15 total
Motion to remove defence counsel for allegedly using summonses for improper pre-trial discovery dismissed.
The plaintiff brought a motion on the eve of trial to remove the defendant's lead counsel of record, alleging that the defence lawyer improperly used Summonses to Witness to obtain pre-trial disclosure of confidential medical records.
The plaintiff argued that the cover letters accompanying the summonses coerced witnesses into providing documents before trial to avoid attending court during the COVID-19 pandemic.
The court dismissed the motion, finding that a reasonably informed member of the public, reading the summons and cover letter as a whole, would not interpret them as an attempt to obtain improper pre-trial discovery.
The plaintiff's alternative request to quash the summonses was reserved to the trial judge.
Attendant care benefits denied due to failure to prove ongoing economic loss and non-compliance with information requests.
The applicant sought attendant care benefits following a motor vehicle accident, claiming 24-hour care provided by two non-professional service providers.
The insurer denied the benefits on the basis that the providers had not sustained an ongoing economic loss and that the applicant failed to comply with requests for income documentation under section 33 of the Statutory Accident Benefits Schedule.
The arbitrator found that the first provider did not sustain an ongoing economic loss and that both providers failed to provide timely income documentation as reasonably requested by the insurer.
Consequently, the claims for attendant care benefits were dismissed due to non-compliance with section 33.
Judicial review dismissed; GCS score of 9 is a valid proxy for catastrophic impairment under SABS.
The applicant insurer sought judicial review of a FSCO Director's Delegate decision upholding an Arbitrator's finding that the respondent suffered a catastrophic impairment.
The respondent had recorded a Glasgow Coma Scale (GCS) score of 9 several days after a motor vehicle accident, which the insurer argued was confounded by medication and other injuries rather than brain impairment.
The Divisional Court dismissed the application, holding that the standard of review is reasonableness and that the SABS regulation uses the GCS score as a proxy measurement without requiring an inquiry into the patient's prognosis or the specific cause of the lowered score.
Insurer's appeal dismissed; GCS score of 9 met catastrophic impairment definition despite confounding medical factors.
The appellant insurer appealed an arbitrator's decision finding that the respondent insured sustained a catastrophic impairment following a motor vehicle accident.
The arbitrator found the respondent met the definition under the Statutory Accident Benefits Schedule based on a Glasgow Coma Scale (GCS) score of 9 recorded four days post-accident.
The insurer argued the score was invalid due to consciousness-lowering drugs and was not taken within a reasonable time.
The Director's Delegate dismissed the appeal, holding that the definition of catastrophic impairment is a legal test, not a medical one, and does not require excluding confounding factors.
The Delegate found no error in the arbitrator's conclusion that the GCS score resulted from a brain impairment and was taken within a reasonable time.
Leave granted to amend claim adding insurers and uninsured coverage issues.
The plaintiffs brought a motion for leave to amend their Statement of Claim to add additional defendants, including insurers, and to seek declaratory relief regarding entitlement to statutory accident benefits and uninsured or underinsured motorist coverage following a motor vehicle accident involving an uninsured driver.
The proposed insurers opposed the amendments, arguing that accident benefits claims required prior mediation and that there was insufficient evidence to support entitlement to coverage as dependent relatives under the relevant policies.
The court considered Rule 26.01 of the Rules of Civil Procedure and whether the proposed amendments raised triable issues.
It held that there were serious and triable issues regarding potential coverage under the insurance policies and that denying the amendments would be premature.
The court granted leave to amend the Statement of Claim and allowed the proposed insurers to be added as defendants.
Appeal of preliminary catastrophic impairment finding rejected to avoid delaying the scheduled final arbitration hearing.
The appellant insurer sought to appeal a preliminary arbitration order which found that the respondent insured had sustained a catastrophic impairment based on Glasgow Coma Scale scores.
The Director's Delegate declined to exercise discretion to hear the appeal at this time, noting that the issues raised were not novel and that hearing the appeal would prejudice the respondent by delaying the final substantive arbitration hearing scheduled for two months later.
The appeal was rejected without prejudice to it being raised after all issues in dispute have been finally decided.
Applicant met catastrophic impairment threshold based on Glasgow Coma Scale scores of 9 despite presence of sedatives.
The Applicant was injured in a motor vehicle accident and applied for enhanced statutory accident benefits, claiming a catastrophic impairment due to a brain impairment resulting in a Glasgow Coma Scale (GCS) score of 9 or less.
The Insurer disputed the catastrophic impairment designation.
The arbitrator found that while a GCS score of 3 during intubation and medical paralysis was untestable and could not satisfy the definition, subsequent GCS scores of 9 recorded by a nurse were valid.
Relying on the Court of Appeal's decision in Liu, the arbitrator held that the GCS test is a legal bright-line rule rather than a scientifically precise measurement, and declined to adjust the score for the potential effects of sedatives.
The arbitrator concluded the Applicant suffered a catastrophic impairment.
Appeal dismissed; experts must answer questions on the foundation of their opinions during cross-examination on affidavits.
The plaintiffs in a personal injury action appealed an order requiring their expert witnesses to answer questions regarding the foundation and assumptions of their opinions during cross-examination on affidavits filed in response to a summary judgment motion.
The Divisional Court dismissed the appeal, finding no error in the motions judge's ruling that cross-examination on an expert's affidavit should be subject to the same rules as other affiants and is not strictly limited to the four corners of the affidavit.
Taxi driver stabbed by passenger was not involved in an 'accident' under the Schedule.
The applicant, a taxi driver, was stabbed by a passenger during a robbery and applied for statutory accident benefits.
The insurer initially paid income replacement benefits but later terminated them, arguing the incident was not an 'accident' under the Schedule.
The arbitrator found that the event setting the chain of causation in motion was an assault, not the use or operation of an automobile, and therefore the applicant was not involved in an 'accident'.
The arbitrator also held that the insurer did not waive its right to deny coverage by initially paying benefits, as there was no conscious intention to abandon a known right.
Insurer ordered to pay for nerve blocks and a special award, but botox claim denied as experimental.
The applicant was injured in a motor vehicle accident and sought statutory accident benefits for nerve block injections, botox injections, massage treatments, and a special award for delayed payment of psychological and vocational assessments.
The arbitrator found that the nerve block injections were a reasonable and necessary treatment for short-term pain relief, ordering the insurer to pay the $800 cost.
However, the claim for botox and massage was dismissed, as the arbitrator accepted expert evidence that botox is an experimental treatment for chronic pain.
The arbitrator also awarded a special award of $1,170 against the insurer for unreasonably denying psychological treatment without requesting a Designated Assessment Centre (DAC) assessment, despite the insurer settling the claim shortly before the hearing.
Arbitration stayed until applicant attends reasonably required insurer's examination for attendant care benefits.
The insurer brought a motion to stay the arbitration, arguing the applicant was not entitled to access dispute resolution mechanisms because he failed to make himself reasonably available for an insurer's examination under section 65 of the Statutory Accident Benefits Schedule.
The applicant argued the assessment was not reasonably required as there was extensive medical documentation and no change in circumstances since a prior DAC assessment.
The arbitrator found the assessment was reasonably required given the passage of time since the last insurer's assessment and the applicant's age.
The arbitration in respect of attendant care benefits was stayed until the applicant makes himself reasonably available for the assessment.
Arbitration for attendant care benefits stayed until insured attends reasonably required insurer's examination.
The insurer brought a motion to stay the insured's arbitration for attendant care benefits on the basis that the insured failed to attend a requested insurer's examination under section 65 of the Statutory Accident Benefits Schedule.
The insured argued the assessment was not reasonably required because a previous Designated Assessment Centre (DAC) assessment had already established his needs and there was no change in his condition.
The arbitrator found that the requested assessment was reasonably required, noting the passage of time since the last insurer's assessment and the insured's changing life circumstances.
The arbitrator ordered that the arbitration be stayed until the insured makes himself reasonably available for the assessment.
Ongoing weekly income benefits granted and $10,000 special award ordered for unreasonable termination without notice.
The applicant was injured in a motor vehicle accident and received weekly income benefits until the insurer terminated them after the 156-week mark.
The applicant sought ongoing benefits under subsection 12(5)(b) of the Statutory Accident Benefits Schedule, arguing she was continuously prevented from engaging in suitable employment.
The arbitrator found that the applicant lacked the physical capacity to return to her former physically demanding jobs and lacked the skills for sedentary office work without further retraining.
The arbitrator ordered ongoing weekly income benefits.
Additionally, the arbitrator awarded a $10,000 special award under section 282(10) of the Insurance Act because the insurer unreasonably terminated benefits without proper notice or justification.
Post-accident disability tax credit is included when calculating a student's pre-accident earning capacity for LECBs.
The insurer appealed an arbitration order that included a post-accident disability tax credit in the calculation of a student's pre-accident earning capacity (PEC) for Loss of Earning Capacity Benefits (LECBs) under the SABS-1994.
The Director's Delegate dismissed the appeal, finding that the PEC for students is a notional amount based on the Average Weekly Earnings, and the conversion to net weekly income under sections 81 and 85 explicitly includes the disability tax credit without restriction.
The calculation of tax liability is determined at the time the calculation is done, meaning the insured's current tax status governs.
Disability tax credit must be included when calculating pre-accident earning capacity for LECBs.
The applicant was injured in a motor vehicle accident and received weekly education disability benefits before becoming eligible for loss of earning capacity benefits (LECBs).
The parties disputed whether the applicant's disability tax credit should be included in the calculation of his pre-accident earning capacity.
The arbitrator held that the Schedule requires the disability tax credit to be considered when translating the gross annual income figure into a net weekly income figure, even though the credit was only received post-accident.
The preliminary issue was resolved in favour of the applicant.