An ongoing source of frustration for seriously injured car accident victims concerns the refusal by their accident benefits insurers to fund assessments for a determination of Catastrophic Impairment (catastrophic).  The Statutory Accident Benefits Schedule (SABS) sets out the obligations on insurers to pay for assessments. Typically, assessments that relate to a benefit or payment are funded out of the rehabilitation and treatment limits under the policy- either $50,000 (or $3,500 if a claimant has been categorized under the Minor Injury Guideline (MIG)).  This is set out in s. 14, 15 and 18 of the SABS. However, s. 25 of the SABS specifically requires an insurer to pay reasonable fees charged for preparing an application for determination of catastrophic impairment under s.45, including any assessment or examination necessary for that purpose.

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On July 19, 2019, the Ontario Court of Appeal released Stegenga v Economical Mutual Insurance Company 201 ONCA 615). The central question on appeal concerned the jurisdiction of the Licence Appeal Tribunal to hear a bad faith claim against Economical for its handling of the plaintiff, Morgan Stegenga’s accident benefits claim under the Statutory Accident Benefits Schedule [SABS] in light of the 2016 amendments to the SABS.

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