Philippa G. Samworth

The respondent was rendered paraplegic in a motor vehicle accident.

His mother took an unpaid leave of absence to provide 24-hour care.

The insurer argued that under SABS-2010, it was only required to pay attendant care benefits for the 40 hours per week of paid employment the mother forgone, as that was the extent of her 'economic loss'.

The Court of Appeal held that economic loss serves as a threshold for entitlement to attendant care benefits, not as a measure of the quantum.

Once the threshold is met, the insurer must pay for all reasonable and necessary care provided, subject to statutory maximums.

The appeal was dismissed.

The appellant was seriously injured while riding an uninsured dirt bike in Florida.

Her insurer denied her claim for Statutory Accident Benefits (SABs), arguing the dirt bike was not an 'automobile' under her policy.

The application judge dismissed her claim.

On appeal, the Court of Appeal applied the Adams test and found that because the appellant's own dirt bike was insured as an 'automobile' under her policy, the Florida dirt bike of the same make and model also fell within the policy's definition of 'other automobile driven by you'.

The appeal was allowed and a declaration for SABs entitlement was granted.

The appellant was injured in Florida while riding a friend's uninsured dirt bike.

She applied for Statutory Accident Benefits under her standard automobile policy, which covered her own dirt bike.

The insurer denied the claim, and the application judge dismissed her application.

On appeal, the Court of Appeal held that the Florida dirt bike was an 'automobile' within the meaning of the policy, as the policy defined 'automobile' to include 'other automobile driven by you' and the appellant's own dirt bike was insured as an automobile.

The appeal was allowed and a declaration of entitlement to benefits was granted.

The respondent was injured in a motor vehicle accident and applied to the appellant for statutory accident benefits.

An arbitrator found the appellant was the first insurer to receive the application and ordered it to pay benefits pending the resolution of a priority dispute, despite the appellant's claim that it was a victim of a fraudulent pink slip and had no real nexus to the respondent.

The appellant appealed and sought a stay of the arbitrator's order pending the appeal.

The Director's Delegate denied the stay request, finding that granting a stay would thwart the clear legislative intent of O. Reg. 283/95, which is to ensure that the payment of accident benefits to claimants is not delayed due to disputes between insurers over who is liable to pay.

The appellant insurer sought to appeal a preliminary arbitration order determining it was responsible for paying statutory accident benefits to the respondent.

The appellant also requested a stay of the order.

Two other entities, another insurer and an industry association, sought intervenor status.

The Director's Delegate accepted the appeal from the preliminary order but declined to grant a stay, emphasizing the need for seamless receipt of benefits pending dispute resolution.

Both requested intervenors were granted status on specific terms to make submissions on issues of law.

This insurer priority appeal concerned whether an injured 22-year-old qualified as an insured person under his mother's automobile policy because he was principally dependent on her for care while living with her on bail terms.

The Court of Appeal held that dependency for care under the Statutory Accident Benefits Schedule is not determined by a snapshot at the accident date and that the surety relationship, while relevant, is not determinative.

Applying a reasonableness standard to the arbitrator's mixed fact and law determination, the court found the arbitrator properly assessed the broader relationship and correctly concluded the injured person remained substantially independent.

The appeal was allowed, the arbitrator's decision reinstated, and responsibility for benefits remained with the insurer of the occupied vehicle rather than the mother's insurer.

The appellant was injured when crushed between a forklift and a van.

He notified his insurer of a claim for statutory accident benefits nearly two years later, well beyond the 30-day limit under the Statutory Accident Benefits Schedule.

The insurer denied the claim.

The motion judge found the appellant had no reasonable excuse for the delay and declined to grant relief from forfeiture under s. 129 of the Insurance Act, citing prejudice to the insurer.

The Court of Appeal upheld the decision, finding no error in the motion judge's exercise of discretion to deny relief from forfeiture.

The appellant insurer sought indemnification from the respondent insurer under s. 275 of the Insurance Act for accident benefits paid following a motor vehicle collision.

The arbitrator and the Superior Court of Justice held that the limitation period for arbitrating the dispute commenced with the first benefit paid, rendering the claim time-barred.

The Court of Appeal allowed the appeal, holding that a new cause of action and limitation period arises with every payment for which indemnification can be claimed.

The appellant, a truck driver, was ambushed, beaten, and shot after stopping to ask for directions.

He claimed statutory accident benefits, arguing the incident was an 'accident' under the SABS-1996.

The Arbitrator found that the use or operation of the truck did not directly cause his injuries.

On appeal, the Director's Delegate upheld the decision, finding that the assault was an intervening act and the truck was merely the location of the attack, not the direct cause of the impairment.

The insured person was injured in a motor vehicle accident and hospitalized.

His mother took a leave of absence from work to visit him daily, losing $3,966.43 in wages.

The insured claimed this amount as visitor's expenses under s. 21 of the SABS-1996.

The arbitrator allowed the claim, but the insurer appealed.

The Director of Arbitrations allowed the appeal, holding that lost income is not an 'expense incurred' within the meaning of s. 21, distinguishing it from attendant care benefits which explicitly cover lost income or the value of services.

The applicant sought death and funeral benefits after her son was shot and killed in an underground parking garage while performing maintenance on his vehicle.

The insurer denied the claim on the basis that the death was not an 'accident' under the Statutory Accident Benefits Schedule.

The arbitrator dismissed the application, finding that the vehicle did not play a direct instrumental role in the chain of events leading to the death.

The direct and intervening cause of death was the gunshot, not the normal use and operation of the automobile.

This appeal concerned a priority dispute between two automobile insurers over statutory accident benefits payable to a truck driver injured while driving his employer's vehicle.

The court held that the driver was deemed a named insured under the employer's policy by virtue of s. 91(4) of the Statutory Accident Benefits Schedule, with the result that the employer's insurer had priority under s. 268 of the Insurance Act.

The court rejected the argument that the regulation impermissibly altered the statutory meaning of “named insured”, holding that entitlement and priority must be read together.

It further held that s. 91(4) was authorized by the Act's broad regulation-making power.

The appellant insurer appealed an arbitrator's decision awarding a $10,000 death benefit to each of the deceased's parents under s. 25(2) 5. i of the Statutory Accident Benefits Schedule (SABS-1996).

The insurer argued that only a single $10,000 payment was payable in respect of the death of a dependant, relying on previous decisions under earlier SABS regimes.

The Director's Delegate dismissed the appeal, finding that the subtle shift in language in SABS-1996 contemplated that more than one person could qualify for the payment, entitling both parents to the benefit.

The applicant was injured in a motor vehicle accident and hospitalized for two months.

His mother stopped working to visit him daily and claimed her lost wages as a visitor expense under section 21 of the Statutory Accident Benefits Schedule.

The insurer denied the claim, arguing that lost wages are not an 'expense incurred' under the Schedule.

The arbitrator held that the mother's wage loss was the financial cost of her daily hospital visits and fell within the meaning of 'expenses incurred'.

The mother was entitled to recover her lost wages.

The applicant's spouse died from carbon monoxide poisoning while operating a Gravely tractor in an underground parking garage.

The applicant sought death benefits under a standard automobile policy.

The insurer denied the claim on the basis that the tractor was not an automobile.

The arbitrator applied the three-stage test from Regele v. Slusarczyk and found that the tractor was not an automobile in ordinary parlance, was not covered by the policy, and was not required to be insured under the Compulsory Automobile Insurance Act or the Off-Road Vehicles Act because it was not operated on a highway or off the owner's property.

The preliminary issue was resolved in favour of the insurer.

The applicants' 16-year-old son died in a motor vehicle accident.

The insurer paid the parents a joint death benefit of $10,000 under the 1996 Statutory Accident Benefits Schedule.

The parents applied for arbitration, arguing they were each entitled to a separate $10,000 benefit.

The arbitrator held that under subparagraph 25(2)5(i) of the 1996 SABS, the insurer is required to pay a benefit of $10,000 to each person in respect of whom the insured person was a dependant at the time of the accident.

The insurer was ordered to pay an additional $5,000 to each parent.

The applicant was injured in two motor vehicle accidents in 1995 and sought statutory accident benefits, including caregiver benefits, housekeeping expenses, and medical/rehabilitation costs.

The insurer terminated caregiver benefits in 1996 based on surveillance and medical assessments suggesting the applicant was exaggerating her symptoms.

The arbitrator dismissed the claim for ongoing caregiver benefits, finding the applicant's evidence unreliable and her limitations overstated.

However, the arbitrator partially granted the claims for housekeeping expenses, recognizing some ongoing impairment, and ordered the insurer to pay outstanding medical, chiropractic, and transportation expenses.

The applicant sought interim income replacement and medical-rehabilitation benefits following a motor vehicle accident.

The insurer had terminated benefits, and the parties were unable to resolve their disputes through mediation.

The arbitrator found that the applicant established a probable case for entitlement to income replacement benefits and demonstrated financial urgency, awarding partial interim income replacement benefits at $235.74 per week.

The arbitrator also awarded interim benefits for housekeeping and transportation to medical appointments, but denied other requested medical and rehabilitation expenses, finding they were either past expenses or not urgently required.

The issue of a special award was reserved for the main arbitration hearing.

The Applicant was injured in a motor vehicle accident and sought statutory accident benefits.

The Insurer argued that the Applicant was precluded from proceeding to arbitration under section 71.1 of the Statutory Accident Benefits Schedule because she failed to attend Insurer's Examinations and Designated Assessment Centre (DAC) assessments.

The Arbitrator found no evidence that the Applicant failed to attend a section 65 examination.

Furthermore, the Insurer failed to request the required certificates for supplementary medical and rehabilitation expenses, meaning there was no basis to require DAC assessments for those claims.

The Arbitrator ruled the Applicant was entitled to proceed to arbitration on all issues.

The applicant claimed statutory accident benefits from the insurer, alleging she was injured as a passenger in a motor vehicle accident.

The insurer denied the claim on the basis that she was not a passenger in the vehicle at the time of the collision.

Following a hearing on this preliminary issue, the arbitrator found significant inconsistencies and contradictions in the evidence provided by the applicant and the driver, particularly when compared to the investigating police officer's notes.

The arbitrator concluded that the applicant was not in the vehicle at the time of the accident and dismissed her claim for benefits.