Accident Benefits Archives | Campisi LLP

Accident Benefits Update: LAT Examines Glasgow Coma Scale As Category

Campisi Law on November 7, 2018

In a recent decision of the Licence Appeal Tribunal, E.W. v Primmum Insurance Company, the applicant, E.W. had been seriously injured in a single vehicle collision while under the influence of alcohol. He suffered extensive orthopedic injuries requiring ongoing rehabilitation to the point that he exhausted his monetary limits under the Statutory Accident Benefits Schedule (SABS). As a result, he applied for a determination of Catastrophic Impairment (CAT), which if accepted, would provide greatly enhanced medical benefits.
Immediate grounds for a CAT determination exist where an insured suffers a brain impairment that results in a score of 9 or less on a test of cognition known as the Glasgow Coma Scale (GCS) within a reasonable time after the accident. E.W. based his CAT application entirely upon a GCS of 8T recorded immediately following his surgery.

Accident Benefits Update- LAT Considers CAT Based On Glasgow Coma Scale

Campisi Law on November 7, 2018

A designation of catastrophic impairment (CAT) following a car accident provides an injury victim with access to greatly enhanced medical, rehabilitative and other benefits under the Statutory Accident Benefits Schedule (SABS). There are several categories of impairment that qualify immediately as catastrophic, including a Glasgow Coma Scale (GCS) score of 9 or lower.

Accident Benefits Update: LAT Clarifies Role of Causation in CAT Applications

Campisi Law on October 10, 2018

In Applicant v TD Insurance, a recent decision of the Licence Appeal Tribunal (LAT), Member Sewrattan had to consider whether an insurer could use causation as grounds for refusing to fund rebuttal assessments requested by the unnamed applicant to determine whether he had suffered a catastrophic impairment (CAT) under the Statutory Accident Benefits Schedule (SABS).

M.G. And Primmum Insurance Company

Campisi Law on April 7, 2018

On October 14, 2014, the applicant (“M.G.”) attempted to cross the intersection of Keele Street and Sheppard Avenue West in Toronto on foot. As she crossed, a vehicle made an improper right turn, hitting her on her knees and knocking her over. She applied for accident benefits under the Statutory Accident Benefits Schedule (the “SABS”).

Accident Benefits Update: Chronic Pain Is Not a Minor Injury (Again!)

Campisi Law on March 10, 2018

The central issue in the recent Reconsideration of 17-000835 v. Aviva General Insurance Canada (2018 CanLII 83520) was whether chronic pain should be considered a “minor injury” or “clinically associated sequelae” under the Minor Injury Guideline (MIG) and Statutory Accident Benefits Schedule (SABS). While this issue should have been resolved already, Insurance companies continue to use the MIG as justification for denying payment of benefits to chronic pain claimants.
The Applicant, T.S. was injured in a collision on January 16, 2015 and sought treatment through his automobile insurer, Aviva. Based on the report of his initial injuries, his claim was processed under the MIG by Aviva, and was subject to a $3,500 cap on funding.

Accident Benefits Update: Divisional Court Confirms Smith Test for 20-Year-Old IRB Claim

Campisi Law on January 8, 2018

Recently, in Aviva Canada Inc. v. Sidhu et al (2018 ONSC 6506), the Divisional Court heard an Application for judicial review by Aviva from a 2017 Financial Services Commission of Ontario (FSCO) appeal. The appeal had upheld a preliminary ruling by the Arbitrator that the claimant, Mr. Sidhu’s income replacement benefits (IRBs) claim was not statute-barred under the Limitations Act.

What You Need To Know About Our Insurance Act And Car Accidents

Campisi Law on January 2, 2018

Many of you do not know that our legal system is prejudiced against plaintiffs who are injured in car accidents. In response to pressure from the Insurance industry, our Insurance Act has built-in relief for defendant insurance companies from paying damages to plaintiffs. Briefly, damages under a certain amount are subject to an automatic deductible which stays in the defendant insurer’s pocket. So, if a jury awards you $70,000 for pain and suffering, you will only receive $40,000. The jury is not told that this happens.

Does failure to attend an insurer’s examination forbid an accident victim to apply for accident benefits?

Campisi Law on November 10, 2017

The decision of the Licence Appeal Tribunal (LAT) in the case called S.L. v Certas Home and Auto Insurance Company answers the question on whether or not the failure to attend an insurer’s examination (IE) forbid an accident victim to apply for accident benefits.

Licence Appeal Tribunal (LAT) Awards Cost After Insurance Company Fails to Provide Documents

Campisi Law on August 11, 2017

The case called
B. F. v Wawanesa Mutual Insurance Company decided by the Licence Appeal Tribunal (LAT) on January 30, 2017 emphasizes the importance of following the orders of the Tribunal. B.F., the applicant in this case, was injured in a motor vehicle accident on February 28, 2014. As a result of the accident, B. F. filed an accident benefit claim with her insurer Wawanesa Mutual Insurance Company. A disagreement arose between B. F. and Wawanesa regarding B. F.’s entitlement to accident benefits under the
Statutory Accident Benefits Schedule. As a result of the disagreement, B. F. submitted an application for dispute resolution with the LAT.

What Constitutes One Assessment under Statutory Accident Benefits Schedule

Campisi Law on April 10, 2017

The Statutory Accident Benefits Schedule (SABS) – a regulation under the Insurance Act – sets the maximum amount that an insurance company is required to pay for one assessment of the extent of an accident victim’s injury at $2,000.

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