Category: Divisional Court

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.

Miceli v. TD General Insurance Co. (2025 ONSC 496)

The claimant appealed the Tribunal’s decision that she was not involved in an “accident”. The claimant was injured in the back seat of her car when coffee was spilled on her due to the lid of a coffee cup coming off. The Court allowed the appeal, holding that the incident was an “accident” under the SABS definition. The Court held that the Tribunal erred in failing to follow the Court of Appeal’s decision in Dittman v. Aviva, which was a case involving similar facts. As in Dittman, the purpose test and the causation test were both met. The inadvertent spill of hot coffee purchased from a drive-through was part of the ordinary use and operation of a vehicle.

Dooman v. TD Insurance Co. (2025 ONSC 184)

The claimant appealed the Tribunal’s decision that his injuries fell within the MIG and that he was not entitled to disputed medical benefits. The Court dismissed the appeal. The Court held that the Tribunal properly approached the competing medical and expert evidence. The Tribunal was entitled to reject the opinion of the claimant’s expert notwithstanding the insurer not having a responding expert report. The claimant’s arguments regarding the weight of medical evidence and opinion was not reviewable on appeal. The Tribunal’s findings regarding pre-existing conditions considered the medical evidence submitted, and the conclusions were reasonable. Finally, the Tribunal was under no obligation to request the parties submit more evidence or better evidence when confronted with illegible doctor’s notes. A written hearing format was agreed upon by the parties, and the claimant had the obligation to put forward evidence in support of his position.

Plante v. Economical Insurance Company (2024 ONSC 7171)

The claimant appealed the Tribunal’s decision that she was not entitled to ACBs, home modifications, and other various medical benefits. The claimant’s appeal was based on the procedures used by the LAT in this case. At the Case Conference, the adjudicator ordered that a joint 20 day hearing would take place, and that both the claimant and her mother’s claim would be decided based on the same evidence and witnesses, which largely overlapped. At the beginning of the hearing, the Vice Chair altered the schedule, separating the two claims and only allowing five to six days of hearing for the claimant. The Vice Chair also did not allow the claimant to enforce a subpoena to cross-examine the insurer’s OT, despite draft reports suggesting that earlier versions of the report had been changed to better support the insurer’s position. The Court held that the Tribunal had breached the claimant’s right to a procedurally fair hearing, and ordered the matter be re-heard by a new adjudicator. The Court emphasized that any hearing scheduled set in a Case Conference ought to be followed unless prior sufficient notice is given to the parties regarding a change, and that the right to cross-examine an opposing party’s expert was fundamental to the procedural fairness of the hearing.

Noble v. Economical Insurance Company (2024 ONSC 6985)

The claimant appealed the Tribunal’s decision that she was not entitled to dispute benefits because she did not attend a psychiatric IE. Prior to this appeal, the claimant attended the IE and commenced a new LAT application. Nevertheless, the claimant continued with the appeal arguing that the LAT erred in barring the dispute, and in failing to provide procedural fairness. The Court dismissed the appeal. The Court held that the LAT did not make any legal error in barring the dispute, and that any arguments relating to factual errors were not proper for the Court to consider on appeal. The Court also found there was no lack of procedural fairness. The claimant’s arguments that limitations defence might now apply to the treatment plans in dispute was an indirect challenge to the claims being made rather than the Tribunal hearing.

Hall v. Unifund Assurance Company (2024 ONSC 6677)

The claimant appealed the Tribunal’s decision that he did not suffer a catastrophic impairment as a result of the accident. The Court dismissed the appeal, holding that the claimant’s appeal was essentially a re-argument of the evidence. The Tribunal was entitled to weigh the evidence as it saw fit, and the adjudicator provided full and cogent reasons for the decision. There was no error of law or denial of procedural fairness to the claimant.

McDonald v. Aviva Insurance Company (2024 ONSC 6030)

The claimant appealed the Tribunal’s decision that he was not entitled to a special award in relation to housing benefits following the insurer’s concession just prior to the hearing. The claimant had sustained a catastrophic impairment and required 24-hour care. He sought accessible housing, which was denied by the insurer. He then sought a rental, which was also denied by the insurer. The insurer reconsidered its position and approved the benefits shortly prior to the hearing. The matter proceeded solely on the issue of a special award. The Tribunal decided that an award was appropriate for some of the other disputed benefits, but not the housing benefits. The reason for not granting a special award on the housing benefits because there was no evidence before the Tribunal regarding the value of the renovations that would be required to accommodate the claimant’s needs. The Court held that the Tribunal erred in its application of s.10 by assuming that evidence was needed to adjudicate the housing benefits before a special award could be granted. Where an amount has been agreed upon, as it was in this case when the insurer agreed to pay the benefit, the claimant was not required to prove the amount of his entitlement for the Tribunal to make a special award.

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