Patrick M. Baker

This appeal addressed the application of the discoverability doctrine to the limitation period for income replacement benefits (IRBs) under the Statutory Accident Benefits Schedule (SABS).

The appellant insurer, The Personal Insurance Company (TPIC), argued that the Divisional Court erred in finding that the insured's application to the Licence Appeal Tribunal (LAT) was not limitations-barred.

The Court of Appeal affirmed that the doctrine of discoverability applies to IRB claims, consistent with its prior decision in Tomec.

It held that a pre-emptive denial of benefits by an insurer does not trigger the limitation period if the insured was not yet eligible for or had not applied for the benefits.

The Court found that the LAT adjudicator had not made an implicit factual finding regarding when the insured applied for benefits, thus allowing the Divisional Court to draw its own inferences.

The appeal was dismissed, upholding the Divisional Court's decision to remit the matter to the LAT for a new hearing on the substantive merits of the IRB claim.

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.

The insurer appealed a Licence Appeal Tribunal decision finding that the insured's claim for income replacement benefits was not statute-barred, as the termination letter was not clear and unequivocal.

The insured cross-appealed the dismissal of her claim for post-104 week income replacement benefits, arguing the adjudicator failed to consider whether alternative employment was comparable in status and reward.

The Divisional Court dismissed both appeals, holding that the limitation issue was a question of mixed fact and law not subject to appeal, and that the post-104 test under the Schedule does not require alternative employment to be comparable in status and reward.

The appellant insurer appealed a tribunal reconsideration decision that found its counsel was in a conflict of interest for acting in both a priority dispute and a benefits dispute against the same insured.

The tribunal also excluded examination under oath transcripts obtained in the priority dispute from being used in the benefits dispute.

The Divisional Court dismissed the appeal, holding that the tribunal's findings on conflict of interest and the circumvention of procedural protections under section 33 of the Statutory Accident Benefits Schedule were reasonable.

Two Ontario residents injured in separate accidents outside Ontario involving an all-terrain vehicle (ATV) and a dirt bike sought statutory accident benefits (SABs) under their Ontario automobile insurance policies.

Both insurers denied coverage, arguing that the definition of "automobile" under Ontario law should be determined by the law of the jurisdiction where the accidents occurred (lex loci delicti).

The Court of Appeal held that Ontario law applies to the interpretation of Ontario contracts and statutes, and that the definition of "automobile" in the Insurance Act and Off-Road Vehicles Act applies uniformly regardless of where the accident occurs.

Both vehicles qualified as automobiles under the extended definition because they would have required insurance if operated in Ontario under the Off-Road Vehicles Act.

The court allowed the appeal of the insured and dismissed the appeal of the insurer.

The appellant was injured in an all-terrain vehicle accident and sought statutory accident benefits.

The Licence Appeal Tribunal adjudicator found the vehicle was not an automobile and denied benefits.

The Executive Chair reconsidered the decision, cancelled it, and ordered a rehearing.

Both parties appealed the reconsideration decision to the Divisional Court.

The court dismissed both appeals, finding the Executive Chair's decision to order a rehearing was reasonable given the complexity of the case and the need to resolve factual disputes regarding the vehicle's status.

The court also held that an appeal does not stay a request for reconsideration under the Statutory Powers Procedure Act.