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The Court of Appeal ordered a new trial on whether an insurer unreasonably withheld accident benefits, finding the trial judge misapplied the statutory definition of incurred expenses.
The insurer appealed a trial judgment that awarded the insured household and attendant care expenses for a pre-judgment period, regardless of whether they were actually incurred.
The Court of Appeal found the trial judge erred by not applying the statutory definition of "incurred" under s. 3(7)(e) of the SABS-2010 and by misapprehending evidence regarding the insurer's delay in assessing benefits for the purpose of deeming expenses under s. 3(8).
The Court allowed the appeal, set aside the relevant parts of the trial judgment, and ordered a new trial on the issue of whether the insurer unreasonably withheld or delayed payments.
Extension for service refused due to lack of diligence and prejudice to defendants.
The plaintiffs brought a motion for substitute service of a statement of claim and an extension of time for service under Rules 16.04 and 3.02 of the Rules of Civil Procedure.
The action arose from a fatal pedestrian motor vehicle accident, but the defendants had not been served within the required six‑month period after issuance of the claim.
The court found the plaintiffs had made minimal efforts to locate and serve the defendants and had not demonstrated due diligence.
Applying the principles in Chiarelli v. Weins and considering prejudice arising from the delay, the court held that both presumed and actual prejudice existed, including the loss of key witnesses and impaired ability to pursue claims against other potentially liable parties.
The plaintiffs failed to rebut the presumption of prejudice.
The motion for substitute service and extension of time was therefore dismissed.
Human rights application dismissed after applicant failed to attend the scheduled hearing.
The applicant filed a human rights application but failed to attend the scheduled hearing on the merits, despite having confirmed the date and time with Tribunal staff two days prior.
The respondent attended with counsel.
The Tribunal dismissed the application, noting that applicants have a responsibility to attend and provide evidence, and that the Tribunal has a duty to dispose of applications fairly, justly, and expeditiously to ensure effective use of public resources and fairness to respondents.
Supplementary medical and rehabilitation benefits under the SABS-1996 transitional provisions are subject to a 10-year durational limit.
The appellant insurer appealed an arbitration decision finding that the respondent's supplementary medical and rehabilitation benefits were not time-limited.
The Director's Delegate allowed the appeal, finding that the arbitrator erred in relying on external interpretive aids (brochures) to interpret the transitional provisions of the Statutory Accident Benefits Schedule.
The Director's Delegate held that the transitional provisions increased the monetary maximum for medical and rehabilitation benefits but did not eliminate the 10-year durational limit.
The arbitration order was varied to state that the respondent is not entitled to claim supplementary medical or rehabilitation benefits for a period in excess of ten years post-accident.
Temporal limits do not apply to transitional medical and rehabilitation benefits under subsection 70(3) of the Schedule.
The applicant was injured in a motor vehicle accident and claimed statutory accident benefits.
The insurer denied medical rehabilitation and housekeeping expenses beyond 104 weeks and denied indexation of income replacement benefits.
On a preliminary issue, the arbitrator found that while the insurer failed to offer the optional indexation benefit when the applicant chose the transitional coverage option, the arbitrator lacked jurisdiction to order a remedy.
However, the arbitrator held that temporal limits do not apply to the transitional provisions under subsection 70(3) of the Schedule, entitling the applicant to claim supplementary medical and rehabilitation benefits beyond 104 weeks.
Applicant awarded partial arbitration expenses despite losing on causation, as the claim was brought in good faith.
Following a decision dismissing the applicant's claims for medical and rehabilitation benefits due to a lack of causation, both parties sought their expenses of the arbitration.
The arbitrator found that the applicant's claim was brought in good faith and awarded him 75 percent of his legal fees and 100 percent of his assessable disbursements.
The arbitrator reduced the claimed counsel hours from 90 to 40, set the hourly rate at $110, and allowed the full $1,100 cost of an occupational therapist's report.
Claim for accident benefits dismissed as minor collision did not materially contribute to need for assistive devices.
The applicant was injured in a minor motor vehicle accident and claimed medical and rehabilitation benefits for various assistive devices, including a boat, snowmobile, and ATV, to help him function at his remote cottage.
The insurer denied the claims, arguing the need for the devices arose from a pre-existing back condition.
The arbitrator found that the applicant had a long history of severe back problems, including a prior surgery, and that the minor car accident did not materially contribute to his need for the assistive devices.
The claim for benefits was dismissed.
Applicant and her daughter awarded death benefits after establishing three-year continuous cohabitation with the deceased.
The applicants sought death benefits following the death of the insured in a motor vehicle accident.
The insurer denied the claim on the basis that the applicant and the insured had not cohabited continuously for three years and were therefore not spouses under the Insurance Act.
The arbitrator found that despite maintaining separate residences for a portion of the three-year period, the parties lived together as a family unit, shared domestic chores, and were financially interdependent.
The arbitrator concluded the parties were spouses and awarded death benefits to the applicant and her daughter.
