Laura Frances Hodgins

The applicant was injured in a motor vehicle accident and sought statutory accident benefits.

The insurer took the position that the applicant's injuries were restricted by the Minor Injury Guideline (MIG), limiting his benefits to $3,500.

The applicant argued that he suffered from pre-existing conditions and subsequent psychological disabilities, including chronic pain, PTSD, and TMJ syndrome, which took him outside the MIG.

The arbitrator found that the insurer bears the burden of proving that an insured falls within an exception to coverage, such as the MIG.

The arbitrator concluded that the applicant's TMJ, chronic pain, and psychological impairments were separate and distinct from his soft tissue injuries and were supported by credible evidence.

Therefore, the applicant was not precluded from claiming benefits beyond the $3,500 limit.

The appellant insurer appealed an arbitrator's decision finding that the respondent insured sustained a catastrophic impairment following a motor vehicle accident.

The arbitrator found the respondent met the definition under the Statutory Accident Benefits Schedule based on a Glasgow Coma Scale (GCS) score of 9 recorded four days post-accident.

The insurer argued the score was invalid due to consciousness-lowering drugs and was not taken within a reasonable time.

The Director's Delegate dismissed the appeal, holding that the definition of catastrophic impairment is a legal test, not a medical one, and does not require excluding confounding factors.

The Delegate found no error in the arbitrator's conclusion that the GCS score resulted from a brain impairment and was taken within a reasonable time.

The appellant insurer sought indemnification from the respondent insurer under the loss transfer provisions of the Insurance Act for the costs of insurer-generated medical assessments.

The respondent conceded its insured was 100 per cent at fault but refused to indemnify the costs of the medical assessments, arguing they were not payments 'in relation to' statutory benefits paid.

The arbitrator and the Superior Court judge ruled in favour of the respondent.

The Court of Appeal dismissed the appeal, holding that the expense of insurer-generated medical assessments is not recoverable under s. 275(1) of the Insurance Act as payments 'in relation to such benefits paid'.

The appellant insurer sought to appeal a preliminary arbitration order which found that the respondent insured had sustained a catastrophic impairment based on Glasgow Coma Scale scores.

The Director's Delegate declined to exercise discretion to hear the appeal at this time, noting that the issues raised were not novel and that hearing the appeal would prejudice the respondent by delaying the final substantive arbitration hearing scheduled for two months later.

The appeal was rejected without prejudice to it being raised after all issues in dispute have been finally decided.

An insurer appealed a private arbitration award concerning a statutory accident benefits loss transfer dispute arising from a multi‑vehicle highway collision.

The arbitrator had found that a heavy commercial truck insured by the appellant caused a chain‑reaction collision and was 100% at fault under Rule 9(4) of the Fault Determination Rules, entitling the respondent insurer to full indemnification for benefits paid to its insured.

The appellant argued the incident constituted a pile‑up governed by Rule 11, which would limit liability to 50%, and challenged the finding of a collision involving its insured vehicle.

The court held the arbitrator’s factual findings were supported by the evidence and that Rule 9(4) was correctly applied because the other vehicles were stationary in the same lane at the time of impact.

The appeal was dismissed and the arbitration award affirmed.