Vivekanantham v. Certas Home and Auto Insurance Company
This page is a summary and commentary on a publicly available court decision, written for general informational and educational purposes only. It is not legal advice and does not create a lawyer-client relationship with Azimi Law, regardless of how specific or applicable it may seem to your situation.
This summary may be incomplete, simplified, or not reflect the most current state of the law — the decision may be appealed, distinguished, or overtaken by later rulings. Independently verify this case against the official decision before relying on it. Nothing here guarantees the outcome of any other matter, including yours.
Do not rely on this page to make decisions about your own situation. Consult a licensed lawyer, or contact Azimi Law to discuss your situation directly.
The Facts
The applicant was hurt in an accident on June 1, 2018. Her claims failed at a five-day LAT hearing in 2023. The Divisional Court sent the matter back for a fresh hearing before a different adjudicator because the first decision had not dealt with her special-award claim and had leaned on a psychiatric report although its author was never made available for cross-examination. Certas had taken her out of the Minor Injury Guideline in September 2022 but left earlier-denied treatment plans unreassessed and unpaid for more than six months. It had also stopped her income replacement benefits in May 2019 and did not restart them until January 2023, shortly before the hearing.
What the Court Decided
The adjudicator directed Certas to pay a special award of 25% of the benefits it unreasonably withheld or delayed, and dismissed the catastrophic-impairment and attendant-care claims. Once Certas dropped its Minor Injury Guideline position, its continued failure to reassess and pay the treatment plans was unreasonable; its own claim notes recorded the plans as unpaid without any apparent reason. As for income replacement, the file notes described the reason for termination as unclear, an apparent mistake was left uncorrected, and payments resumed on the eve of the hearing with no new medical evidence or explanation. The insurer had not kept reviewing her entitlement as it was required to do.
Does This Affect You?
- ✓Your insurer terminated or delayed benefits and later reinstated them shortly before a hearing.
- ✓You lost your LAT hearing but the Divisional Court sent it back for rehearing.
- ✓You are considering a special award claim under section 10 of Regulation 664.
Key Takeaways
- An insurer must keep reviewing entitlement after an initial denial.
- Paying benefits again just before a hearing, with no new evidence behind the change, can support a special award.
- Insurer log notes can be central to proving unreasonable conduct.