Category: Divisional Court

Vivekanantham v. Certas Direct Insurance Company (2024 ONSC 6198)

The claimant appealed and sought judicial review of the Tribunal’s decision that she did not sustain a catastrophic impairment and that she was not entitled to a special award. At the Tribunal hearing, the insurer’s psychiatric assessor refused to attend to give evidence despite a summons, but the adjudicator still allowed the IE report to be considered. Also during the hearing, the insurer conceded the claimant’s entitlement to IRBs, removal from the MIG, and entitlement to medical benefits, and paid amounts owing plus interest. However, the adjudicator concluded that she did not have jurisdiction to grant a special award once the benefits were approved. The Court granted the appeal, holding that the Tribunal erred when it failed to consider whether to make a special award on IRBs and the approved medical benefits, and in breaching procedural fairness when it admitted the psychiatry IE despite the refusal of the assessor to attend the hearing. The Court wrote that the Tribunal should have excluded the IE report once it was clear the assessor would not attend the hearing. The Court remitted the matter to the Tribunal for a new hearing.

Cabral v. Northbridge General Insurance (2024 ONSC 6057)

The claimant appealed and sought judicial review of the Tribunal’s decision that he did not suffer a catastrophic impairment as a result of a 2002 accident. The Tribunal concluded that the claimant’s impairments did not meet the necessary psychological injuries, and that a subsequent 2006 accident was a primary factor for the reported impairments. The Court dismissed the appeal and the judicial review, holding that there were no legal errors made by the Tribunal. The adjudicator applied the correct tests, and did not improperly weigh any evidence or improperly admit hearsay evidence.

Pourkhodaya v. The Personal Insurance Company (2024 ONSC 6019)

The claimant appealed and sought judicial review of the Tribunal’s decision that she was not involved in an “accident” as defined in the SABS. The claimant suffered an aneurysm in 2020 incident in which she was in a vehicle that was being pursued and harassed by a group of motorcyclists. There was no collision or contact between any of the vehicles. The aneurysm was caused by intense stress caused by the incident. The aneurysm resulted in a spinal cord hemorrhage, leaving the claimant paraplegic. The Tribunal found that the incident did not qualify as an accident because the causation test was not met. The Court granted the appeal and remitted the matter to the Tribunal for a new hearing. The Court found that the Tribunal’s decision was based on an unreasonable and unfair review of the expert evidence as to the cause of the aneurysm, and the Tribunal improperly relied upon the insurer’s expert. The Tribunal also erred in its analysis of the intervening cause question and dominant feature question.

Kumar v. Aviva General Insurance Company (2024 ONSC 5882)

The claimant appealed the Tribunal’s decision that he was not entitled to post-104 week IRBs, and the Tribunal’s decision refusing to extend the time for reconsideration. The Court dismissed the appeal and the judicial review, holding that the Tribunal did not make any reviewable errors. The adjudicator was entitled to control the process with respect to the examinations and cross-examinations of witnesses, and the adjudicator applied the property “complete inability” test in the context of the evidence presented at the hearing.

Kaloczi v. Wawanesa Mutual Insurance Company (2024 ONSC 5665)

The claimant appealed the Tribunal’s decision that she did not suffer a catastrophic impairment. She argued that the Tribunal erred in applying the “but for” causation test, and failing to properly weigh other issues that led to psychological impairment. The Court dismissed the appeal, holding that there was no basis to reversed the Tribunal. The adjudicator carefully considered the evidence relating to psychological impairment and concluded that the claimant failed to prove that she had sufficiently reduced impairment in three spheres of function. Further, the adjudicator’s conclusion that the accident was not a necessary cause of the claimant’s condition was fact driven, and was based on the evidence before the Tribunal.

Achaia-Shiwram v. Intact Insurance Company (2024 ONSC 5479)

The claimant appealed the Tribunal’s decision that she did not suffer a catastrophic impairment and that she was not entitled to IRBs. She argued that the Tribunal erred in its causation analysis, in considering pre-existing conditions, and in attributing impairments to a subsequent event. The Court dismissed the appeal. The Court held that the Tribunal did not make any legal errors in its decision. The Tribunal correctly used the “but for” test in determining causation of the psychological injuries, and was correct in considering the claimant’s pre-accident and post-accident functioning in order to determine the cause of the psychological injuries. Finally, the Court held that the Tribunal’s consideration of a subsequent injury as an intervening event was not an error of law.

Luluquisin v. Aviva Insurance Co. of Canada (2024 ONSC 5369)

The claimant appealed the Tribunal’s dismissal of his claim for attendant care benefits. He argued that the Tribunal failed to consider all the evidence and gave insufficient reasons. The Court agreed that the Tribunal failed to provide sufficient reasons. The claimant had a catastrophic impairment, and the Tribunal summarily dismissed the claim for ACBs without engaging in the evidence presented by the claimant. The Tribunal ought to have engaged in the statutory scheme in greater detail with reference to the relevant evidence. The Court remitted the matter back to the Tribunal for a new hearing.

Said v. Northbridge General Insurance Company (2024 ONSC 5248)

The claimant appealed the Tribunal’s dismissal of her claims based on res judicata. The Court dismissed the appeal, holding that the claimant’s remedy if she disagreed with the first decision was to seek reconsideration or appeal of that decision. The Tribunal’s second decision based on res judicata was correct in law, and did not result in procedural unfairness.

Fernandez v. Commonwell Mutual Insurance (2024 ONSC 5180)

The claimant appealed the Tribunal’s refusal to grant an adjournment of her hearing for a catastrophic impairment, and ultimately finding that she did not suffer a catastrophic impairment. The Court held that the Tribunal’s refusal to grant an adjournment breached fairness concerns, and ordered a new hearing. The Court explained that the claimant had limited proficiency in English, the issues were complex, and the claimant quickly retained new counsel after her previous counsel got off the record.

Ho v. Allstate Insurance (2014 ONSC 6317)

The claimant appealed the Tribunal’s decision that his settlement was valid. The claimant argued that the version of the Settlement Disclosure Notice he signed in 2004 was invalid. The Court upheld that Tribunal’s decision that the settlement was valid, as the discrepancy regarding the two business day cooling off period did not affect the validity of this settlement. Additionally, the claimant’s signature was on all pages of the SDN, and he was aware of all conditions of the settlement.

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