As of April 1, 2016, any disputes a car accident victim has with his or her insurance company must be heard by an adjudicator at the License and Appeals Tribunal (LAT).
We have been really rattled over the recent budget for the year 2015-16 by the government with massive changes to auto insurance being tabled that will further restrict access to accident benefits for those injured, and put the medical and rehabilitative needs of Ontarians in jeopardy. We feel compelled to reach out to others to help us advocate on behalf of those that need these benefits the most.
Read More about Changes to Accident Benefits Threaten Both Individuals and the Healthcare System
S.A. v. Guarantee Insurance, 2019 CanLII 77002 (ON LAT)was an application for Reconsideration of the Licence Appeal Tribunal (LAT) decision in which the LAT adjudicator found the Applicant, S.A. was not entitled to Non-Earner Benefits (NEBs) following her February 5, 2016 collision.
Read More about Accident Benefits Update: Nebs, and (Natural) Justice for All
M.F.Z. v Aviva Insurance Canada (and its companion claim, J.C.C. v Aviva Insurance Company of Canada, which was argued on behalf of the passenger at the same time), a far-reaching beneficial decision for accident victims, was recently reconsidered by the executive chair of the Safety, Licensing Appeals and Standards Tribunals Ontario (“SLASTO”), Linda Lamoureux, at the insurer’s request.
Read More about M.F.Z. V Aviva Insurance Canada – Beneficial Decision For Accident Victims
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.
Read More about Car-Surfing Injury Is an “Accident” -Divisional Court Upholds Lat Decision
Many of you do not know that our legal system is prejudiced against plaintiffs who are injured in car accidents. In response to pressure from the Insurance industry, our Insurance Act has built-in relief for defendant insurance companies from paying damages to plaintiffs. Briefly, damages under a certain amount are subject to an automatic deductible which stays in the defendant insurer’s pocket. So, if a jury awards you $70,000 for pain and suffering, you will only receive $40,000. The jury is not told that this happens.
Read More about Accident Benefits Update: Legal System Is Prejudiced Against Plaintiffs
In A.M. v the Dominion of Canada General Insurance Company, 2019 CanLII58194 (ON LAT), a dispute arose over the A.M, the applicant’s Income Replacement Benefits (IRBs). He was injured on December 21, 2017 when his vehicle was rear-ended. He applied for “no-fault” accident benefits including IRBs under the Statutory Accident Benefits Schedule (SABS) from his auto insurer, Dominion.
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.
In Gilbraith v. Intact Insurance Company (2019 ONSC 1875), Intact brought a Summary Judgment Motion to dismiss Ms. Gilbraith’s claim. She had been seriously injured following an unusual chain of events that she claimed was an “accident” as defined in the Insurance Act. On April 11, 2014 she and a friend were walking when she was struck in the eye by an egg, thrown from a passing carwhich fled the scene. As a result, Ms. Gilbraith lost central vision in her right eye.
Since the introduction of the “no fault” accident benefits system in Ontario, the legislature has imposed further disclosure obligations on accident victims seeking entitlement to benefits. For example, the Automobile Insurance Rate Stability Act, 1996, (at s.33(1) of the current Statutory Accident Benefits Schedule or SABS) required a claimant to provide to an insurer any information “reasonably required” to assist in determining the claimant’s entitlement to benefits and, if requested, to furnish a statutory declaration. Later, Ontario Regulation 281/03 (at s.33(2)) gave an insurer the right to request a mandatory Examination Under Oath (EUO) from the claimant to gather information pertaining to the application for benefits.
Read More about It Was Fun While It Lasted: Court Of Appeal Restores Status Quo For EUO
