The insurer appealed the Divisional Court’s decision that the limitation period on IRBs did not commence because the denial did not provide any medical reasons. The insurer argued that the only basis for denial was the claimant’s return to work (i.e. an “other” reason), and that it was not required to state a medical reason where one did not exist. The Court of Appeal agreed, reversing the Divisional Court’s decision. The Court held that the phrase “medical and any other reason” used the word “and” in a joint and several sense. The Court recognized that some cases will have both medical reasons and other reasons; some cases will have only medical reasons or only other reasons. The insurer was not required to invent a medical reason for the denial where one did not exist. The denial of further IRBs based on the return to work complied with section 37, and was sufficiently clear and unequivocal to trigger the limitation period.
The insurer appealed the decision of the Divisional Court (which upheld the Tribunal’s decision) that a dirt bike involved in an accident was an “automobile” for the purposes of the SABS. The Tribunal had concluded that the dirt bike was required to be insured under the Off-Road Vehicles Act and was not exempt from insurance through the regulation that allowed off-road vehicles to be uninsured when “driven or exhibited at a closed course competition or rally sponsored by a motorcycle association.” The Court of Appeal agreed with the Divisional Court that the dirt bike was an “automobile” based on the Off-Road Vehicles Act and its regulations. The Court agreed that one of the purposes of the Off-Road Vehicles Act was to promote universal insurance coverage, and that the Act had to be read in the context of the multiple statutes and regulations governing automobile insurance and the Government’s goal of ensuring universal insurance coverage with only a few exceptions.
The claimant appealed the Divisional Court’s decision that HST payments on attendant care benefits were included in the $6,000 monthly limits. The Court dismissed the appeal and held that the HST on attendant care services was included in the monthly limit, and was not payable on top of the limit. The Court found that sections 14 and 19, when read together, did not support the interpretation advanced by the claimant and the provisions were not ambiguous. The Court also held that the FSCO Bulletin stating that HST was not included in the SABS limits was not incorporated into the SABS, and was contradicted by the Cost of Goods Guideline, which stating that HST was a reasonable expense and that reasonable expenses were subject to the maximum limits.
The claimant appealed the Divisional Court’s dismissal of her judicial review application, in which the Divisional Court held that judicial review of a LAT decision should only be granted in exceptional circumstances. The Court of Appeal upheld the decision dismissing the judicial review, but modified the grounds on which judicial review could be sought. The Court of Appeal held that judicial review of the LAT should only be heard in the rare case where the adequate alternative remedies of reconsideration, together with a limited right of appeal, are insufficient to address the particular factual circumstances of a given case. The Divisional Court retains the discretion to hear and determine judicial review applications. Where a party commences both an appeal and a judicial review of a LAT decision, the matters ought to be joined and heard simultaneously. In terms of the claimant’s judicial review, the Court of Appeal held that the Divisional Court correctly dismissed it because the LAT’s decision that the claimant disputed her entitlement to IRBs outside of the limitation period was reasonable.
The claimant was declared catastrophically impaired seven years after the accident. The insurer had denied entitlement to further attendant care benefits and housekeeping expenses at the 104 week anniversary. The claimant sought entitlement to ACBs and HK expenses from the 104 week anniversary onwards following the catastrophic impairment designation. The insurer argued that the claims were barred by the limitation period. The Tribunal agreed with the insurer that the claims were time barred. On review, the Divisional Court upheld the Tribunal’s decision. However, the Court of Appeal reversed the decision and concluded that a degree of discoverability applied to the limitation period. The Court reasoned that the claimant could not have been expected to dispute entitlement to post-104 week ACBs and HK expenses before knowing that her injuries met the catastrophic impairment definition. The limitation period therefore did not apply to the claim.
The Tribunal and the insurer appealed the Divisional Court’s decision that there was a reasonable apprehension of lack of adjudicative independence. The Court of Appeal dismissed the appeal and held that the Divisional Court had correctly applied the case law regarding adjudicative independence. The dispute was remitted to the Tribunal for a new hearing on the catastrophic impairment.