6 total
Applicant partially awarded accident benefits; one claim barred for failure to attend insurer's examination.
The applicant sought statutory accident benefits following a motor vehicle accident.
The respondent denied several treatment plans, prompting the applicant to apply to the Licence Appeal Tribunal.
The Tribunal found the applicant was statute-barred from pursuing one occupational therapy treatment plan because she failed to attend a properly scheduled insurer's examination without a reasonable explanation.
However, the Tribunal ordered the respondent to pay for a driving assessment and a dietician assessment because the respondent failed to provide proper notice of denial under s. 38(8) of the Schedule.
Another occupational therapy plan was partially approved based on medical evidence supporting the need for cognitive and psycho-emotional support.
The claim for an award for unreasonable delay was dismissed.
Judicial review dismissed; insurer's termination letter was ambiguous and did not trigger the limitation period.
The applicant insurer sought judicial review of a Licence Appeal Tribunal decision finding that the respondent insured was not barred by the two-year limitation period from claiming income replacement benefits.
The Tribunal had concluded that the insurer's termination letter was not a clear and unequivocal denial because it left open the possibility of future benefits upon submission of an updated disability certificate.
The Divisional Court dismissed the application, holding that the Tribunal's interpretation of the letter as ambiguous was both reasonable and correct.
The court also upheld the Tribunal's refusal to extend the time for the insurer's reconsideration request.
Extension of time for judicial review granted due to ongoing related Court of Appeal proceedings.
The moving party insurer sought an extension of time to commence an application for judicial review of a 2020 Licence Appeal Tribunal (LAT) decision regarding income replacement benefits.
The moving party relied on the recent Supreme Court of Canada decision in Yatar to explain the delay.
The Divisional Court granted the motion on terms, noting that while finality is a central principle, the prejudice to the respondent was diluted by the fact that an appeal regarding the same benefits was still outstanding at the Court of Appeal.
Two insurers found to be of equal priority due to the interplay of the Insurance Act and O. Reg. 283/95 must share liability for statutory accident benefits equally.
The appellant, Chubb Insurance Company of Canada, appealed an arbitration decision that held it solely liable for Statutory Accident Benefits (SABS) payments to an injured person, despite Zurich Insurance Company being the actual primary insurer.
The Supreme Court of Canada had previously ruled that Chubb, as the first insurer to receive a misdirected SABS application, was deemed an insurer for the claim.
The Superior Court found that the arbitrator erred by not fully analyzing the interplay between the Insurance Act and O. Reg. 283/95.
The court concluded that both Chubb and Zurich were insurers of equal priority due to the unique circumstances and must share liability 50/50, with each responsible for 2% compound interest for delays attributable to them.
Appeal from LAT decision denying income replacement benefits dismissed; no error of law or procedural unfairness found.
The appellant appealed a Licence Appeal Tribunal (LAT) decision and a reconsideration decision that denied his claim for ongoing income replacement benefits following a motor vehicle accident.
The appellant argued the LAT erred in law by admitting the insurer's expert reports without the required expert forms, misinterpreting the Statutory Accident Benefits Schedule (SABS), and denying procedural fairness.
The Divisional Court dismissed the appeal, finding the adjudicator properly exercised her discretion to admit the reports and weigh the evidence, correctly applied the SABS disability tests, and afforded the appellant procedural fairness.
Catastrophic impairment designation denied because the applicant's mobility impairment and SCIM score were not permanent.
The applicant was injured in a motor vehicle accident and sought a catastrophic impairment designation under s. 3.1(1)2(iii) of the Statutory Accident Benefits Schedule based on a temporary Spinal Cord Independence Measure (SCIM) score of four.
The respondent denied the claim, arguing the impairment must be permanent.
The Tribunal agreed with the respondent, finding that a plain reading and purposive analysis of the Schedule requires a permanent alteration of function, measured by a permanent SCIM score between zero and five.
As the applicant's mobility impairment was temporary, she did not meet the criteria for a catastrophic impairment.
