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Accident Benefits Update- CAT Claim

Campisi Law on March 20, 2020

In Pucci v. Wawanesa (2019 ONSC 1706), a recent Ontario Superior Court of Justice decision, the court weighed in on causation in a catastrophic impairment (catastrophic) claim. The plaintiff claimant, Brittany Pucci, had been injured in a car accident on June 16, 2013. She suffered various physical injuries and psychological impairments following the accident. Her insurer, Wawanesa paid for her accident benefits including income replacement benefits (IRBs), attendant care (AC) and housekeeping and home maintenance (HKHM) as required under the Statutory Accident Benefits Schedule (SABS) until her non-catastrophic limits were exhausted. Following termination, she applied to the Court for declarations that she had suffered a catastrophic impairment from a mental or behavioral disorder (MBD), and that she was entitled to ongoing IRBs, HKHM and AC benefits.

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Accident Benefits Updates: Motorcycle Accident

Campisi Law on March 20, 2020

Mr. Cowdrey was involved in a serious motorcycle accident on September 15, 2013. He was riding alone just after midnight in Innisfil, Ontario when he struck a pothole and was thrown from his motorcycle. He suffered life-threatening injuries including a serious traumatic brain injury and extensive physical injuries including the loss of his left eye. He was airlifted to Sunnybrook Hospital in Toronto and placed in a medically induced coma for 2 weeks. As a result of the severity of his injuries, he was deemed catastrophically impaired pursuant to the Statutory Accident Benefits Schedule (SABS) under the Insurance Act.

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Accident Benefits Update: LAT Approves Attendant Care Despite Lawyer’s Return to Work

Campisi Law on March 20, 2020

On March 20, 2020, the Licence Appeal Tribunal (LAT) released its decision in J.W. v. Security National Insurance Company (2020 CanLII 30385). The central question in this decision concerned a catastrophically injured (catastrophic) applicant’s entitlement to Attendant Care (AC) benefits, and the quantum of those benefits if found reasonable and necessary. The applicant, J.W. had been seriously injured in a motor vehicle accident on October 20, 2014 while riding a motorized scooter. He sustained a traumatic brain injury (TBI) and multiple orthopedic and other injuries. Security National, his accident benefits insurer, accepted that he was catastrophic.

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ACCIDENT BENEFITS UPDATE- LAT CONSIDERS CAUSATION IN CAT CLAIM

Campisi Law on March 20, 2020

In F.D. and Allstate Canada, a recent decision of the Licence Appeal Tribunal (LAT) before Adjudicator Daoud, causation was again a central issue in a claim for determination of catastrophic impairment (catastrophic). The claimant, F.D. had been rear-ended on August 6, 2014. She suffered extensive soft-tissue injuries, with post-concussion symptoms, anxiety and depression. She sought treatment for ongoing pain and functional limitations, as well as increasing cognitive dysfunction and psychological impairment. Her insurer, Allstate, paid her accident benefits claims up to the non-catastrophic limits then denied further funding. Mediation failed to resolve the issue between the parties, which led to the present hearing.
At the hearing, the sole issue was whether F.D. had suffered a catastrophic impairment from a Mental and Behavioral Disorder (MBD) as a result of the collision. A catastrophic determination would entitle her to enhanced benefits under the Statutory Accident Benefits Schedule (SABS).

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Pastore Revisited: Catastrophic Impairment Victory Changed the Accident Benefits Landscape

Campisi Law on March 20, 2020

On September 27, 2012, the Ontario Court of Appeal released its landmark decision in Pastore vAviva. Mrs. Pastore was successfully represented by Joseph Campisi, the founding partner of Campisi Law. 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.

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Campisi Success Story – Automobile Insurance Claim

Campisi Law on March 20, 2020

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 Law.  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.  

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Accident Benefits Updates: Egg Incident

Campisi Law on March 20, 2020

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.

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Accident Benefits Newsletter – Paediatric Brain Injury Victim Denied CAT Determination

Campisi Law on March 9, 2020

Generally, the June 1, 2016 Amendments to the Statutory Accident Benefits Schedule have made it more challenging for car accident victims to qualify for a determination of catastrophic impairment (catastrophic). The declared legislative intention is that the amendments were introduced to promote clarity in the catastrophic criteria, with the ultimate goal of providing more efficient and cost-effective resolution of these claims. However, from the claimants’ perspective, these goals appear one-sided in favour of the insurance industry. With fewer claims leading to a catastrophic finding, insurer payouts are reduced. At the same time, the greater challenges to a successful catastrophic determination operate as a disincentive to claimants, their care providers and legal representatives.

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