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Application for assessment costs dismissed; insurer not required to pay provider travel expenses or exceed fee cap.
The applicant, who was catastrophically impaired in a motor vehicle accident, sought payment for various assessment costs under the Statutory Accident Benefits Schedule.
The insurer denied portions of the treatment plans on the basis that they exceeded the $2,000 cap per assessment under s. 25(5)(a) or were for provider travel expenses not covered under s. 25(4).
The Tribunal agreed with the insurer, finding that the applicant failed to demonstrate the reasonableness of the unapproved portions, including attempts to bifurcate assessments to circumvent the fee cap.
The application was dismissed.
The court dismissed a summary judgment motion on a limitation period defence because the defendants failed to prove when the plaintiff's injuries met the threshold.
The defendants moved for summary judgment to dismiss the plaintiff's motor vehicle accident claim, arguing it was statute-barred by the Limitations Act, 2002.
The court dismissed the motion, finding that the defendants failed to meet their evidentiary burden to establish there was no serious issue requiring a trial regarding the discoverability of the claim, specifically whether the plaintiff's injuries met the "threshold" for non-pecuniary damages within the limitation period.
The court also found that the matter was not suitable for resolution using expanded summary judgment powers due to overlapping evidence with the merits of the claim.
Medical benefits partially granted; one treatment plan statute-barred for failure to attend insurer's examination.
The applicant sought statutory accident benefits for physiotherapy, chiropractic treatment, and the cost of completing an OCF-18 following a motor vehicle accident.
The Tribunal found the $2,495.48 treatment plan reasonable and necessary to assist in the applicant's recovery.
However, the $3,260.64 treatment plan was dismissed as the applicant was statute-barred under s. 55 for failing to attend an insurer's examination.
The claim for the cost of completing the OCF-18 was also dismissed as it did not meet the criteria under s. 25(1)3.
The Tribunal declined to order an award under s. 10 of O. Reg. 664, finding no evidence that the insurer acted in bad faith.
Respondent awarded $700 in expenses after insurer's appeal of an interim order was declined.
The appellant insurer filed an appeal from an arbitrator's order, which the Director's Delegate declined to hear on the basis that it was an appeal of an interim or preliminary order.
The respondent subsequently sought expenses for the appeal proceeding.
The Director's Delegate rejected the insurer's argument that expenses should be deferred until a hypothetical future hearing on the merits, and awarded the respondent $700 inclusive of disbursements and HST for the written proceeding.
Insurer ordered to pay $52,000 Special Award and over $39,000 in expenses for unreasonably delaying benefits.
Following a finding that the insurer unreasonably delayed payment of attendant care and medical benefits, the arbitrator determined the quantum of the Special Award and expenses.
The arbitrator awarded a Special Award of $52,000, finding the insurer's conduct blameworthy and noting the vulnerability of the insured.
The arbitrator also awarded the applicant $35,360.45 for arbitration expenses and $4,279.88 for the costs of the written hearing on these issues.
Tribunal orders insurer to pay for physiotherapy, laser therapy, and assessments, finding them reasonable and necessary.
The applicant sought payment for several medical benefits and assessments following a motor vehicle accident, which the respondent insurer denied.
The Licence Appeal Tribunal found that the proposed physiotherapy and laser spinal decompression treatments were reasonable and necessary, rejecting the insurer's argument that they were merely passive therapies.
The Tribunal also approved a psycho-vocational and functional abilities evaluation, capping the cost at the statutory limit of $2,000 per assessment, and allowed an in-home assessment for attendant care needs despite the 104-week mark having passed, as the applicant might be entitled to future benefits if deemed catastrophically impaired.
Ongoing attendant care benefits and Special Award granted due to insurer's unreasonable delay in payments.
The applicant was injured in a motor vehicle accident when the bus he was on collided with a train, resulting in catastrophic impairments.
He sought ongoing attendant care benefits and a Special Award for the insurer's unreasonable delay in paying benefits.
The arbitrator found that the applicant was entitled to ongoing attendant care benefits at $6,000 per month, rejecting the insurer's argument that the applicant must continually prove the expenses were 'incurred' each month.
The arbitrator also awarded a Special Award, finding that the insurer acted unreasonably, imprudently, and inflexibly in delaying payments for attendant care and medical benefits despite having sufficient evidence of the applicant's economic loss and catastrophic impairments.
Appeal dismissed; personal injury action statute-barred as plaintiff failed to diligently investigate permanence of injuries.
The appellant was struck by a car and retained a lawyer who pursued accident benefits but failed to commence a tort action within the limitation period.
The appellant sued the lawyer for negligence, and new counsel subsequently issued a statement of claim against the driver.
The motion judge dismissed the tort action as statute-barred, finding the appellant failed to exercise reasonable diligence to discover whether her injuries met the Insurance Act threshold.
The Court of Appeal upheld the dismissal, concluding that the appellant's failure to inquire about the permanence of her injuries was unreasonable and that a defence medical report obtained during litigation did not toll the limitation period.
Leave to appeal security for costs order denied; motions judge properly considered ATE insurance.
The plaintiff sought leave to appeal an interlocutory order requiring her to post security for costs.
She argued the motions judge failed to properly consider her After the Event (ATE) Legal Expense Insurance as an asset in Ontario.
The Divisional Court dismissed the application, finding the motions judge did consider the ATE insurance as one of several factors and there was no good reason to doubt the correctness of the decision.
The court also declined to admit fresh evidence regarding the ATE insurance on the leave application.
Successful insurer awarded $5,000 in arbitration expenses, reduced to reflect applicable legal aid tariff rates.
Following the dismissal of the applicant's claim for statutory accident benefits, the successful insurer sought its expenses for the arbitration.
The arbitrator found the insurer was entitled to expenses, noting it had bettered its offer to settle and the issues were not novel.
However, the arbitrator reduced the claimed amount because the insurer's counsel incorrectly billed at the higher hourly rate reserved for an insured person's counsel under the Dispute Resolution Practice Code, rather than the applicable legal aid tariff rate.
Costs were fixed at $5,000.00 inclusive of HST.
Plaintiff awarded $12,500 in partial indemnity costs after defendant abandoned summary judgment limitation period motion.
The defendant brought a motion for summary judgment to dismiss the plaintiff's motor vehicle accident claim based on the expiry of the limitation period.
On the eve of the motion, the defendant abandoned it, and the parties attended a hearing solely to determine costs.
The plaintiff sought costs on a substantial indemnity basis, arguing the motion was unreasonable from the outset because the permanency of her injuries was not discoverable until a later medical report was obtained.
The court found no reason to depart from the presumption under Rule 37.09(3) that the responding party is entitled to costs of an abandoned motion.
However, the court declined to award substantial indemnity costs, finding no bad faith or egregious conduct by the defendant.
Costs were fixed at $12,500 on a partial indemnity basis.
Unnecessary motion led to costs against the successful moving defendant.
This was a costs decision following a summary judgment motion in an insurance consent dispute arising from a motor vehicle accident.
Although the moving defendant ultimately succeeded on the underlying motion and had served favourable offers to settle, the court held the motion process was unnecessary because he failed for years to answer undertakings and produce contemporaneous insurer communications that would likely have resolved the coverage dispute earlier.
Applying the costs discretion under s. 131 of the Courts of Justice Act and the Rule 57.01 factors, with particular emphasis on whether an unnecessary step was taken, the court awarded costs against the moving defendant to the insurer respondent.
The decision emphasizes the post-Hryniak culture shift requiring timely disclosure and cooperative, proportionate litigation conduct.
Summary judgment denied; mini-trial ordered to determine implied consent to vehicle possession.
The defendant vehicle owner brought a motion for summary judgment seeking dismissal of the claim against him arising from a rear-end collision, arguing the driver had taken the vehicle without consent under s.192(2) of the Highway Traffic Act.
The record included a statutory declaration from the driver asserting she had taken the vehicle without consent, but conflicting statements and incomplete discovery evidence raised credibility concerns.
The court held that inconsistencies, evidentiary gaps, and unresolved credibility issues prevented a fair determination on the written record.
Applying the summary judgment framework from Hryniak v. Mauldin, the court declined to grant summary judgment and ordered a limited oral hearing.
A mini-trial was directed to determine whether the driver had the owner’s implied consent to possess the vehicle.
Vehicle owner rebutted statutory consent presumption and was not negligent in safeguarding keys.
The moving defendant sought summary judgment dismissing a motor vehicle negligence action against her arising from a collision caused by her estranged spouse driving her vehicle while impaired.
The issue was whether the vehicle was in the driver’s possession with the owner’s implied consent under s. 192(2) of the Highway Traffic Act, or alternatively whether the owner was negligent in safeguarding her car keys.
The court held the owner rebutted the statutory presumption of consent, finding she had taken reasonable steps to prevent access to the vehicle and did not grant express or implied permission.
The alleged inconsistencies in her testimony were immaterial and did not undermine credibility on the central issues.
The court also rejected the insurer’s negligence argument, finding the owner acted as a reasonable and prudent person in controlling the keys.
Order varied on consent to deduct CPP disability benefits from ongoing income replacement benefits.
The insurer brought an application to vary a 2007 order that required it to pay the insured $263.51 per week in income replacement benefits.
The insurer argued that the insured's receipt of CPP Disability Benefits constituted a material change in circumstances and that the benefits should be deducted from the income replacement benefits.
The insured consented to the variation, provided it was effective from the date she was served with the application.
The arbitrator found a material change in circumstances and varied the order on consent, reducing the weekly income replacement benefits to $130.35 effective October 2, 2013.
Appeal dismissed; concurrent tort liability finding made alleged charge errors immaterial.
Following a jury verdict apportioning fault for a motor vehicle accident between two motorcyclists, the appellant challenged the trial judge’s jury instructions on causation, joint tortfeasor liability, and concurrent liability.
The court held that any alleged error concerning joint tortfeasor instructions was immaterial because the jury’s answers clearly established liability as a concurrent tortfeasor, and the evidence supported that route to liability.
The court also rejected the argument that the charge was unbalanced or unfair when read as a whole.
It further upheld the dismissal of a post-verdict Rule 21.01 motion concerning insurance coverage, holding that the issue could properly proceed in a separate action.
Accident benefits claim dismissed; expert evidence proved the alleged collision never occurred, constituting willful misrepresentation.
The applicant sought statutory accident benefits following an alleged motor vehicle collision where he claimed to be a passenger in a BMW struck by a Nissan.
The insurer denied the claim, arguing the accident did not occur.
At a preliminary issue hearing, the insurer presented uncontroverted expert evidence from a collision reconstructionist demonstrating that the physical damage to the vehicles was entirely inconsistent with a collision between them.
The arbitrator accepted the expert's findings, concluded the applicant was not involved in an accident as defined by the Schedule, and found that the applicant had wilfully misrepresented material facts in his application for benefits.
Plaintiff entitled to costs where verdict plus prejudgment interest exceeded settlement offer.
Following a jury verdict awarding damages for personal injury arising from a motor vehicle accident, the court addressed entitlement to costs in light of competing Rule 49 settlement offers.
The jury awarded $60,000 in total damages, including $15,000 for general damages and $45,000 for future loss of income or competitive advantage.
The court considered whether prejudgment interest should be notionally applied to the general damages award when comparing the verdict to the defendant’s settlement offer for Rule 49 purposes, particularly given the statutory deduction under the Insurance Act.
The court held that statutory deductions are ignored when determining entitlement to costs and that prejudgment interest should be notionally added to the general damages.
With that calculation, the plaintiff obtained a judgment slightly more favourable than the defendant’s offer and was therefore presumptively entitled to costs.
Successful insurer awarded appeal expenses calculated at Legal Aid rate plus experience allowance.
The insurer was wholly successful on an appeal regarding an arbitration expenses award and sought its legal expenses for the appeal.
The Director's Delegate found that the appeal did not raise novel issues and that the insurer's success entitled it to its legal expenses.
The Delegate reduced the claimed preparation time and awarded the insurer $1,078.55 in total expenses, inclusive of HST and disbursements, calculated at the Legal Aid rate plus experience allowance.
Appeal of costs order dismissed; arbitrator's disallowance of travel time and use of preparation time multiple upheld.
The appellant appealed an arbitrator's costs order following the withdrawal of the insurer's variation application.
The appellant argued the arbitrator erred by disallowing counsel's travel time, applying a multiple to hearing time to calculate preparation time rather than using actual docketed hours, and disallowing a disbursement for a psychological report.
The Director's Delegate dismissed the appeal, finding no error in the arbitrator's exercise of discretion.
Travel time is generally not compensable, the use of a 4:1 ratio for preparation time appropriately compensated for wasted preparation, and the expert report was reasonably found to be unhelpful and unnecessary for the hearing.