Consequences for Unreasonable Delay

Explore What May Happen if an Insurance Company Unreasonably Delays Payment This issue was the central focus of the recent decision of the License and Appeal Tribunal (“Tribunal”) called Blas v. Aviva Insurance Canada.[1] Ms. B was injured in a MVA on August 24, 2017. She sought statutory accident benefits from Aviva. Aviva denied most of her requested benefits on the grounds that they were not reasonable and necessary. Ms. B applied to the Tribunal for dispute resolution. An applicant has the onus of proving that the proposed treatment, its goals and cost, are all reasonable and necessary.[2] The particular…

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Procedural Fairness in LAT Proceedings

Find out about some examples where an insurance company failed to meet the minimal requirements of fairness Lockyear v. Wawanesa Mutual Insurance Company[1] is a recent case where an appeal to the Superior Court of Justice, from a decision of the License Appeal Tribunal (LAT) rejecting the insured’s application to be designated as catastrophically impaired, was granted on the basis that the LAT hearing and reconsideration breached the duty of procedural fairness. Procedural fairness is recognized by the courts as a central principle of Canadian administrative law. Procedural fairness refers to the right to be heard, for someone to participate…

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Challenging a MIG Determination

Discover Limits to the Tribunal’s Jurisdiction or Ability to Hear This Issue A recent case, Bobak v. Travelers Insurance[1], explored whether the License Appeal Tribunal (“Tribunal”) has jurisdiction over a matter in which the above issue is the only issue in dispute. Mr. B was injured in a MVA on September 16, 2017. He sought statutory accident benefits from Travelers Insurance. Travelers denied his claims. He challenged this denial to the License Appeal Tribunal (Tribunal). The issue in the proceeding is whether Mr. B’s injuries fall within the definition of the Minor Injury Guideline (MIG). However, the insurance company brought…

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Lacroix v. Wawanesa Mutual Insurance, 2021 ONLAT 20-004333 (CanLII) – Case Comment

Learn more about a recent case that illustrates a number of topics I have discussed recently in my blog posts – exceptions to the MIG limits In Lacroix v. Wawanesa Mutual Insurance[1], the Applicant Mr. L had been injured in a motor vehicle accident on January 17, 2017 and applied for statutory accident benefits from Wawanesa Mutual Insurance (“Wawanesa”). The mechanics of the accident was that he was travelling through an intersection facing a green light when a vehicle in the opposing lane of traffic suddenly turned left and collided with his vehicle. In particular, Mr. L claimed: $2,148.93 for…

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Traumatic Brain Injury

Location and Definition A traumatic brain injury (or TBI) is an injury to the brain caused by an external physical force, which can have temporary or permanent cognitive, behavioral and/or physical impairments. The brain consists of the cerebellum, brainstem, corpus collosum and four lobes (frontal, temporal, parietal and occipital). Function The frontal lobe is responsible for motor planning, motor movement, executive functions, personality and memory. The parietal lobe is responsible for goal-directed voluntary movement, spatial and touch perception, visual attention and perception, integration of sense and manipulation of objects. The temporal lobe is responsible for understanding language, sequencing, organization, memory…

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Spinal Injuries

Location and Definition The spine consists of 33 vertebrae (or bones) and runs from the base of the skull to the tailbone (called the coccyx). It is divided into five functional areas: cervical spine, thoracic, lumbar, sacral and coccygeal. Function The spinal cord transmits motor information from the brain to the muscles and transmits sensory information from the skin, joints etc. to the brain. The spinal cord can also produce responses (called reflexes) by receiving sensory messages and sending motor messages without any input from the brain. Injuries The spinal cord can be injured at any point along its axis.…

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Skateboard Safety in Malls

An interesting recent case One’s personal safety can be affected in many ways at malls – accidentally being run into by people not paying attention, slipping on wet floors and tripping on objects brought into the mall by patrons. Here, we examine a case, called Drummond v. Cadillac Fairview Corp., where a man tripped over a skateboard in the food court and sued the mall-owner for occupier’s liability. First instance[1] The plaintiff was having something to eat at the food court with his daughter and fiancé. When he went to get a refill of his drink, he tripped over a…

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Escaping the MIG – Reasonable and Necessary – Two Recent Cases

Exploring some examples involving the reasonable and necessary requirement Section 3 of the Statutory Accident Benefits Schedule (“SABS”) defines a minor injury as “one or more of a sprain, strain, whiplash associated disorder, contusion, abrasion, laceration or subluxation and includes any clinically associated sequelae to such an injury”.[1] Subsection 18(1) of SABS provides that the sum of the medical and rehabilitation benefits payable in respect of an insured person who sustains an impairment that is predominantly a minor injury shall not exceed $3,500.[2] However, subsection 18(2) provides that, despite subsection 18(1), the limit in that subsection does not apply to…

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The Nonearner Benefit

Most common questions and their answers 1- What is the nonearner benefit (or “NEB”)? The nonearner benefit provides financial support to the insured if he/she was not employed or was retired or was a full-time student or recent (elementary, high school, university, college) graduate at the time of the accident. 2 Who pays for the nonearner benefit? Your insurance company 3- What is the legal test for entitlement to the nonearner benefit? The insured person must satisfy one of the following conditions: He/she suffers “a complete inability to carry on a normal life as a result of and within 104…

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What is the procedure of an accident benefit lawsuit?

Acquire knowledge of the six main stages of an accident benefit claim In 2016, the procedure in AB lawsuits fundamentally changed when the Licensing and Appeal Tribunal (“LAT”) took over jurisdiction over ABs from the Financial Services Commission of Ontario (“FSCO”). Below is our summary of an informative continuing legal education paper entitled “Latest Word on Procedure, Process and Best Practices in Accident Benefit Litigation” (2019) by lawyers Sven Mascarenhas and Catherine Wilde from the 2nd Motor Vehicle Litigation Summit. Claims Stage Initially, the insured applies to the insurer for one or more benefits, the insured and insurer exchange information,…

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