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Accident Benefits Update: New Catastrophic Paraplegia Criteria Tested

Campisi Law on March 20, 2021

In Patel v. RSA Insurance (19-000560-AABS), a recent decision before the Licence Appeal Tribunal, a dispute arose over the new Paraplegia criteria for meeting the definition of catastrophic impairment. The applicant, Aiysha Patel suffered a severe spinal cord injury in a car accident. She sought a determination that she was catastrophically impaired (catastrophic) under the Statutory Accident Benefits Schedule (SABS), which would entitle her to greatly enhanced ongoing benefits from RSA, her insurer.

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A Campisi Success Story – Motorcycle Accident Case

Campisi Law on January 20, 2021

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: AVIVA BEATS DEAD HORSE… TWICE!

Campisi Law on December 3, 2020

In two recent decisions of the Licence Appeal Tribunal, released on consecutive days, Aviva mounted spirited attempts to broaden the scope of accident benefits claims under the Minor Injury Guideline or MIG. N.R. and Aviva, 2019 CanLII 51313, and the Reconsideration Decision in G.S. and Aviva, 2019 CanLII 51320, were both heard in writing before Vice-Chair Susan Mather released May 9 and 10, respectively. At issue in both was whether the claimant’s chronic pain was a minor injury under the MIG. Historically, Aviva had some success in demonstrating that the presence of chronic pain does not remove a claimant from the MIG unless there is evidence of functional impairment.

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Accident Benefits Update: Proving Chronic Pain? – a Cautionary Tale

Campisi Law on November 3, 2020

In S.K. v. Aviva Insurance Canada (2019 CanLII 126203) recent Reconsideration Hearing before the Licence Appeal Tribunal (LAT), the applicant S.K. argued that the LAT had erred in fact and at law by finding that her injuries were appropriately treated under the Minor Injury Guideline (MIG). As a result of this finding, her claims for outstanding treatment plans were also dismissed.

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Accident Benefits Update: Shades of Grey between Moderate and Marked Impairment

Campisi Law on September 3, 2020

K.S. andTD Home and Auto Insurance Company (2019 CanLII 22189), a recent decision by the Licence Appeal Tribunal (LAT), considered the fine line for establishing catastrophic impairment (catastrophic) under s.3(2)(f) of the Statutory Accident Benefits Schedule or SABS (prior to June 2016), which deals with Mental and Behavioural Disorders (MBD). The applicant, K.S., was injured on October 28, 2014 while riding his bicycle. He was struck by a passing motorcyclist and flung from his bike, landing on the pavement and splitting his head open. As a result of the accident, K.S. sustained physical injuries to his head, upper body, knees and a fractured neck. He also suffered psychological impairments including poor concentration, irritability, anxiety, stress and depression, as well as uncontrollable and sometimes violent outbursts.

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Accident Benefits Update: LAT split on “Reasonable and Necessary” CAT assessments

Campisi Law on June 3, 2020

In V.L. vs. Pafco Insurance Company (2019 CanLII 119760), a recent hearing in writing before the Ontario Licence Appeal Tribunal (LAT), the applicant, V.L sought payment from Pafco, her insurer for the costs of her assessments to determine catastrophic impairment (catastrophic). Pafco had approved approximately 2/3 of the requested $25,719.25, denying the remaining $8,884.00 on the grounds that these costs were not reasonable or necessary. Two denied Chiropractic treatment plans were also in dispute.

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Accident Benefits Update: ONCA’s TOMEC Decision on SABS Limitations

Campisi Law on May 3, 2020

On November 8, 2019, the Ontario Court of Appeal released Tomec v Economical Mutual Insurance Company (2019 ONCA 882). The central issue on the appeal was whether the two-year limitation to start a proceeding following a denial of accident benefits was a “hard” limitation or was subject to the principle of discoverability.

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Accident Benefits Update – Catastrophic Assessment Report Slammed by LAT

Campisi Law on March 20, 2020

The Licence Appeal Tribunal (LAT) recently released P.S. vs. Allstate Insurance (2020 CanLII 87980) a catastrophic impairment claim heard immediately before the COVID measures took effect. In this decision, Adjudicator Hines was required to determine whether P.S., the applicant was entitled to enhanced catastrophic benefits under the Statutory Accident Benefits Schedule (SABS).

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