insurers in these circumstances, and noting the insurer had complied with the statutory notification obligations under the Insurance Act.
Successful party on motion awarded reduced partial indemnity costs.
Following the dismissal of a defendant’s motion to strike portions of a claim alleging bad faith and punitive damages, the court determined the appropriate costs award.
The successful party sought partial indemnity costs totalling $7,994.
The defendant argued that no costs should be awarded or that costs should be payable in the cause, citing the reasonableness of bringing the motion and the plaintiff’s unsuccessful alternative argument for nunc pro tunc amendments to the pleadings.
The court held that the successful party on a contested motion generally has a reasonable expectation of receiving costs and that the defendant had not established grounds to depart from that principle.
However, the court reduced the claimed amount to reflect time spent on the unsuccessful alternative argument and fixed costs at $4,000 inclusive of disbursements and tax.
Action for accident benefits dismissed as statute-barred due to plaintiff's failure to mediate and return settlement funds.
The defendant insurer brought a motion for summary judgment to dismiss the plaintiff's action for statutory accident benefits, arguing it was statute-barred because the plaintiff failed to mediate her claim and failed to return settlement funds prior to commencing the action.
The plaintiff brought a cross-motion for partial summary judgment for ongoing income replacement benefits.
The court granted the defendant's motion, finding that the failure to mediate and return the settlement funds deprived the court of jurisdiction.
The plaintiff's cross-motion was dismissed on the merits due to contradictory evidence regarding her disability.
Action for accident benefits dismissed for failure to submit timely SABS application.
The defendant insurer brought a motion for summary judgment dismissing the plaintiff’s action for statutory accident benefits arising from a motor vehicle accident.
The plaintiff sought non-earner benefits under the Statutory Accident Benefits Schedule but had not submitted a timely application for benefits and did not provide a reasonable explanation for the delay of several years.
The court found that the insurer had provided the appropriate accident benefits package and repeatedly advised the plaintiff and his counsel of the need to submit an application.
The evidence demonstrated that no application for benefits was made within the statutory timelines and that the plaintiff lacked any reasonable explanation under the SABS for the delay.
The court held that the insurer suffered prejudice due to the inability to investigate the claim years later and granted summary judgment dismissing the action.
Late SABS claim barred by limitation despite allegedly misleading denial explanation.
The defendant insurer brought a motion for summary judgment dismissing the plaintiff’s action for statutory accident benefits as statute‑barred.
The plaintiff sought non‑earner benefits following a motor vehicle accident but did not request mediation until several years after the insurer’s written refusal.
The court held that the insurer’s OCF‑9 form clearly denied the benefit and triggered the two‑year limitation period under the Statutory Accident Benefits Schedule and the Insurance Act.
Although the plaintiff argued the denial contained a misleading explanation and that she did not understand her entitlement, the court found that once she retained counsel in early 2006 she was deemed to know of the limitation period and her rights.
The mediation request and subsequent claim were therefore well outside the limitation period.
The action and the request to amend the claim to plead negligent misstatement were dismissed.
Treating professionals must comply with Rule 53.03 to give expert opinion evidence at trial.
The appellant appealed the dismissal of his claim for damages arising from a motor vehicle accident.
At trial, the judge excluded opinion evidence from several of the appellant's treating professionals and medical assessors because they had not complied with the expert report requirements of Rule 53.03.
The Divisional Court upheld the trial judge's rulings, confirming that the application of Rule 53.03 depends on the nature of the evidence (opinion vs. factual) rather than the role of the witness (treating professional vs. litigation expert).
The court held that any witness seeking to provide expert opinion evidence must comply with Rule 53.03.