18 total
Application for catastrophic impairment designation dismissed as applicant failed to meet whole person impairment threshold.
The applicant sought statutory accident benefits following a 2019 motor vehicle accident, claiming he sustained a catastrophic impairment.
The Licence Appeal Tribunal assessed the applicant's impairments under criteria 7 and 8 of the Schedule.
The Tribunal found the applicant's whole person impairment rating was 46%, falling short of the 55% threshold required under criterion 7.
Under criterion 8, the Tribunal rejected the applicant's claim of a marked impairment in social functioning, finding his pre-accident history contradicted the expert's opinion.
The Tribunal also dismissed the applicant's claims for the cost of a catastrophic determination assessment, an award for unreasonable delay, and interest, as the applicant failed to meet his evidentiary onus.
Insurer ordered to pay income replacement benefits due to failure to provide proper statutory notice.
The applicant sought an income replacement benefit (IRB) following a motor vehicle accident.
The respondent insurer failed to pay the benefit, provide a notice of medical or other reasons for denial, or request further information directly from the applicant within 10 days of receiving the disability certificate, as required by s. 36(4) of the Statutory Accident Benefits Schedule.
The Licence Appeal Tribunal held that the respondent's failure to comply with s. 36(4) triggered s. 36(6), obligating the respondent to pay the IRB from the date the application was received until proper notice is given.
The applicant's claim for an award for unreasonable delay was dismissed due to a failure to disclose particulars.
Tribunal awards costs against insurer for improperly redacting log notes but declines to state contempt case.
The applicant sought statutory accident benefits following a motor vehicle accident.
During the hearing, several preliminary motions were heard.
The Tribunal excluded the respondent's late-filed catastrophic assessment reports and denied the applicant's request to add catastrophic determination as an issue.
The Tribunal ordered the disclosure of improperly redacted log notes, finding that 'client-to-client' discussions did not automatically attract litigation privilege.
The Tribunal awarded $2,000 in costs against the respondent for bad faith conduct in failing to comply with previous production orders and improperly redacting documents.
However, the Tribunal declined to state a case for contempt of court.
Following the denial of an adjournment request, the applicant withdrew her application.
Appeal of arbitration award dismissed; priority insurer must reimburse full out-of-province accident benefits paid.
Allstate paid Michigan-level personal injury protection (PIP) benefits to an insured following a motor vehicle accident in Michigan.
TD Home accepted priority as the proper insurer but only reimbursed Allstate for Ontario-level benefits, arguing it was not obligated to pay Michigan-level benefits because it had not signed Michigan's Certification List.
An arbitrator ordered TD Home to reimburse the full amount.
TD Home appealed.
The Superior Court of Justice dismissed the appeal, finding the arbitrator's decision was reasonable and within his authority under the Arbitration Act to decide the dispute in accordance with law and equity.
Appeal of SABS decision dismissed; Arbitrator's credibility findings and application of legal tests upheld.
The appellant appealed an Arbitrator's decision denying her claims for catastrophic impairment, attendant care, caregiver, medical, and housekeeping benefits following a 2009 motor vehicle accident.
The appellant argued the Arbitrator provided inadequate reasons, applied incorrect legal tests for burden of proof and causation, and erred in weighing evidence and assessing credibility.
The Director's Delegate dismissed the appeal, finding that the Arbitrator's reasons were adequate, the correct legal tests were applied, and the credibility findings were supported by ample evidence.
The Arbitrator's decision was confirmed and costs of $3,390 were awarded to the respondent.
Application for statutory accident benefits and catastrophic impairment designation dismissed due to lack of credibility.
The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including a determination of catastrophic impairment, attendant care, caregiver, medical, and housekeeping benefits.
The arbitrator found that the applicant failed to prove her entitlement on a balance of probabilities, noting significant issues with her credibility, evidence of malingering, and a failure to disclose pre-existing medical conditions.
The arbitrator preferred the evidence of the insurer's medical experts, who concluded that the applicant had reached maximum medical recovery and did not meet the threshold for catastrophic impairment.
All claims for benefits were denied.
Motion to extend trial set-down deadline granted despite plaintiff's delay, but plaintiff ordered to pay $30,000 costs.
The plaintiff insurer brought a motion to extend the deadline for setting the action down for trial, effectively seeking to avoid the Registrar's dismissal of the action for delay.
The court applied the test for setting aside a dismissal order, including the Reid factors.
Although the plaintiff failed to adequately explain its 19-month delay or prove inadvertence, the court granted the extension because the defendants failed to establish actual prejudice resulting from the delay.
However, due to the plaintiff's lengthy unexplained delays and conduct, the court ordered the successful plaintiff to pay the defendants $30,000 in substantial indemnity costs.
Standard accident benefit forms and PHIPA permit disclosing non-party medical records in fraud litigation.
The plaintiff insurers alleged a conspiracy to defraud by the defendants involving false medical assessment reports and invoices for statutory accident benefits claimants.
The moving defendants sought directions on producing medical documentation containing personal health information (PHI) of non-party claimants.
The court held that the claimants' consent in the Application for Accident Benefits (OCF-1) was broad enough to permit disclosure in civil litigation.
Furthermore, section 49(1) of the Personal Health Information Protection Act, 2004 (PHIPA) independently permitted the plaintiffs, as recipients, to use and disclose PHI for the action's purposes.
To address privacy concerns, the court directed that PHI be filed separately in a sealed envelope with the presiding judicial officer, not in the public court file.
Appeal of jury trial conduct and cross-appeal on costs dismissed; no substantial wrong demonstrated.
The appellant appealed a jury award of $114,216.44 arising from a motor vehicle collision, arguing the trial judge made several errors including admitting a WSIB statement of claim, failing to strike the jury due to improper cross-examination, and providing an inadequate jury charge.
The respondents cross-appealed the trial judge's costs award regarding disbursements incurred after a Rule 49 settlement offer.
The Court of Appeal dismissed both the appeal and cross-appeal, finding no substantial wrong or miscarriage of justice in the trial's conduct and insufficient evidence on the record to prove an error in the costs award.
Leave to appeal order permitting video-recording of defence psychiatric examination denied.
The defendants sought leave to appeal an order permitting the plaintiff to video-record a defence psychiatric examination.
The motions judge had allowed the recording because the defence doctor refused to allow the plaintiff to take notes or record the examination.
The Divisional Court dismissed the application for leave to appeal, finding no conflicting decision under Rule 62.02(4)(a) and that the matter was not of general importance under Rule 62.02(4)(b), as the Court of Appeal had already established the legal principles in Bellamy v. Johnson.
Arbitrator lacked statutory authority to add paralegal as a party and order him to pay costs.
A paralegal associated with a treatment facility commenced an arbitration proceeding using forged authorizations from the insured persons.
The Arbitrator found the proceeding was unauthorized, added the paralegal as a party, and ordered him to pay the arbitration expenses of the insured persons and the insurer.
On appeal, the Director's Delegate held that the Arbitrator exceeded her authority, as there is no statutory power under the Insurance Act or the Statutory Powers Procedure Act to order a representative or non-party to pay arbitration expenses, nor to add them as a party for that purpose.
The appeal was allowed and the arbitration withdrawn.
Insurer is only required to pay a single $10,000 death benefit under s. 25(2)(5)(i) of SABS.
Following the death of their daughter in a motor vehicle accident, the parents applied for death benefits under the Statutory Accident Benefits Schedule.
The insurer paid a single $10,000 benefit to the father as the principal financial supporter, but denied the mother's claim for an additional $10,000 as the principal caregiver.
The Divisional Court held that multiple payments were required.
The Court of Appeal allowed the insurer's appeal, holding that the modern rule of statutory interpretation and the legislative context of the SABS indicate that only a single $10,000 death benefit is payable under s. 25(2)(5)(i), which may be paid jointly to the principal financial supporter and caregiver.
Treatment provider who commenced unauthorized arbitration using forged patient signatures ordered to pay parties' expenses.
A partner at a treatment centre commenced arbitration applications for statutory accident benefits in the names of two former patients.
The patients had previously settled their claims and paid the treatment centre's account in full.
The arbitrator found that the authorizations filed by the treatment provider were forged and that the patients had not authorized the proceedings.
Finding that the treatment provider commenced the arbitration on his own account and abused the tribunal's process, the arbitrator amended the style of cause to make the provider the applicant and ordered him to pay the expenses of the patients and the insurer before being permitted to withdraw the applications.
Insurer must pay separate death benefits to each parent upon whom the deceased was dependent.
Following the death of their daughter in a motor vehicle accident, both parents applied for death benefits from the insurer.
The insurer paid the father but denied the mother's claim, arguing the Statutory Accident Benefits Schedule only contemplated a single payment.
The motions judge agreed and dismissed the mother's action.
On appeal, the Divisional Court held that the wording of s. 25(2)5.i. of the Schedule, which provides for payment to 'a person' rather than 'the person', requires the insurer to make separate payments to each person upon whom the deceased was dependent.
The appeal was allowed.
Child's go-kart is a motorized land vehicle excluded from homeowner's insurance coverage.
A visitor was injured when a child lost control of a go-kart on the insureds' property.
The insureds claimed coverage under their homeowner's insurance policy.
The insurer denied coverage, relying on an exclusion for 'motorized land vehicles'.
The motion judge found the go-kart was a toy or 'implement' and thus excepted from the exclusion.
The Court of Appeal allowed the insurer's appeal, holding that the go-kart was a motorized land vehicle and did not fall within the exception for 'implements' such as lawnmowers or snow blowers.
The claim was therefore excluded from coverage.
Applicant awarded ongoing weekly income benefits after 156 weeks due to continuous disability from accident.
The applicant was injured in a motor vehicle accident and received weekly income benefits for 156 weeks.
The insurer terminated benefits, arguing the applicant was no longer disabled and could return to work.
The applicant applied for arbitration, claiming ongoing disability due to chronic pain, depression, and cognitive difficulties.
The arbitrator found the applicant credible and preferred the medical evidence supporting her disability over the insurer's medical examinations.
The arbitrator concluded that the applicant was continuously prevented from engaging in any occupation for which she was reasonably suited by education, training, or experience.
The applicant was awarded ongoing weekly income benefits and interest on overdue payments.
Arbitrator has jurisdiction to determine if a settlement exists, but no enforceable settlement was achieved here.
The applicant sought to enforce a settlement agreement regarding statutory accident benefits after the insurer rescinded its offer.
The insurer argued the arbitrator lacked jurisdiction to determine if a settlement existed.
The arbitrator held that she had jurisdiction by necessary implication to determine if a settlement was reached.
However, because the insurer had not delivered the written notice required by the Settlement Regulation (O. Reg. 780/93) before the settlement was entered into, no enforceable settlement was achieved.
The applicant was awarded expenses for the preliminary hearing.
Payments from applicant's sole proprietorship qualify as deductible post-accident income under the Schedule.
The applicant was injured in a motor vehicle accident and received weekly income benefits.
He owned a courier service that continued to operate for two months post-accident.
The insurer sought to deduct payments made to the applicant by his business during this period.
The arbitrator found that as the sole proprietor, any money flowing to the applicant from the business qualified as post-accident income under section 15 of the Schedule.
The arbitrator concluded that the applicant received $9,130 in post-accident compensation, of which 80% was deductible from his weekly income benefits.