It is important for social workers and health care providers to understand what benefits are automatically available to those injured in a motor vehicle accident. We regularly publish recent legal findings related to accident benefits here. You can also Subscribe to our Electronic Newsletter to be kept informed on this topic.
Read the Superintendent’s Report on the Definition of Catastrophic Impairment in the Statutory Accident Benefits Schedule
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| Release Date |
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| Dec 28, 2011 |
| Acceptable to combine physical and psychological impairment ratings. |
| Kusnierz and Economical – CATASTROPHIC IMPAIRMENT; Court of Appeal affirms that combining ratings for physical and psychological impairments is acceptable procedure; decision in Desbiens is affirmed; class of persons considered Catastrophic through combining would still remain small; allowing combination promotes fairness and objectives of Statutory Accident Benefits
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| Dec 19, 2011 |
| Catastrophic impairment due to overall marked impairment |
| T.S. and AllState Insurance – CATASTROPHIC IMPAIRMENT; Designated Assessment Centre determined insured not catastrophic; insured was self represented; insured’s psychologist assessed insured as CAT based on “overall” marked impairment; three categories rated as Marked; supporting psychological reports; absence of psychologist in DAC team and limited evidence of collective determination; fibromyalgia should have been provided with rating under AMA Guides by analogy; support for combining physical and psychological impairment ratings; DAC did not rate all impairments and Arbitrator would not speculate; Arbitrator supported CAT designation based on marked impairment due to mental or behavioural disorder based on evidence from insured
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| Dec 14, 2011 |
| Special award made where insurer failed to fairly adjust file. |
| Sinnapu and Economical – SPECIAL AWARD; where a finding of unreasonableness on part of insurer then a special award is mandatory; unreasonable behaviour seen as behaviour which was excessive, imprudent, stubborn, inflexible, unyielding or immoderate; onus on insurer to weigh entire available evidence when assessing entitlement to income replacement benefits; insurer had conflicting medical assessments but adopted reports that supported termination.
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| Nov 13, 2011 |
| Car accident did not contribute to catastrophic impairment. |
| ML and Economical Mutual Insurance – CATASATROPHIC IMPAIRMENT assessment; insufficient evidence to show injuries arising from previous car accident resolved prior to subject car accident; moderate to severe traumatic brain injury from previous car accident; lay witness evidence of increased impairment not supported by medical evidence; medical evidence does not show significant improvement prior to subject car accident; subject car accident did not cause or materially contribute to insured’s current condition or complaints
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| Nov 13, 2011 |
| Car insurer required to produce policy manuals. |
| Osmani and Economical Mutual Insurance – PRODUCTION OF DOCUMENTS; insured seeking policy manual, correspondence, reserve information; insurer seeking Ontario Works file; insurer believed that insured’s claim based on fraud; insured entitled to know if insurer adjusted file in accordance with own policies; insured only required to produce medical records one year prior to accident.
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| Nov 13, 2011 |
| Insurer did not make timely request for neuropsychological medical assessment |
| Shindler and State Farm Insurance – Insurer Examination; insurer seeking neuropsychological examination; insured disputing income replacement benefits that were terminated; examination allowed where reasonably necessary to determine ongoing entitlement; consider timing of request, did claimant provide timely disclosure of relevant material, is other information available to insurer, any change in diagnosis or insured’s condition, is there connection between request and injuries; insurer did not act in timely manner; insurer seen to be attempting to bolster claim at arbitration rather than assessing insured entitlement to income replacement benefits.
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Disclaimer: This blog is not intended to provide specific legal advice. This information should never replace the advice of a lawyer familiar with the specific facts relating to your particular situation. Reviewing our website should not be viewed as having sought professional advice.
You may also be interested in viewing these recent presentations given by Robert Deutschmann:
- FSCO 5 Year Review - Strategies for Health Care Providers
- The Power of Advocacy
- Lawyer, Case Manager, Candlestick Maker
Here are further presentations given by Doug O'Toole:
- Capacity to Manage Finances and Strategies when Capacity is Impaired
- The Law of Mental Capacity
Further Resources
FSCO Expert Panel – Proposed CAT Changes
Recommendations for Changes to the Definition of Catastrophic Impairment
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