Svet Ivanov

The applicant sought reconsideration of a Tribunal decision dismissing her application for accident benefits.

The insurer had denied two Treatment and Assessment Plans and requested insurer examinations, providing only general statements that the medical documentation did not support the need for treatment.

The Executive Chair found that the insurer failed to satisfy the notice requirements under s. 38(8) of the Statutory Accident Benefits Schedule, as it did not provide specific medical reasons based on the applicant's file.

Consequently, under s. 38(11)2, the insurer was ordered to pay for the disputed benefits.

The request for a special award was denied.

The plaintiff's property was damaged when a dam on a neighbouring property broke, releasing a deluge of water.

The defendant insurer denied coverage under the plaintiff's comprehensive homeowners policy, citing exclusions for ground water, surface water, and general water damage.

The plaintiff brought a motion for summary judgment on the issue of liability.

The court found that the initial grant of coverage applied and that the ground and surface water exclusions did not.

While the general water exclusion applied, the court held that the exceptions for the sudden and accidental escape of water from a sewer or drain, and for water entering through an opening created suddenly and accidentally, brought the loss back into coverage.

Summary judgment was granted to the plaintiff.