Category: Divisional Court

Sparks v. Primmum Insurance Company (2026 ONSC 3803)

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Post date July 20, 2026
No Comments on Sparks v. Primmum Insurance Company (2026 ONSC 3803)

The claimant appealed the Tribunal’s decision that her dispute over a partially approved treatment plan was brought after the expiry of the limitation period. The claimant argued that the denial did not comply with the SABS because it did not explain all appeal rights following a LAT decision, nor did it explain the principles of discoverability. The Court dismissed the appeal, holding that the insurer was not required to explain the right to an appeal of a LAT decision, nor was the insurer required to explain the principle of discoverability or stated that the limitation clock “may” begin at the time of denial rather than stating that the limitation clock “will” begin at the time of denial.

Zabarain v. Coseco Insurance Company (2026 ONSC 3712)

Post author By tgp-admin
Post date June 30, 2026
No Comments on Zabarain v. Coseco Insurance Company (2026 ONSC 3712)

The claimant appealed the Tribunal’s decision that he was not entitled to IRBs, that he was required to repay an overpayment of IRBs, and that the insurer did not wrongfully pay a hospital account. The Tribunal found that the claimant had returned to work as a lawyer and did not meet the post-104 week IRB test, and that his receipt of IRBs after his return to work resulted in an overpayment of IRBs. The Tribunal also found that the insurer properly paid for a large hospital account that was invoiced to the claimant due to being a non-resident. The Court dismissed the appeal. The Court concluded that the insurer properly paid for the hospital account when it received the hospital invoice and that an OCF18 was not required. Furthermore, nothing in the SABS prohibited an insurer from paying for an incurred expense that was related to the accident. The Court accepted that the Tribunal mis-stated the law on wilful misrepresentation, but that the error did not affect the outcome because the claimant had withheld employment information that resulted that was detrimental to the IRB claim.

Chevalier-Wara v. Economical (2026 ONSC 2982)

Post author By tgp-admin
Post date May 25, 2026
No Comments on Chevalier-Wara v. Economical (2026 ONSC 2982)

The claimant appealed the Tribunal’s decision that he did not suffer a catastrophic impairment based on the GOS-E test, and that he was not entitled to attendant care benefits. The claimant argued that the Tribunal’s reasons were inadequate. The Court agreed, concluding that the reasons were largely conclusory, rested on factual findings that there was no evidence to support, and the reasons failed to grapple with the opposing expert views on the claimant’s impairments. The Court granted the appeal, and ordered the Tribunal to conduct a new hearing on the claim.

Atkinson v. Economical (2026 ONSC 2605)

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Post date May 5, 2026
No Comments on Atkinson v. Economical (2026 ONSC 2605)

The claimant appealed the Tribunal’s decision that she was not entitled to certain benefits. Her primary argument was that she was denied procedural fairness when the Tribunal refused to require the insurer to present its IE assessor for cross-examination. The Tribunal upheld its original decision on reconsideration. After the claimant commenced this appeal, the Tribunal began a second reconsideration procedure and concluded that the original decision should be vacated and returned to an adjudicator for a new hearing. The Court held that the Tribunal could not commence a second reconsideration procedure because the time elapsed after the first reconsideration was too long (over 18 months) and because initiating a second review after the appeal process had started breached the finality principle. The proper course was for the Tribunal to participate in the appeal and make submissions for the overturning of the initial decision. The Court quashed the second reconsideration as being beyond the jurisdiction of the Tribunal. The matter was returned to the Tribunal for a new hearing because the original decision and first reconsideration were also quashed by the Court in oral reasons given immediately after arguments.

Jones-Whyte v. Intact Insurance Company (2026 ONSC 1927)

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Post date April 13, 2026
No Comments on Jones-Whyte v. Intact Insurance Company (2026 ONSC 1927)

The claimant appealed the Tribunal’s decision that she did not suffer a catastrophic impairment due to three Class 4 marked impairments. The claimant argued that the Tribunal acted unfairly in limiting the time for examination and cross-examination of witnesses, and by allowing the insurer’s expert to comment on the claimant’s expert’s report but not vice versa. The Court dismissed the appeal, finding that the Tribunal acted fairly. The adjudicator was entitled to control the process, and the time limits on examination and cross-examination were applied fairly and equally to all witnesses, and the parties were able to call all witnesses they wished to testify. The Court did not find unfairness in the adjudicator allowing the insurer’s expert to comment on the claimant’s expert’s report while disallowing the reverse because the insurer’s expert had a copy of the claimant’s expert’s report when generating his own report, whereas the claimant’s expert did not have the insurer’s expert’s report when generating his report. Further, the claimant could have requested an addendum report from her own expert to respond to the insurer’s expert, but chose not to.

Hamad v. Security National Insurance Company (2026 ONSC 1983)

Post author By tgp-admin
Post date April 2, 2026
No Comments on Hamad v. Security National Insurance Company (2026 ONSC 1983)

The claimant appealed the Tribunal’s decision that she was not an insured person, and therefore not entitled to accident benefits. The claimant’s son was involved in an accident. The claimant sought benefits under a policy issued to her brother. To prove entitlement, the claimant needed to show that she was dependent on the brother. The Tribunal concluded that the claimant had sufficient financial means to cover at least half of her expenses, and that the relationship between the claimant and her brother was not one of financial dependence. The Court dismissed the appeal, holding that the Tribunal applied the correct legal test and considered the evidence submitted by the parties.

Muddapati v. Primmum Insurance Company (2026 ONSC 1878)

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Post date March 31, 2026
No Comments on Muddapati v. Primmum Insurance Company (2026 ONSC 1878)

The claimant appealed the Tribunal’s decision that her MIG dispute was res judicata because she had already made an earlier LAT application disputing the MIG and medical benefits that was dismissed. The Court dismissed the appeal, holding that the Tribunal acted reasonably in concluding that res judicata barred the claimant’s application. The information relied upon by the claimant had been available at the time of the original hearing, and was not new evidence that would have altered the original decision.

Coban v. Allstate Insurance Company (2026 ONSC 1925)

Post author By tgp-admin
Post date March 31, 2026
No Comments on Coban v. Allstate Insurance Company (2026 ONSC 1925)

The claimant appealed the Tribunal’s decision that he was not entitled to IRBs because he was receiving WSIB at the time of the accident rather than income from an employer. The Court allowed the appeal, holding that the claimant was an employed person at the time of the accident, even though he was not receiving income directly from his employer. The claimant was participating in a retraining program through his employer and WSIB, and intended to return to work, had the car accident not occurred. The Court reasoned that the Tribunal’s interpretation of the term “employed” was too narrow and defeated the consumer protection nature of the SABS.

Abu-Ain v. Security National Insurance Company (2026 ONSC 1494)

Post author By tgp-admin
Post date March 31, 2026
No Comments on Abu-Ain v. Security National Insurance Company (2026 ONSC 1494)

The claimant appealed the Tribunal’s decision that he was not an insured person under the Security National policy and was therefore not entitled to accident benefits. The claimant suffered a catastrophic impairment when he was injured in an uninsured vehicle. He applied to Security National for accident benefits under a policy issued to his aunt and uncle on the basis that he was a dependant. Security National commenced a priority arbitration against the Fund. In the interim, Security National adjusted the claim, and certain benefits were denied. When a LAT dispute was commenced, Security National requested a preliminary issue hearing on whether the claimant was an insured person. The Tribunal held that the claimant was not an insured person and dismissed the LAT application. The claimant appealed, arguing that the Tribunal should not have heard the preliminary issue decision while the priority dispute was pending. The Court agreed and reversed the Tribunal’s decision. The Court held that it was an abuse of process to determine the insured person issue while the priority dispute was pending. The Tribunal failed to consider the interplay between a priority dispute and the claimant’s entitlement to benefits, and the importance of the “pay pending dispute” aspect of the SABS and the priority rules. The Tribunal’s approach left the catastrophically injured claimant without benefits, even though he was entitled to receive the benefits from one of the two insurers involved in the priority dispute.

Goovaerts (Litigation Guardian) v. Motor Vehicle Accident Claims Fund (2026 ONSC 1687)

Post author By tgp-admin
Post date March 24, 2026
No Comments on Goovaerts (Litigation Guardian) v. Motor Vehicle Accident Claims Fund (2026 ONSC 1687)

The claimant was injured in a June 1999 accident. He applied to the Fund and received attendant care benefits for over one year, including supervisory 24-hour care. The Fund stopped payment of attendant care benefits without assessing the claimant in November 2000. The Fund acknowledged the error in over a decade later, and agreed to pay attendant care benefits for what was incurred. The claimant applied to the Tribunal, which awarded $120.40 per month in attendant care benefits. The claimant appealed the Tribunal’s decision and argued that a retroactive Form 1 of $5,575.31 per month ought to be paid. The Court granted the appeal and remitted the matter for a new hearing. The Court held that the Tribunal failed to properly grapple with the claimant’s need for supervisory care and emergency care. The fact that the claimant was able to live independently for extended lengths of time did not negate his supervisory needs, as shown by a few incidents in which the claimant suffered injury while alone. The Court also held that the adjudicator’s reliance on what services were provided in deciding what was reasonable was an error, as the 1996 SABS required payment of attendant care benefits for all reasonable services regardless of whether the services were provided or incurred.

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