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ACCIDENT BENEFITS UPDATE: Glass half full?

Campisi Law on March 20, 2020

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.

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It Was Fun While It Lasted: Court Of Appeal Restores Status Quo For EUO

Campisi Law on March 20, 2020

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.

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Accident Benefits Update: CAT

Campisi Law on March 20, 2020

In E.E. and Aviva Insurance Company, a recent decision of the Licence Appeal Tribunal (LAT), the Applicant, E.E. claimed that he had suffered Catastrophic (CAT) Impairment under the Statutory Accident Benefits Schedule (SABS) following a serious single vehicle collision on January 28, 2012 in which he was a passenger.  His initial complaints included neck and back pain with loss of sensation in his right arm. No neurological defects were noted at the hospital. His condition deteriorated over time, and he required several emergency room visits culminating in significant spinal surgery. He continued to suffer from spasticity in his extremities with severely altered gait and very limited use of his dominant right hand, as well as ongoing psychological impairments.  

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Lat Applies Heath Test- Orders Non-earner Benefits (Neb) For Chronic Pain

Campisi Law on March 20, 2020

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.

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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 UPDATE: FSCO MISSES THE POINT OF MIG APPEAL

Campisi Law on January 5, 2019

In Aviva Canada Inc. v. Sleep(FSCO Appeal P17-00034), Director’s Delegate Murray was required to review an arbitration decision concerning the Minor Injury Guideline (MIG) of the Statutory Accident Benefits Schedule (SABS).  In the decision, Arbitrator Anschell found that the Respondent, Mr. Sleep had sustained injuries from a March 26, 2014 collision that exceeded the definition of “Minor Injury” under the MIG.

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