Category: Divisional Court

Davis v. Aviva General Insurance Co. (2024 ONSC 3054)

The claimant appealed the Tribunal’s decision that she was not involved in an “accident” when she slipped on ice while in the process of getting into her vehicle. The claimant also argued that the insurer’s decision to raise that issue more than three years after the accident was procedurally unfair. The Court granted the appeal and ordered a hearing with respect to the disputed benefits. The Court found that the facts of loss supported the conclusion that the claimant was involved in an “accident”. Slipping on black ice while she had the electronic fob in her hand to open and enter her car was part of the use of a motor vehicle. The claimant was close enough to the car that her leg came to rest under the front driver’s side wheel. The Court also noted in its decision that the Tribunal has equitable powers, and can act to prevent an abuse of process. However, the Court found that the Tribunal did not err in allowing the insurer to raise the argument about whether the facts of loss constituted an “accident”.

Pope v. Pilot Insurance Company (2024 ONSC 2932)

The claimant appealed the Tribunal’s decision that her 2002 settlement in relation to a 1995 accident was valid, and that she was not entitled to rescind the settlement. The Settlement Disclosure Notice used in the settlement did not contain some information about the maximum benefits available to her (as required by the SDN at the time). The Court rejected the appeal, holding that the Tribunal’s decision was correct. The Court agreed with the claimant that the Tribunal applied the incorrect burden, and that it was the insurer’s burden to prove that its disclosure complied with its obligations, rather than an insured’s obligation to prove the reverse. That said, the burden did not change the outcome in this case. The errors in the SDN were technical, and there was some compliance with the requirements of the Settlement Regulations. The errors did not deprive the claimant of any important information to which she was entitled.

Adam v. Aviva General Insurance Company (2024 ONSC 3577)

The claimant appealed the Tribunal’s decision that he was not entitled to post-104 week IRBs. The Court rejected the appeal, holding that the Tribunal correctly concluded that the insurer complied with section 37 regarding the denial of IRBs, and the denial did not lack medical reasons or specificity for the denial. The Court also dismissed the arguments that the Tribunal did not properly weigh the evidence.

Fagundes v. Intact Insurance (2024 ONSC 2575)

The claimant appealed the Tribunal’s decision that she was not entitled to post-104 week IRBs. The Court dismissed the appeal. The Court held that there was considerable evidence on which the Tribunal relied in coming to its conclusion, and the Tribunal was entitled to weigh and prefer the expert evidence of the insurer over the claimant. The Court also rejected the argument that the Tribunal applied the wrong test by using the approach in Traders General v Rumball rather than Burtch v. Aviva. The Court wrote that under either approach, the claimant had not proven a complete inability to engage in any employment or self-employment.

Hathaway-Warner v. TD General Insurance Company (2024 ONSC 2511)

The claimant appealed the Tribunal’s decision relating to proper hourly rate for ACBs, whether she had incurred attendant care services, whether she required supervisory care, whether she required home modifications, and the cost of a home modification assessment. The Court upheld the Tribunal’s decision on all points. The claimant’s accident occurred on July 14, 2010. The claimant argued that the most recent hourly rates and Guidelines for attendant care services should apply. The insurer argued that the rates in place in 2010 applied. The Court upheld the Tribunal’s decision that the 2010 rates applied based on the language of the transitional provisions in the SABS. The Court upheld the Tribunal’s decision finding that the insurer’s Form 1 related to supervisory care was based on the evidence before the Tribunal, which showed that the claimant would be self-sufficient in an emergency. The Court upheld the Tribunal’s decision that the claimant’s psychological impairments did not support the need for home modifications. Finally, the Court rejected the claimant’s Charter arguments that the Tribunal’s differential treatment of psychological and physical injuries breached her rights, finding that the very nature of the SABS requires that such distinctions must be made when considering entitlement to benefits.

Laljee v. Aviva General Insurance Company (2024 ONSC 2577)

The claimant appealed the Tribunal’s dismissal of her claim for a catastrophic impairment designation and various treatment plans. The Court dismissed the appeal, finding that there was no merit to the claimant’s arguments. The claimant had not been denied procedural fairness, and had been provided with all documentation referred to during the hearing. The Tribunal’s findings of fact were based on the ample evidence before it, as was the conclusion that the claimant’s impairments were largely a result of pre-existing conditions.

Nouracham v. Aviva General Insurance Company (2024 ONSC 2415)

The claimant appealed the Tribunal’s decision that she was not entitled to IRBs because she was not employed at the time of the accident. The Court dismissed the appeal. The claimant was “on call” with a temp agency, and occasionally worked at a factory for one day or several days at most. She had not worked for six weeks at the time of the accident, and she had not worked for at least 26 of the prior 52 weeks. She had worked nine of the prior 17 weeks for between 11 and 26 hours in each of those weeks. The Tribunal applied the Court’s decision in Arab v. Unica in concluding that the claimant was not “employed”. The Court held that the Tribunal properly applied the analysis in concluding that the claimant was not employed, even though she was “on call” and potentially could be called in.

Shahin v. Intact Insurance Company (2024 ONSC 2059)

The claimant appealed the Tribunal’s conclusion that she did not suffer a catastrophic impairment. She argued that she was denied procedural fairness due to: (i) failure by the Tribunal to make the insurer’s expert re-attend for cross-examination, (ii) by the Tribunal deciding causation when it was not argued by the parties; and (iii) by the Tribunal’s reference to documents that were not discussed by the parties or witnesses. The Court agreed that the Tribunal breached procedural fairness due to each of the three argued reasons. The Court remanded the dispute to the Tribunal for a new hearing.

Keulen v. Allstate Insurance Co. (2024 ONSC 2033)

The claimant appealed the Tribunal’s decision that it did not have jurisdiction to award punitive damages. The Court dismissed the appeal, holding that the Tribunal correctly interpreted its jurisdiction, which was limited to matters provided for in the SABS. The only non-benefit the Tribunal could award was a section 10 award. The Court also rejected the argument that the Court retained jurisdiction to award punitive damages. The Court held that any jurisdiction the Court formerly had over accident benefits disputes was removed by section 280 of the Insurance Act.

Travis v. Aviva Insurance Company (2024 ONSC 1683)

The claimant appealed the Tribunal’s decision that his injuries were not the result of an accident. The claimant was a firefighter who responded to the 2018 van attacks in Toronto where 10 people were killed. The claimant arrived at the scene after the incident, and was confronted with the bodies of the deceased and injured victims. He suffered psychological trauma as a result. He initially applied to WSIB, but was eventually denied after he was found capable of returning to work. He then applied for accident benefits. The Court dismissed the appeal, holding that the Tribunal correctly concluded that the claimant’s injuries were not a direct result of the use and operation of a vehicle. The firetruck that brought the claimant to the scene of the accident did not cause the claimant’s injuries, and the rental van was not in use by the time the claimant arrived at the scene.

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