Lisa Crystal Pool

The applicant sought entitlement to an income replacement benefit (IRB) and various treatment plans following a 2011 motor vehicle accident.

The respondent insurer brought a preliminary issue motion arguing the IRB claim was statute-barred and the treatment claims were barred due to the applicant's failure to attend insurer examinations (IEs).

The Tribunal found the IRB claim was brought well beyond the two-year limitation period and that the applicant did not meet the test for substantial inability within 104 weeks.

The Tribunal also found the applicant failed to attend properly scheduled s. 44 IEs by imposing unreasonable conditions and refusing to cooperate, barring his treatment claims under s. 55 of the Schedule.

The application was dismissed.

The applicant sought funding for a multidisciplinary catastrophic impairment assessment totaling $24,700 after being denied by the insurer.

The insurer argued the claim was statute-barred under s. 56 of the Schedule and that the assessments were not reasonable and necessary.

The Adjudicator found that catastrophic impairment assessments are not tied to a specific benefit, so the limitation period did not apply.

The Adjudicator also found the assessments reasonable and necessary to allow the applicant to obtain their own medical opinions, ordering the insurer to pay up to $2,000 per assessment and $200 for documentation, while denying duplicate entries.

The applicant sought expenses following an arbitration decision regarding statutory accident benefits.

The insurer argued for a reduced amount or that each party bear their own expenses due to divided success.

The arbitrator found the applicant was more successful overall and entitled to expenses.

Applying the principle of fairness and legal aid rates, the arbitrator fixed the applicant's expenses at $54,250.27 inclusive of fees, disbursements, and HST.

The moving party, who was found vicariously liable for 40% of the plaintiffs' damages in a motor vehicle accident, brought a motion for judgment on its cross-claim against the responding parties, who were found 60% liable.

The responding parties had previously settled with the plaintiffs for their policy limits but were not released from cross-claims.

The moving party paid the balance of the plaintiffs' damages and costs, exceeding its 40% share, and sought contribution and indemnity under s. 1 of the Negligence Act.

The responding parties argued that s. 1 did not apply because the moving party was only vicariously liable and not at fault.

The court rejected this argument, holding that s. 1 applies to vicariously liable parties to ensure fair allocation of financial responsibility.

The moving party was granted judgment for the excess damages and a portion of the costs it paid.

The Applicant was severely injured in a motorcycle accident and applied for statutory accident benefits.

The Insurer raised a preliminary issue that the Applicant was precluded from claiming benefits because he was driving without valid insurance.

The Arbitrator found that the Applicant, who had purchased what he believed to be a legitimate policy from a third party, reasonably believed he was insured.

On the substantive issues, the Arbitrator awarded pre-104 income replacement benefits, finding the Applicant suffered a substantial inability to perform his pre-accident employment tasks due to cognitive and physical impairments.

However, the claim for post-104 income replacement benefits was dismissed as the Applicant had returned to work and earned more than his pre-accident income.

The Arbitrator also awarded attendant care benefits, finding the Applicant's family members sustained an economic loss, and granted ongoing housekeeping and home maintenance benefits.

Following a successful arbitration for statutory accident benefits, the applicant sought expenses of $22,076.18.

The insurer disputed the quantum.

The arbitrator reviewed the claimed legal fees and disbursements, reducing the hourly rate to the Legal Aid rate and disallowing administrative tasks.

The arbitrator also disallowed expert witness fees for a chiropractor and a social emotional assessor, finding their evidence unnecessary or irrelevant, but allowed the fees for the applicant's family doctor.

The applicant was awarded $7,704.47 in total expenses.

The applicant was injured in a motor vehicle accident and sought accident benefits, including an attendant care assessment and a psychological assessment.

The insurer initially denied the assessments on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and there was insufficient medical documentation.

The arbitrator found that the applicant had compelling pre-existing conditions, including a prior brain injury and psychiatric diagnoses, which took him outside the MIG.

The arbitrator held that the requested assessments were reasonable and necessary to determine the applicant's entitlement to benefits.

Furthermore, the arbitrator ordered the insurer to pay a special award of $1,083.42, finding that the insurer had unreasonably delayed and withheld payments despite having sufficient information about the pre-existing conditions early on.

The applicant sought statutory accident benefits following a motor vehicle accident.

After the applicant failed to attend a pre-hearing discussion and his representative lost contact with him, the insurer brought a motion to dismiss the application for arbitration.

The arbitrator proceeded in the applicant's absence pursuant to Rule 37.7 of the Dispute Resolution Practice Code.

As the applicant bore the onus of proving entitlement and presented no evidence, the application was dismissed.

The insurer was awarded $750 in expenses for preparing for and attending the proceedings.

The Applicant sought to add issues to the arbitration agenda and requested production of the Insurer's log notes.

The Insurer consented to adding some issues on the condition that a preliminary issue regarding a section 30(1)(b) exclusion be heard separately, and also sought production of documents and a stay of the hearing.

The Arbitrator ordered that all issues, including the preliminary issue, be added to the agenda and heard together to avoid delay.

The Arbitrator granted both production requests, requiring the Insurer to provide an Affidavit of Documents due to unusual delays, and adjourned the hearing on terms to allow the Insurer to obtain its requested records.

This was a costs decision following the defendant's successful summary judgment motion in a statutory accident benefits action.

The court held that substantial indemnity costs were warranted because the plaintiff delayed for years in making the accident benefits claim and made unsupported allegations of dishonesty against the insurer.

The defendant's bill of costs was found to be modest.

Costs were fixed at $10,000 all-inclusive, payable by the plaintiff to the defendant.

The appellant was injured in a motor vehicle accident and sued her insurer for caregiver benefits and extra-contractual damages.

The trial judge dismissed the action, finding it was statute-barred because it was commenced more than two years after the insurer's clear refusal to pay benefits.

The trial judge also found the appellant failed to establish entitlement to caregiver benefits beyond the 104-week period and dismissed her claims for bad faith and mental distress.

The Court of Appeal upheld the trial judge's findings, including his evidentiary ruling that medical reports in a document brief not referred to by witnesses were inadmissible for the truth of their contents.

The defendant insurer moved for summary judgment dismissing a Statutory Accident Benefits action arising from a 2003 motor vehicle accident.

The plaintiff did not file an application for accident benefits until 2014, despite receiving the required materials shortly after the accident and consulting counsel in 2009 about a potential claim.

The court held that the evidence could not establish a reasonable explanation for the extensive delay under s. 31 of O. Reg. 403/96, especially the unexplained period from 2009 to 2014.

The court also found the evidence incapable of supporting entitlement to benefits or a bad faith claim, and granted summary judgment dismissing the action.

Following trial, the court determined entitlement and quantum of costs after the defendant succeeded and the plaintiff failed to respond to the defendant’s bill of costs.

The court considered the presumptive consequences under Rule 49.10 where a party obtains a result as good as or better than a settlement offer, as well as the discretionary factors under Rule 57.01.

While acknowledging the plaintiff’s sympathetic financial circumstances, the court held that sympathy cannot displace the usual costs consequences where the plaintiff was represented by experienced counsel and proceeded despite litigation risks.

The court scrutinized the defendant’s bill of costs and reduced several claimed amounts due to lack of detail and excessive disbursements, including photocopying and expert witness preparation fees.

Costs were fixed with partial indemnity before the offer and substantial indemnity thereafter, subject to reductions.

The plaintiff was injured in a motor vehicle accident and sought statutory accident benefits, including caregiver and non-earner benefits, from her insurer.

The insurer terminated caregiver benefits after 104 weeks, prompting the plaintiff to sue for the benefits, as well as damages for bad faith and mental distress.

The Superior Court of Justice dismissed the action, finding that the claim was statute-barred because it was commenced more than two years after the insurer's clear refusal to pay.

Furthermore, the court held that even if the claim were not statute-barred, the plaintiff failed to prove she suffered a complete inability to carry on a normal life, largely due to pre-existing conditions and a lack of objective medical evidence.

The claims for bad faith and mental distress were also dismissed as the insurer's conduct was reasonable and there was insufficient evidence of compensable distress.

Costs ruling following a summary judgment motion in an insurance dispute.

The moving party successfully obtained summary judgment dismissing claims for wrongful infliction of mental distress, bad faith, and aggravated, punitive, and exemplary damages totaling $1.2 million, but failed to dismiss the primary claim for breach of contract.

The court held that both parties achieved partial success on the motion.

Considering the divided success and the parties’ written submissions, the court exercised its discretion to make no costs award.

The defendant insurer brought a motion for summary judgment dismissing an insured’s claims for breach of contract, intentional infliction of mental distress, bad faith, and aggravated, punitive and exemplary damages arising from the denial of non-earner accident benefits.

The court held there was a genuine issue requiring a trial on whether the insurer’s 2004 denial complied with the Statutory Accident Benefits Schedule, including the notice requirements under s. 32 and related provisions, and therefore whether the limitation period was triggered.

However, the court granted summary judgment dismissing claims for mental distress, bad faith, and punitive-type damages.

The court found the insurance contract was not a “peace of mind” contract whose breach would reasonably contemplate psychological harm, the alleged mental suffering was insufficient to warrant compensation, and the insurer’s conduct did not amount to bad faith or high‑handed misconduct.

The appellant's basement flooded after a municipal culvert became blocked during a major storm.

The appellant sued the city for negligence, alleging inadequate inspection and maintenance.

The trial judge dismissed the action, finding the appellant failed to establish causation because the culvert likely became blocked during the storm itself.

The Court of Appeal found no palpable and overriding error in the trial judge's conclusions on causation or damages and dismissed the appeal.

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

The insurer denied a non-earner benefit based on an initial disability certificate indicating the applicant did not suffer a complete inability to carry on a normal life.

More than two years later, the applicant submitted a new disability certificate supporting a complete inability and sought to arbitrate the denial.

The insurer argued the arbitration was statute-barred by the two-year limitation period.

The arbitrator held that the initial denial was not a valid refusal because there was no valid application for a non-earner benefit at that time, as the applicant had accepted his doctor's opinion that he was ineligible.

Therefore, the limitation period did not commence, and the applicant was not precluded from proceeding to arbitration.