Joe Nemet

The applicant insurer sought judicial review of a director's delegate's decision upholding an arbitrator's finding that the insurer's refusal to designate the respondent as catastrophically impaired did not trigger the two-year limitation period under s. 281.1(1) of the Insurance Act.

The Divisional Court held that the standard of review was reasonableness, rejecting the insurer's argument for correctness.

The Court found the director's delegate reasonably concluded that a catastrophic impairment determination is not a benefit itself, and the insurer's denial letter did not constitute a clear and unequivocal refusal of a benefit.

The application for judicial review was dismissed.

The applicant insurer sought judicial review of a FSCO Director's Delegate decision upholding an Arbitrator's finding that the respondent suffered a catastrophic impairment.

The respondent had recorded a Glasgow Coma Scale (GCS) score of 9 several days after a motor vehicle accident, which the insurer argued was confounded by medication and other injuries rather than brain impairment.

The Divisional Court dismissed the application, holding that the standard of review is reasonableness and that the SABS regulation uses the GCS score as a proxy measurement without requiring an inquiry into the patient's prognosis or the specific cause of the lowered score.

The applicant insurer sought judicial review of a Director's Delegate decision upholding an arbitrator's award for private school tuition and a special award for unreasonably withholding benefits under the Statutory Accident Benefits Schedule.

The Divisional Court found the Delegate's broad interpretation of 'incurred' and 'undertaken' under s. 15 of SABS was reasonable.

The court also upheld the finding that the insurer unreasonably denied benefits by relying on flawed expert reports and ignoring the insured's future needs.

The court fixed the quantum of the special award at $20,000.

The applicant insurance company sought judicial review of a Financial Services Commission of Ontario (FSCO) decision regarding the applicable interest rate on overdue Statutory Accident Benefits.

The central issue was the interpretation of transitional provisions between the old and new Statutory Accident Benefits Schedules for amounts becoming overdue after September 1, 2010.

The Divisional Court determined the standard of review was reasonableness, as the Tribunal was interpreting its home statute.

The Court dismissed the application, finding the Tribunal reasonably concluded that the 2% interest rate under the old regulation continued to apply to amounts that became overdue after September 1, 2010.

The applicants sought judicial review of a decision by a Director's Delegate of the Financial Services Commission of Ontario, which upheld an arbitrator's denial of statutory accident benefits.

The applicants argued breaches of procedural fairness, incorrect application of the burden of proof, improper judicial notice, and failure to accept uncontradicted medical evidence.

The Divisional Court dismissed the application, finding the Delegate's decision reasonable in all respects.

The court affirmed that the burden of proof rests on the insured to establish entitlement to benefits and does not shift to the insurer.

The applicant insurer sought judicial review of a FSCO Director's Delegate's decision.

The respondent was injured in an accident and subsequently filed an amended tax return reporting previously unreported income.

The Director's Delegate held that under s. 64.1(2) of the Statutory Accident Benefits Schedule, the respondent was entitled to have his income replacement benefits adjusted to reflect the higher income reported in the amended return.

The Divisional Court dismissed the application, finding the standard of review was reasonableness and that the Director's Delegate's interpretation of s. 64.1(2) was both reasonable and correct.

The applicant sought judicial review of an arbitrator's decision, affirmed by the Director's Delegate, awarding costs against him personally in a Financial Services Commission of Ontario (FSCO) arbitration.

The Divisional Court applied a reasonableness standard of review.

The court found no denial of procedural fairness, as the applicant had notice and an opportunity to respond.

The court upheld the arbitrator's finding that the applicant caused expenses to be incurred without reasonable cause, and dismissed the application with costs.

The applicant sought to introduce fresh evidence on an application for judicial review of a decision by the Director's Delegate, which had upheld an Arbitrator's decision.

The Director's Delegate had previously refused to admit the applicant's affidavit because it failed the Palmer test, as the evidence was available during the arbitration.

The Divisional Court agreed, refusing to admit the affidavit for the purposes of the application.

The court allowed certain other documents to be referenced on consent of the parties, but excluded the accompanying affidavit.

The applicant insurer sought judicial review of an arbitrator's refusal to declare a mistrial and recuse himself from a statutory accident benefits arbitration.

The applicant argued that the arbitrator's exposure to settlement offers and off-the-record discussions during an emotional outburst by the self-represented respondent created a reasonable apprehension of bias.

The Divisional Court dismissed the application, finding that the arbitrator's knowledge of settlement information did not automatically mandate a mistrial and that his handling of the situation did not raise a reasonable apprehension of bias.

The applicant insurer sought judicial review of a decision by the Director's Delegate of the Financial Services Commission of Ontario, which upheld two arbitrators' refusals to order independent medical examinations of the respondent claimant.

The arbitrators had denied the insurer's requests primarily due to the insurer's delay in seeking the examinations until the eve of or during the arbitration hearings.

The Divisional Court applied the reasonableness standard of review and dismissed the application, finding that the Director's Delegate reasonably concluded the arbitrators had properly exercised their discretion to refuse the examinations in the interests of fairness and preventing delay.

The applicant insurer sought judicial review of a decision by the Director's Delegate of the Financial Services Commission of Ontario.

The Director's Delegate had overturned a preliminary arbitration order that found the respondent insured's application for mediation was time-barred.

The Divisional Court held that the Director's Delegate was reasonable in concluding that the two-year limitation period under the Insurance Act and the Statutory Accident Benefits Schedule did not begin to run until the insurer provided notice of refusal to pay following a negative Designated Assessment Centre report, rather than from the initial notice of stoppage of benefits.

The application for judicial review was dismissed.

The applicant insurer sought judicial review of a decision by the Director's Delegate of the Financial Services Commission of Ontario, which upheld an arbitrator's order requiring the insurer to pay the claimant approximately $4,350 for attendant care and housekeeping services.

The insurer argued the arbitrator erred by relying on an excerpt from a medical report and by judging the claimant's credibility solely on her demeanour.

The Divisional Court dismissed the application, finding that the excerpt was properly in evidence as part of a larger report filed by the insurer, and that the arbitrator reasonably weighed credibility in the context of the evidence as a whole.

The standard of review applied was reasonableness.

The applicant insurer sought judicial review of decisions by a FSCO arbitrator and Director's delegate finding that the respondent insured suffered a catastrophic impairment under s. 2(1.1)(e)(i) of the Statutory Accident Benefits Schedule.

The insurer argued the arbitrator unreasonably interpreted 'reasonable period of time' for a Glasgow Coma Scale score.

The Divisional Court dismissed the application, holding that the standard of review is patent unreasonableness and the tribunal's decisions were supported by evidence and within its specialized jurisdiction.

The applicant sought judicial review of a decision by the Director of Arbitrations, which upheld an Arbitrator's dismissal of his claim for statutory accident benefits and ordered him to pay arbitration expenses.

The applicant claimed he was injured on a TTC bus, but initially reported it as a subway accident.

The Divisional Court dismissed the application, finding that the Arbitrator's factual findings and costs order were supported by the evidence and not patently unreasonable.

The appellant insurer appealed a Divisional Court decision which found that the insurer's notice cancelling the insured's weekly income benefits was inadequate to trigger the two-year limitation period.

The Court of Appeal allowed the appeal, finding that the Director's Delegate had applied the correct 'clear and unequivocal' test for the notice.

Furthermore, the Court held that the Divisional Court erred in requiring the reasons for cancellation to be legally correct under section 24(8) of the Statutory Accident Benefits Scheme; the reasons merely need to be provided to allow the insured to decide whether to challenge the cancellation.

The applicant sought judicial review of a Director's Delegate's decision which found her claim for statutory accident benefits was statute-barred.

The Director's Delegate had concluded that the insurer's notice of refusal, while containing technical defects and incorrect reasons, was 'substantially clear' and triggered the limitation period under s. 281(5) of the Insurance Act.

The Divisional Court quashed the decision, holding that a notice of refusal must be strictly clear and unequivocal, and must provide the correct reasons for refusal to trigger the limitation period.

The court found that the Director's Delegate erred in law by applying a 'substantially clear' standard.

The applicants sought judicial review of a Hearing Officer's decision declaring jurisdiction to proceed with a hearing regarding an amended Plan for the Niagara Escarpment Planning Area.

The applicants argued that an investigation and survey under s. 3(2) of the Niagara Escarpment Planning and Development Act was a condition precedent to amending the Plan following a boundary alteration.

The Divisional Court dismissed the application, holding that the statutory requirement for an investigation and survey only applied when the Area was originally established, not for subsequent boundary amendments.