Every year, over half a million Canadians sustain a traumatic brain injury. Motor vehicle accidents account for more than 50% of all acquired brain injuries, this according to the Brain Injury Society of Toronto.
In Applicant and Royal and Sun Alliance, a recent decision of the Licence Appeal Tribunal (LAT), the applicant was injured in a car accident on March 3, 2014 while she was still a minor (age 14). She applied for accident benefits including non-earner benefits (NEBs) under the Statutory Accident Benefits Schedule (SABS). Her insurance company, Royal and Sun Alliance (RSA) denied the NEBs and treated her injuries under the Minor Injury Guideline (MIG), which caps treatment at $3,500.
In Gilbraith v. Intact Insurance Company (2019 ONSC 1875), Intact brought a Summary Judgment Motion to dismiss Ms. Gilbraith’s claim. She had been seriously injured following an unusual chain of events that she claimed was an “accident” as defined in the Insurance Act. On April 11, 2014 she and a friend were walking when she was struck in the eye by an egg, thrown from a passing carwhich fled the scene. As a result, Ms. Gilbraith lost central vision in her right eye.
Since the introduction of the “no fault” accident benefits system in Ontario, the legislature has imposed further disclosure obligations on accident victims seeking entitlement to benefits. For example, the Automobile Insurance Rate Stability Act, 1996, (at s.33(1) of the current Statutory Accident Benefits Schedule or SABS) required a claimant to provide to an insurer any information “reasonably required” to assist in determining the claimant’s entitlement to benefits and, if requested, to furnish a statutory declaration. Later, Ontario Regulation 281/03 (at s.33(2)) gave an insurer the right to request a mandatory Examination Under Oath (EUO) from the claimant to gather information pertaining to the application for benefits.
Read More about It Was Fun While It Lasted: Court Of Appeal Restores Status Quo For EUO
On September 27, 2012, the Ontario Court of Appeal released its landmark decision in Pastore v Aviva. Mrs. Pastore was successfully represented by Joseph Campisi, the founding partner of Campisi LLP. It was a long and challenging fight over several years and multiple appeals. The stakes were very high for the insurance industry, and Aviva did not want to lose.
Read More about Campisi Success Story – Automobile Insurance Claim
The case called F. V. v Wawanesa Mutual Insurance Company decided by the Licence Appeal Tribunal (LAT) on January 30, 2017 answers the question on whether or not family holiday expenses can be classified as payable rehabilitation benefit under section 16 of the Statutory Accident Benefits Schedule (SABS).
Read More about Does Family Holiday Fall Within the Scope of Rehabilitation Expenses?
When you apply for accident benefits coverage after a car accident, you are required to elect one of: Income Replacement Benefits (IRB), Caregiver Benefits, or Non-Earner Benefits (NEB). Of the three, NEBs have the most challenging criteria to meet. NEBs only kick in after six months AND have the highest threshold: the claimant must sustain an impairment as a result of an accident and suffer a complete inability to carry on a normal life as a result of and within 104 weeks after the accident and does not qualify for an income replacement benefit.
Read More about Lat Applies Heath Test- Orders Non-earner Benefits (Neb) For Chronic Pain
The Licence Appeal Tribunal (LAT), and its prejudicial impact on the health and well-being of motor vehicle injury victims across Ontario, is now firmly entrenched.
Read More about The Licence Appeal Tribunal and Its Impact on Vehicle Injury Victims
When you or someone you care for is involved in an accident, your world can be turned upside-down. It’s difficult to know what to do next or how to help matters. Even if you are a nurse or doctor, focused on one aspect of your patient’s return to health, you may wonder where to direct families for other pressing needs.
Read More about The Personal Injury Resource Guide | Campisi LLP
