| Release Date |
Title |
| Dec 29, 2009 |
| Insurer's Examination - is an Assessment Necessary? |
| Aviva Canada and Wilson – INSURER’S EXAMINATION – insurer failed to show that an assessment was reasonably necessary; insufficient information was provided to the insured with respect to the type of examination that the insured was to undergo. |
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| Dec 29, 2009 |
| Insurer not Precluded from Challenging CAT |
| Aviva and Shaughnessy – CATASTROPHIC IMPAIRMENT ASSESSMENT – INSURER NOT PRECLUDED FROM CHALLENGING CAT DAC – insurer entitled to dispute unfavourable CAT designation after insured had commenced arbitration. |
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| Dec 21, 2009 |
| Interim Income Replacement Benefits |
| Estate of DM and Dominion of Canada – MOTION FOR INTERIM INCOME REPLACEMENT BENEFITS – the applicant was able to show a prima facie case, need and urgency and therefore entitled to interim income replacement benefits. She was the primary caregiver for 3 children and about to lose her home because of financial hardship. |
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| Dec 18, 2009 |
| Entitlement to Income Replacement Benefits |
| Brazier and RBC General Insurance – ENTITLEMENT TO IRB - SPECIAL AWARD – Insured’s credibility important to decision where insured suffering from chronic pain and depression. The insured was internally consistent with evidence and supported by abundance of medical information, despite insurer examination providing non-supportive opinion.
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| Nov 29, 2009 |
| Deductibility of Long Term Disability Benefits from Income Replacement Benefits |
| Massa and Allstate Insurance - DEDUCTIBILITY OF LONG TERM DISABILITY BENEFITS FROM INCOME REPLACEMENT BENEFITS – the insured was not aware of, and not made aware of any, employment continuation or disability policy by her employer and was no longer able to apply. Therefore the insurer was not entitled to any deduction for an income continuation or disability benefit plan.
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| Nov 29, 2009 |
| Production of Surveillance |
| Suppa and Motor Vehicle Accident Claims Fund – PRODUCTION OF SURVEILLANCE – The MVAC Fund was neither required to produce surveillance or investigative evidence nor disclose its existence, unless and until it decided to rely on the evidence.
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| Nov 02, 2009 |
| Accident Benefits Options |
| The Ontario government has provided a chart that outlines the various accident benefits available under the new proposed scheme for car accident victims. Note the options that are now available when renewing your car insurance policy after June 2010. |
|
| Nov 02, 2009 |
| New Proposed Changes for Car Insurance |
| Ontario government announces the proposed changes for car insurance in Ontario. There are a number of changes as recommended in the FSCO 5 year review that will significantly alter car insurance benefits for victims in Ontario. |
|
| Oct 19, 2009 |
| Treatment Plan "Reasonable and Necessary" |
| V and Allstate Insurance – TREATMENT PLAN REASONABLE AND NECESSARY; SPECIAL AWARD – despite multiple accidents, insured was able to show that psychological impairment due to car accident and treatment plan reasonable and necessary. Special award ordered as it was found that insurer failed to order necessary medical information despite having authorization from insured and the insurer also unreasonably withheld payments. |
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| Oct 11, 2009 |
| Income Replacement Benefits |
| Adami and Wawanesa Mutual Insurance – INCOME REPLACEMENT BENEFITS – SPECIAL AWARD – insured, a recent immigrant, was able to show that he had a legitimate contract for employment and that his injuries were the result of the car accident. No special award given as insured failed to provide insurer with relevant information to properly assess claim within a reasonable period of time.
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| Oct 01, 2009 |
| Motor Vehicle Accident Claims Fund |
| Tariq and Motor Vehicle Accident Claims Fund – PRIORITY – The Fund was not the proper Accident Benefit insurer since the insured was driving a rental car with coverage but insured waited over 3 years and failed to make adequate efforts to inquire about available insurance coverage |
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| Oct 01, 2009 |
| Attendant Care and Housekeeping Benefits |
| Masroor and State Farm Mutual - ATTENDANT CARE; HOUSEKEEPING – the evidence of the insured is inconsistent with the evidence of lay witnesses and the medical reports. |
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| Sep 30, 2009 |
| Insurer Request for Assessment "Deficient and Not Reasonable" |
| Shin and Cooperators Insurance – INSURER REQUEST FOR ASSESSMENT DEFICIENT AND NOT REASONABLE – arbitrator determined that insurer notice for assessment was deficient as it did not properly detail purpose of examination. Further, the insurer waited over 3 years to request assessment prior to arbitration.
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| Sep 20, 2009 |
| Caregiver Benefits |
| Asghar and State Farm Insurance – CAREGIVER BENEFITS, HOUSEKEEPING AND HOME MAINTENANCE – the evidence from the insured about his pre accident activity was not supported by the evidence of other parties. He was not the primary caregiver for the children and he did little housekeeping. The medical evidence also did not support the insured’s claim that he could not do certain activities.
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| Aug 10, 2009 |
| Income Replacement Benefit Calculations |
| Uribe and Wawanesa Mutual Insurance – An insured will have problems with income replacement benefit calculations where they do not initially disclose all income in their income tax returns.
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| Aug 10, 2009 |
| Statutory Accident Benefits - Integrity Needed |
| Seyed and Federation Insurance – The arbitrator could not rely on Insured’s evidence as there were too many inconsistencies and credibility was suspect. There was also little or no independent evidence to support or corroborate the insured’s evidence. |
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| Jul 26, 2009 |
| Catastrophic Impairment Test |
| Liu v Kim - Recent appeal court decision confirms catastrophic impairment test based on GCS of 9 or less where GCS applied within reasonable period of time after accident by a person trained to administer the GCS.
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| May 22, 2009 |
| Limitation Period for Personal Injury Claims |
| Kanapathipillai and Personal Insurance – insured commenced arbitration for benefits within 90 days from the release of the mediator’s report and therefore not barred by limitation period; the insurer’s refusal letter for certain benefits was equivacol and inaccurate and therefore not a valid refusal. |
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| May 22, 2009 |
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| May 08, 2009 |
| Future Care Reports |
| Baker and ING Insurance - The insurer had sufficient information to determine whether a request to complete a future care report was reasonable and necessary to assess future medical and rehabilitation needs.
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