Category: Divisional Court

Hussein v. Intact Insurance Company (2025 ONSC 842)

The claimant appealed the Tribunal’s decision that he had not given adequate notice to the insurer of his intention to claim benefits. The claimant had been involved in an accident in February 2019, and reported the accident and physical damage to the vehicle one day later. The insurer did not advise the claimant of his right to claim benefits nor did it provide accident benefits forms to the claimant. Only 20 months later did the claimant apply for accident benefits after learning from a paralegal that he had a right to make a claim. In the interim, he had been paying for treatment and was experiencing declining psychological health, and was unable to work. The Court granted the appeal, holding that the claimant’s call to the insurer the day after the accident was sufficient notice of his intention to claim benefits. The Court held that it was incumbent on the insurer to advise the claimant of his right to claim accident benefits, or at a minimum, to clarify if the claimant had any injuries from the accident. The insurer’s failure to provide an accident benefits package or notify the claimant of his potential entitlement was to its own detriment, and it would be against the consumer protection purpose of the SABS to allow the insurer to bar the claim.

Abboud v. Intact Insurance Co. (2025 ONSC 3416)

The applicant requested reconsideration of the Tribunal’s decision. The hearing adjudicator dismissed the request (2024 CanLII 102098). The adjudicator did not agree that s. 280(1) of the Insurance Act could be interpreted as providing jurisdiction to determine the rate to be paid for attendant care. The adjudicator also did not agree that it was an error of law to require a breakdown of what services were provided and for how long they were performed. Lastly, the adjudicator found that finding that Bulletin A-03/18 limited the Form 1 to calculating the amount of attendant care to be paid was not inconsistent with the principles in Malitskiy v. Unica Insurance, 2021 ONSC 4603 for the purpose of applying the ratio method for paying for attendant care.

Hamad v. Cooperators General Insurance Company (2025 ONSC 3318)

The claimant appealed the Tribunal’s decision dismissing his claim for attendant care benefits on the grounds that his family members did not sustain an economic loss. The claimant argued that the Tribunal acted unfairly in requiring him to prove an economic loss, particularly given that he could not afford to hire a support worker. The Court dismissed the appeal, concluding that the Tribunal correctly applied the terms of the SABS, and that Tribunal could not ignore the requirement to prove an economic loss by a non-professional service provider.

Martin v. Certas Home and Auto Insurance Co. (2025 ONSC 665)

The claimant appealed the Tribunal’s decision that she did not sustain a catastrophic impairment. Her primary argument was that the LAT erred in rejecting the evidence of her chiropractor in the ratings for Criterion 6, 7, and 8. The Tribunal rejected the chiropractor’s evidence insofar as the chiropractor gave opinion and diagnosis of psychological injury, and preferred the evidence of the insurer’s experts who were qualified to diagnose psychological conditions. The Court dismissed the appeal, holding that the Tribunal correctly applied the law in restricting the scope of the chiropractor’s admissible evidence. The SABS and AMA Guides permit a chiropractor to give certain opinions on catastrophic impairment when it comes to physical impairment ratings, but does not allow a chiropractor to give evidence outside of their qualified areas of expertise.

Rooney v. Allstate Insurance Company (2025 ONSC 2575)

The claimant appealed the Tribunal’s decision that she was not permitted to rescind a 2000 settlement for two 1996 accidents. The Tribunal initially held that the claimant could not rescind the settlements because she had not paid back the settlement, as required by the Settlement Regulation. Following the claimant’s repayment of the settlement, the Tribunal reconsidered the validity of the settlement, and concluded that the SDN provided sufficient information to the claimant regarding attendant care benefits and housekeeping benefits, and that such information allowed the claimant to make an informed decision. The Tribunal held that the insurer was not required to provide a commuted value for these benefits because they had not been claimed. The Court dismissed the appeal, concluding that the Tribunal correctly applied the law relating to settlements and the requirements of the SDN. Because the claimant had not applied for attendant care or housekeeping prior to the settlement, the lack of information regarding the commuted value could not have reasonably affected the claimant’s decision to settle her claims.

AIG Insurance Co. v. Riddell (2025 ONSC 1979)

The claimant and the insurer appealed the Tribunal’s refusal to grant an adjournment of a hearing addressing a catastrophic impairment status. The Tribunal refused to allow the adjournment despite both parties requesting the adjournment due to their unavailability. The Court acknowledged that it rarely reviewed interlocutory orders, but agreed to do so in the exceptional circumstances. The Court held that the Tribunal’s refusal to grant the adjournment failed to consider the complexity of the case, the legitimate competing obligations of counsel, and prejudice to the parties if an adjournment was not granted. The decision also failed to balance the Tribunal’s interest in the administration of justice with the interests of the parties. The Court ordered the Tribunal to vacate the hearing dates and re-schedule the hearing for later dates acceptable to both parties and their counsel.

Jamali v. Economical Insurance Company (2025 ONSCDC 1393)

The claimant appealed the Tribunal’s decision that he did not suffer a catastrophic impairment. The claimant raised multiple procedural issues and fairness issues. The Court dismissed the appeal, holding that the reasons applied the correct legal tests and provided detailed, comprehensive reasons for the conclusions reached. The causation test used by the Tribunal was correct, and the Tribunal’s conclusion that the alleged injuries and impairments were not caused by the accident was supported by the record. The claimant was given a seven day hearing and was allowed to present her case, call witnesses, cross-examine the insurer’s experts, raise objections, and make submissions. There was no indication that the hearing was conducted in a manner inconsistent with procedural fairness or the claimant’s expectations.

Baskaran v. Security National Insurance Company (2025 ONSC 1014)

The claimant appealed the Tribunal’s decision that he suffered a MIG injury. The Court rejected the appeal, concluding that the claimant was essentially seeking a re-weighing of the evidence. The Court acknowledged that the Tribunal made a factual error in the medical chronology, but that the error was not sufficiently central or significant to the outcome, and would not have changed the result.

Traders General Insurance Company v. Rumball (2025 ONSC 779)

The insurer sought judicial review of the Tribunal’s decision that the claimant’s IRB entitlement was barred by the limitation period. The Tribunal had found that the denial in 2015 was not clear or unequivocal because it stated that if the claimant stopped working again, she could submit a new Disability Certificate to determine eligibility. The Court dismissed the judicial review, finding that the Tribunal’s decision was reasonable, and that there was no unfairness to the insurer in the hearing process.

Jendrika v. Intact Insurance Company (2025 ONSC 652)

The claimant appealed the Tribunal’s decision that she was not entitled to IRBs or disputed medical benefits. The Court dismissed the appeal, holding that there was no procedural unfairness in conducting a written hearing, and that the claimant’s appeal was largely based on disagreement on the weight to be given to the evidence and expert opinions. Neither party made submissions regarding the MIG, so the adjudicator was entitled to conclude that it was not an issue in dispute. Finally, the Tribunal applied the correct test for pre-104 week and post-104 week IRBs.

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