Category: Jurisdiction

Morrissey v Geico Insurance Company (25-006173)

This is a preliminary issue decision addressing two main issues: 1) Is the applicant an “insured person” as defined in s. 3(1) of the SABS, and 2) Does the LAT have jurisdiction under s. 280 of the Insurance Act in this matter? The claimant, an Ontario resident, was a pedestrian involved in a serious pedestrian-motor vehicle accident in New York state in July 2022. The vehicle that struck her was insured by the respondent (the insurance policy was issued to a resident of New York in accordance with the legislative authority of the state of New York). The applicant applied for accident benefits via an OCF-1 in August 2022. The claim was accepted at that time, and the claimant began receiving SABS benefits. In October 2022, the insurer advised the claimant that she was not entitled to SABS benefits, and the insurer would provide her coverage of $50,000 USD in accordance with the statutory obligations of the state of New York. in February 2023, the respondent advised the claimant that the $50,000 USD limit was nearly exhausted, and the file would be closed when it was exhausted. In May 2023, the claimant submitted an OCF-19 for CAT designation. The respondent advised that CAT-level benefits were not available as the claimant was not entitled to SABS benefits. The claimant proceeded to the LAT to dispute the denial. The claimant submitted that the respondent was estopped from denying entitlement to SABS benefits as it initially chose to adjust and pay benefits pursuant to the SABS. The respondent submitted that the claimant was not an “insured person” as she was not insured under any Ontario motor vehicle insurance policy and the accident occurred outside of Ontario. The respondent further submitted that the LAT cannot assume jurisdiction where the claimant was never an “insured person” and equitable principles cannot override statutory ineligibility or be evoked to create an obligation for the respondent to pay SABS benefits. Vice-Chair Morissette found 1) the LAT has jurisdiction to consider equitable remedies, including estoppel; 2) through the doctrine of estoppel by convention, the claimant was an “insured person” pursuant to the SABS; and 3) the LAT had jurisdiction to determine the application.

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.

Mansuri v. Dominion of Canada General Insurance Company (2023 ONSC 5764)

The claimants appealed the Tribunal’s decision permitting the insurer to use the same counsel and same adjuster on three claims made by three relatives of the same household. The claimants argued that there was a conflict because the insurer and its counsel could intermingle the claims materials. The Court dismissed the appeal, finding that it was premature. The Tribunal’s decision was not a final order, and the hearing on the merits of the claims had not yet taken place. There were no exceptional circumstances justifying early judicial review, nor would the claimant suffer irreparable prejudice that could not be cured on ultimate appeal.

Tyner v. Certas Home and Auto Insurance Company (2023 ONSC 5179)

The claimant appealed the Tribunal’s decision regarding a catastrophic impairment, and various medical benefits claims. The claimant sought reconsideration of the decision, which was outstanding at the time of this appeal. The Court dismissed the appeal, holding that the reconsideration decision would be the final order, and that prior to the reconsideration decision, the appeal was premature.

Luluquisin v. Aviva Insurance Company of Canada (2023 ONSC 3912)

The claimant sought judicial review of the Tribunal’s decision regarding the quantum of ACBs awarded, and entitlement to various medical benefits. The insurer argued that the decision should have been appealed, rather than the subject of judicial review. The Court agreed with the insurer, holding that judicial review was not warranted and that the Court should not convert the matter into an appeal given that the proposal had not been raised by counsel at any time prior to the hearing. The Court dismissed the judicial review, without prejudice to the claimant’s ability to appeal the Tribunal’s decision.

Kahissay v. Intact Insurance (2023 ONSC 3650)

Two claimants sought judicial review of the Tribunal Orders staying their applications while ordering the claimants to attend IEs prior to hearings on catastrophic impairment disputes. The Court held that the judicial review was premature and should not be heard. The cases did not raise exceptional circumstances, absent which the Court would not consider review or appeal of interlocutory matters.

Aviva Insurance Canada v. Harland-Bettany (2023 ONSC 3395)

The insurer appealed the Tribunal’s decision that the claimant’s slip and fall on ice met the definition of accident. The claimant’s application included other disputes relating to accident benefits claims that were not yet decided. The Court held that the insurer’s appeal was premature as the accident definition decision was interlocutory. The Court wrote that it would have jurisdiction to hear the insurer’s appeal of that issue once the Tribunal had determined all issues in dispute.

RBC General Insurance Company v Balasubramaniam (19-008701)

The claimant was involved in a motor vehicle accident in 2005. In 2010, FSCO ordered the insurer to pay the claimant IRBs. On July 22, 2019, the insurer applied to the LAT to have the LAT vary or revoke the 2010 FSCO order. Adjudicator Adamidis found that the LAT cannot vary or revoke an order of FSCO unless the proceeding was commenced before June 8, 2019, pursuant to s. 22(1) of O. Reg. 180/19. Adjudicator Adamidis found that when the current Insurance Act came into force on April 1, 2016, section 22(1) provided authority to the LAT to amend FSCO Orders. However, as of June 8, 2019, new regulations came into force, and section 22(1) now explicitly states that no party may commence an application for a variation or revocation of an Order under subsection 284 of the pre-transition date Act. The application was dismissed.

Del Grosso v. Intact Insurance Company (20-013318)

The claimant was involved in an accident in Michigan and elected to receive Michigan no-fault benefits, including Work Loss Benefits (the Michigan equivalent of IRBs). The insurer later learned that the claimant misrepresented his driving history and insurance history when applying for his auto policy. The insurer terminated the claimant’s entitlement to Work Loss Benefits and requested repayment of over $72,000 based on the section 31(1)(b) exclusion. The claimant argued that Michigan benefits were not equivalent to IRBs, and were not excluded and argued that the Tribunal did not have jurisdiction to consider his entitlement to Michigan no-fault benefits. Adjudicator Norris found that he had jurisdiction to consider the matter as the Michigan level benefits were being paid under the SABS. He agreed with the insurer’s position, concluding that the claimant made material misrepresentations in his application for insurance (failing to report an earlier accident and termination of an auto policy), that section 31 (1)(b) barred entitlement to IRBs, and that Work Loss Benefits were equivalent to IRBs. Adjudicator Norris ordered the claimant to repay all Work Loss Benefits received.

Balachandran v. Economical Insurance (21-014940)

The claimant applied to the LAT in order to dispute the hourly rates for ACBs being prescribed by his insurer. Adjudicator Kaur found that the LAT did not have jurisdiction to rule on the matter because there was no dispute regarding the claimant’s eligibility to a benefit under the SABS. The amount being claimed in his Form 1 for ACBs was approved by the insurer. The insurer requested that the claimant submit an expense claim so that he could be compensated for his out-of-pocket expenses for ACBs. The claimant argued that the LAT possessed jurisdiction as the insurer had reportedly disputed the hourly rate at which ACBs were to be paid. Adjudicator Kaur ruled that the LAT did not have jurisdiction to hear the application because neither the claimant’s entitlement to ACBs, nor the amount of the ACB being approved was in dispute. The claimant’s application was dismissed.