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Insurer's request for reconsideration dismissed; no error in accepting applicant's reasonable explanation at hearing.
The respondent insurer requested a reconsideration of a decision finding the applicant entitled to income replacement benefits during a period of suspension.
The insurer argued the Tribunal erred in law by misinterpreting 'reasonable explanation' under s. 33(8)(b) of the Schedule, as the applicant's explanation was only offered at the hearing.
The Adjudicator dismissed the request, finding no error of law, as the Schedule does not impose a time limitation for providing a reasonable explanation and the Tribunal had properly weighed the evidence in finding the explanation credible.
The successful defendant on a motion to dismiss for lack of jurisdiction was awarded $8,000 in partial indemnity costs.
This endorsement addresses the issue of costs following a successful motion by the defendant to dismiss the plaintiff's action for lack of jurisdiction.
The defendant, as the successful party, sought costs.
The plaintiff opposed, arguing bad faith due to a forum selection clause.
The court applied Rule 57.01 of the Rules of Civil Procedure, considering factors such as complexity, importance, and reasonable expectations.
The court found partial indemnity costs appropriate and ordered the plaintiff to pay $8,000 to the defendant, inclusive of disbursements and HST.
Insurer's s. 33 request for prior medical records was reasonable, but deficient notice delayed suspension of benefits.
The applicant sought non-earner benefits following a motor vehicle accident.
The insurer suspended benefits after the applicant refused to provide clinical notes and records, a prior accident benefits file, and a CPP disability file requested under s. 33 of the Statutory Accident Benefits Schedule.
The Tribunal found that the clinical notes and the medical/rehabilitation portions of the prior files were reasonably required to assess causation, given the applicant's pre-existing injuries from a prior accident.
However, because the insurer's initial notices failed to inform the applicant of the saving provision under s. 33(8), the insurer remained liable to pay benefits until a compliant notice was issued on October 19, 2018.
The insurer is not liable to pay benefits after that date until the applicant provides the required information.
