5 total
Applicant found catastrophically impaired due to mental disorder despite social media evidence of international travel.
The applicant was injured in a snowmobile accident and sought a determination that he sustained a catastrophic impairment due to a mental or behavioural disorder.
The respondent disputed the catastrophic impairment designation and denied several treatment plans and assessments.
The adjudicator found that the applicant sustained a catastrophic impairment, concluding he had marked impairments in activities of daily living, social functioning, and adaptation, despite the respondent's reliance on social media posts showing the applicant travelling.
The adjudicator awarded the disputed treatment plans at the catastrophic impairment rates and awarded HST on the assessments, but capped the assessment fees at the $2,000 statutory maximum.
Claims for a special award and costs were dismissed.
The court upheld an arbitrator's decision limiting loss transfer indemnification due to gross claims mismanagement.
Certas Home and Auto Insurance Company appealed an arbitration decision regarding loss transfer indemnification from Intact Insurance Company for statutory accident benefits paid to an insured.
The arbitrator found Certas had grossly mishandled the claim by failing to follow its own adjusting plan and continuing benefits despite medical opinions and the insured's completion of vocational training.
The Superior Court of Justice upheld the arbitrator's decision, finding no palpable and overriding error in the arbitrator's conclusion that Certas grossly mismanaged the claim, thereby limiting Intact's indemnification obligation.
Application for ongoing income replacement benefits and medical treatment dismissed; unreported income excluded from calculation.
The applicant sought an income replacement benefit (IRB) and a medical treatment plan following a 2017 motor vehicle accident.
The insurer paid IRBs until February 2018 based on the applicant's reported income to the CRA, but denied further benefits based on section 44 assessments.
The Tribunal found the insurer correctly calculated the IRB quantum using the CRA reported income, as the Schedule prohibits relying on unreported income.
The Tribunal also found the applicant failed to prove ongoing substantial inability to perform the essential tasks of his pre-accident employment, and failed to prove the treatment plan was reasonable and necessary.
The application was dismissed.
EI maternity benefits and employer top-ups are deductible from Income Replacement Benefits as gross employment income.
The applicant was injured in a motor vehicle accident and subsequently went on maternity leave, receiving Employment Insurance (EI) maternity benefits.
The insurer conceded entitlement to Income Replacement Benefits (IRB) but sought to deduct the EI maternity benefits and available employer top-up amounts from the IRB quantum.
The Tribunal held that EI maternity benefits and employer top-ups fall within the definition of 'gross employment income' under the Statutory Accident Benefits Schedule and are therefore deductible from IRBs.
The Tribunal also found the applicant was entitled to interest on overdue IRBs but dismissed the claim for a special award, noting the delay was due to the applicant's failure to provide requested employment documentation.
Plaintiff acted with reasonable diligence by relying on police accident report for insurance information.
The appellant was injured in a motor vehicle accident and commenced an action against the driver and owner identified in the police accident report.
After the limitation period expired, the appellant learned the vehicle was uninsured and sought leave to amend the statement of claim to add his own insurer for uninsured motorist coverage.
The motion judge dismissed the motion, finding a lack of due diligence.
The Court of Appeal allowed the appeal, holding that the appellant acted with reasonable diligence by relying on the insurance information in the police report until receiving actual notice to the contrary.
