An ongoing source of frustration for seriously injured car accident victims concerns the refusal by their accident benefits insurers to fund assessments for a determination of Catastrophic Impairment (CAT). The Statutory Accident Benefits Schedule (SABS) sets out the obligations on insurers to pay for assessments. Typically, assessments that relate to a benefit or payment are funded out of the rehabilitation and treatment limits under the policy- either $50,000 (or $3,500 if a claimant has been categorized under the Minor Injury Guideline (MIG)). This is set out in s. 14, 15 and 18 of the SABS. However, s. 25 of the SABS...
In Surani v. Perth Insurance Company (2018 ONSC 7254), the Divisional Court reviewed a Financial Services Commission of Ontario (FSCO) appeal that found the applicant, Mrs. Surani’s post-accident business income should be deducted from her Income Replacement Benefit (IRB) entitlement.
ACCIDENT BENEFITS UPDATE: Car-surfing injury is an “Accident” -Divisional Court upholds LAT decision
In order to receive accident benefits under an auto insurance policy, a claimant must prove that they have been injured in an “Accident” as defined in the Statutory Accident Benefits Schedule (SABS). Under the two-part test set out by the Supreme Court of Canada, the claimant must how that the injuries were a) caused by or as a result of b) the ordinary and well-known use and operation of a motor vehicle.
In Applicant and Royal and Sun Alliance, a recent decision of the Licence Appeal Tribunal (LAT), the applicant was injured in a car accident on March 3, 2014 while she was still a minor (age 14). She applied for accident benefits including non-earner benefits (NEBs) under the Statutory Accident Benefits Schedule (SABS). Her insurance company, Royal and Sun Alliance (RSA) denied the NEBs and treated her injuries under the Minor Injury Guideline (MIG), which caps treatment at $3,500.
Many of you are unaware that there is a statutory deductible imposed on non-pecuniary general (pain and suffering) damages below a certain monetary threshold. Prior to August 2015, the defendant insurance company was entitled to deduct $30,000 from an award for pain and suffering under $100,000 (Family Law Act (FLA) claimants faced a $50,000 threshold with a $15,000 deductible). This meant that a plaintiff would receive no compensation despite a jury award of $30,000 or less at trial. This obviously unfair practice was designed to discourage lawsuits in what were perceived as less serious cases. The “no-fault” accident benefit system...
Mr. Cowdrey was involved in a serious motorcycle accident on September 15, 2013. He was riding alone just after midnight in Innisfil, Ontario when he struck a pothole and was thrown from his motorcycle. He suffered life-threatening injuries including a serious traumatic brain injury and extensive physical injuries including the loss of his left eye. He was airlifted to Sunnybrook Hospital in Toronto and placed in a medically induced coma for 2 weeks. As a result of the severity of his injuries, he was deemed catastrophically impaired pursuant to the Statutory Accident Benefits Schedule (SABS) under the Insurance Act.
THE POST-ACCIDENT CONCUSSION DILEMMA Establishing conclusive evidence of a mild traumatic brain injury, or concussion, is one of the most challenging issues for many of our clients as they seek ongoing care following a motor vehicle accident. It is well-documented that concussion symptoms can occur in relatively low speed collisions, and even without direct head trauma. If identified and treated appropriately, concussion sufferers often experience excellent recovery. On the other hand, the impact of an untreated brain injury, “mild” or not, can be widespread, devastating and permanent. Despite this, your own insurance companies, paid by you to protect your interests,...
In Aviva Insurance Company of Canada v. Dittmann, released on March 15, 2018, the Supreme Court of Canada dismissed a leave to appeal application by Aviva and ordered the insurer to pay Ms. Dittmann’s legal costs. Several years earlier, Ms. Dittmann suffered serious burns while attempting to place a drive-through coffee into her cup holder. She applied for accident benefits from Aviva under her automobile insurance policy. Aviva denied the claim because it felt that the injuries were unrelated to her operation of the car. Under the Statutory Accident Benefits Schedule (SABS), an accident is described as, “an incident in...
We have begun recommending that our clients consider purchasing legal cost protection from companies like BridgePoint Indemnity Co. We believe that this empowers our clients, and removes one of the obstacles to achieving fair compensation from the defendant insurance companies. Typically, insurers have used the threat of legal costs against the plaintiff as a means of intimidating our clients into accepting lowball settlement offers. When a client has realizable assets at risk, the threat of losing at trial and being held responsible for a portion of the defendant’s legal costs (which can be many thousands of dollars) is a...
Concussions (aka: mild Traumatic Brain injuries) are in the news a lot in sports-related injuries- especially hockey and football as high-profile athletes suffer repeated head injuries that can shorten their careers and permanently impact their lives. As a result, more attention and money has been devoted recently to understanding the diagnosis and treatment and long-term effects of concussions. Despite this recent attention, however, concussion and particularly post-concussion syndrome remains a gray area medically. Several misconceptions exist amongst the general population, but also in within the medical and rehabilitative community and the automobile insurance industry.