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Accident Benefit News

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.
Select Year: 2010 2009 2008 2007   Result 1 - 20 of 20
Release Date Title
Jul 25, 2010
"Dependant" determination fact based with focus on financial dependancy
Poutney and Economical Mutual Insurance – is injured party a DEPENDANT of the insured – identify intent of financial dependency in year prior to accident – fact specific determination
Jul 17, 2010
Limitation Defence did not apply to Catastrophic Determination
Ramalingam and State Farm Mutual – Catastrophic impairment – no limitation defence for insurer to CAT determination, particularly where no proper denial provided by insurer – insurer cannot issue denial for benefit that has not been explicitly claimed by insured.
Jun 26, 2010
Arbitrator erred in not assessing all impariments for CAT assessment
Bains and RBC General Insurance – CAT DESIGNATION – appeal of decision finding insured not CAT – errors by arbitrator – should have considered ratings for other physical impairments even though not stabilized, sleep disorder and chronic pain – sent back for another CAT determination hearing.
Jun 10, 2010
Denial of Income Replacement Benefits
C.C. and Economical Mutual Insurance – DENIAL OF INCOME REPLACEMENT BENEFITS – injuries the result of an accident - insured failed to establish that accident caused or exacerbated current condition considering pre accident medical condition.
May 20, 2010
Was Treatment Plan Reasonable and Necessary?
L and State Farm Mutual – was treatment plan REASONABLE AND NECESSARY – interpretation could change in the context – in this case the insured had been receiving treatment at approximately the same level before the accident as after – no process to review treatment - negative comments regarding operation of IME – IME placed emphasis on generating reports quickly
May 18, 2010
Income Replacement Benefits
Passarello and Wawanesa Mutual Insurance – SELF EMPLOYMENT – Post 104 week test – complete inability – insured unable to work to the same level in the “real world”
May 17, 2010
New Guidelines for Auto Insurance Health Claims
HCAI has passed the audition and FSCO is ready to roll it out effective May 22, 2010. A new roll out guideline has been issued by FSCO.
May 10, 2010
Transition Rules for the New SABs
Transition rules for the New SABs coming September 1, 2010, have been released by the Financial Services Commission of Ontario. Many benefits continue for "old" accidents but the assessment cost changes will apply to all.
May 01, 2010
Onus on insured to provide evidence of accident
Pilleggi and TTC Insurance – DEFINITION OF ACCIDENT – burden of proof is on the insured – no objective, credible evidence was provided by insured.
Apr 29, 2010
FSCO Bulletin - Transition Rules for new SABs
The Financial Services Commission of Ontario has just released a bulletin outlining the transition rules governing statutory accident benefits applicable to "old accidents" that occur prior to September 1, 2010 and "new accidents" that occur on or after September 1, 2010.
Apr 28, 2010
Determining Catastrophic Impairment
A detailed response from Dr. Brian Levitt and Dr. Ron Kaplan regarding the current state of Catastrophic determination under the SABs. There is clarity and consistency in the process.
Apr 27, 2010
Payment of Third Party Services
MedCentra Inc. v Economical Mutual Insurance – PAYMENT OF THIRD PARTY SERVICES - a third party service provider does not have a right to bring an action against an insurer for payment of MRI examinations provided to the insured.
Apr 06, 2010
Assessor Bias in Treatment Plan Assessment
Forbes and Royal & SunAlliance – ASSESSOR BIAS – insured had conflict with occupational therapist – insurer entitled to assessor of choice but must act reasonably – assessor must maintain professional neutrality
Apr 06, 2010
Cost of Assessments Responsibility of Insurer?
Scott and Dominion – COST OF ASSESSMENT – prior approval necessary before insurer required to pay the cost of the assessment
Apr 06, 2010
Catastrophic Impairment Appeal
Aviva and Pastore – CATASTROPHIC IMPAIRMENT – Appeal – Only one Marked impairment in functioning required to find an insured to be Catastrophically impaired.
Apr 06, 2010
Marked Impairment - Physical or Psychological
Fournie and Coachman Insurance – CATASTROPHIC ASSESSMENT – insured sustained injuries to left heel and ankle – required two crutches and leg brace – found to be Catastrophically Impaired under physical impairment and also under psychological – one Marked impairment sufficient – physical and psychological can be combined
Mar 20, 2010
Principles for Statutory Accident Benefits and the Claims Process
The Financial Services Commission of Ontario provides the principles behind the application of the Statutory Accident Benefits by which the insured and insurer should strive to abide by when working within the Accident Benefits regime.
Mar 03, 2010
New Statutory Accident Benefit Regulations
New Statutory Accident Benefit regulations unveiled. The new SABs will be effective September 1, 2010.
Feb 20, 2010
Accessibility and Design Report Under Cost of Examinations
Burleigh and Allstate – COST OF REPORT - Cost of accessibility and design report should be paid under s.24 (Cost of Examinations) and not s.15 (Rehabilitation Benefit).
Feb 20, 2010
Special Awards for Unreasonable Delays in Payment
Shaikh and Aviva Canada – SPECIAL AWARD – Award could be sought by insured for unreasonable delays in payments by insurer, even where insurer subsequently makes up the delayed payments and there is nothing owing at time of arbitration.
You may also be interested in viewing these recent presentations given by Robert Deutschmann:
  1. FSCO 5 Year Review - Strategies for Health Care Providers
     
  2. The Power of Advocacy
     
  3. Lawyer, Case Manager, Candlestick Maker
Here are further presentations given by Doug O'Toole
  1. Capacity to Manage Finances and Strategies when Capacity is Impaired
     
  2. The Law of Mental Capacity

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.