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Insured ordered to repay attendant care benefits paid in error after failing to prove economic loss.
The applicant insurer sought repayment of $19,170.90 in attendant care benefits paid to the respondent insured.
The insurer had paid the benefits based on the respondent's mother's Employment Insurance statement, pending further proof of her economic loss.
In a prior Tribunal decision, it was determined that the respondent failed to prove his mother sustained an economic loss in providing care.
The Tribunal found that the insurer paid the benefits directly to the respondent in error, as no evidence of economic loss was ever provided.
The Tribunal ordered the respondent to repay the $19,170.90 plus interest, finding that the insurer had provided proper notice within the 12-month limitation period.
Applicant awarded medical, attendant care, and housekeeping benefits due to insurer's procedural breaches; non-earner benefits denied.
The applicant was injured in a motor vehicle accident and sought various statutory accident benefits, including non-earner, medical, attendant care, and housekeeping benefits.
The insurer suspended benefits after the applicant failed to attend an examination under oath, though a previous arbitrator found the notices defective.
The arbitrator found the applicant entitled to the disputed medical treatment plans, as well as attendant care and housekeeping benefits for a limited period due to the insurer's procedural breach in failing to provide assessment reports in a timely manner.
However, the claim for non-earner benefits was dismissed as the applicant did not meet the test of a complete inability to lead a normal life.
The request for a special award was also denied.
Insurer entitled to repayment of accident benefits where the underlying motor vehicle collision was staged.
The insurer appealed an arbitrator's decision denying repayment of accident benefits paid to the insureds.
The arbitrator had found that the motor vehicle collision was staged, but concluded the insurer was not entitled to repayment because there was no evidence of fraud or wilful misrepresentation regarding the specific injuries, treatments, and expenses claimed.
The Director's Delegate allowed the appeal, holding that where fraud or wilful misrepresentation relates to the fundamental facts of the accident itself, the insureds are required to repay all benefits paid directly to them.
The matter was returned to arbitration to determine the specific amounts repayable.
Application for accident benefits dismissed on consent without costs to allow pursuit of FSCO application.
The applicant sought dispute resolution for a medical benefit of $1,346.49 for psychological services following a motor vehicle accident.
The parties consented to the application being dismissed without costs, as the applicant had a similar application before FSCO and wished to pursue that application instead.
The Tribunal dismissed the application without costs.
Application for accident benefits dismissed on consent without costs to allow pursuit of FSCO claim.
The parties consented to the application being dismissed without costs, as the applicant had a similar application before the Financial Services Commission of Ontario (FSCO) that they wished to pursue instead.
The Tribunal ordered the application dismissed without costs.
A staged collision meets the statutory definition of 'accident' under the SABS; intentionality does not preclude it.
The appellants appealed an arbitrator's decision finding that they were not involved in a 'legitimate accident' because the collision was staged.
The Director's Delegate allowed the appeal, finding that the arbitrator erred in law by requiring an accident to be 'accidental' to meet the statutory definition under the SABS.
Relying on the Court of Appeal's decision in Vijeyekumar, the Delegate held that the statutory definition of 'accident' includes intentional incidents, such as a staged collision, and that the insurer should have relied on the wilful misrepresentation provisions (s. 53) rather than arguing the incident was not an accident.
Ontario courts lack jurisdiction over foreign restaurant for slip and fall occurring outside the province.
The appellants, Ontario residents, brought an action in Ontario against a Tennessee corporation for injuries sustained in a slip and fall at the respondent's restaurant in New York.
The respondent moved to stay the proceedings on jurisdictional grounds.
The Court of Appeal applied the factors from the companion case of Muscutt v. Courcelles and held that Ontario courts could not assume jurisdiction over the out-of-province respondent, as the real and substantial connection test was not met and assuming jurisdiction would violate principles of order and fairness.
The appeal was dismissed.
