CASES WE'RE PROUD OF

For anyone who gets an argument from opposing counsel about deficient notice letters, check out this decision. Not only does it reiterate the well established principle that insurers are not doctors, and their notice letters do not need to be perfect. This decision also held that insurers do not need to “refer to specific pieces of evidence” in their denial letters.

The Applicant claimed to have a diagnosis of a concussion but the LAT agreed that the “?” next to the word concussion meant there was no diagnosis.

This is the case involving an Ontario man, who misrepresented in his Application for Insurance, then had an accident in Michigan and elected to receive Michigan benefits, then got caught in the misrepresentation.

Interesting accident benefits decision where the applicant was barred from receiving IRBs due to material misrepresentations in his application for insurance. The applicant was ordered to repay $72,881.74 to the insurer plus interest.

Successful Reconsideration decision confirming the Insurer was not obligated to pay any further benefits and the LAT Application was dismissed.

A LAT decision dismissing claims for NEBs, interest and a s. 10 award.

Economical policy provided coverage for temporary replacement vehicle under the OAP 1, meaning that it was the priority insurer and could claim loss transfer against Intact.

Successful motion for production of prior AB claims file and medical records more than three years prior to the current MVA.

Important priority decision confirming the consequences of Co-Operators' deflection of the claim to Algoma, with optional benefits under the Co-Operators policy.

Interim decision requiring the Applicant to produce outstanding productions and for summonses issued to third parties for employment and LTD records.

Successful opposition to a motion for summary judgment to recover $62,264.74 following a suspicious fire loss and allegations of money laundering.

Adjudicator Robert Watt, in his recent Reconsideration Decision of December 18, 2019, upheld a prior LAT decision denying the claim that his injuries arising from a motor vehicle accident fell outside of the Minor Injury Guideline. In doing so, Adjudicator Watt maintained what has long been accepted by both FSCO and the LAT alike: a diagnosis of chronic pain will not in and of itself automatically remove an insured/applicant from the MIG.

LAT Hearing confirming applicant was not principally dependent upon his father for finances and therefore not an "insured person".

Written LAT Hearing dismissing claims for MIG and various OCF-18s.

Following a 106-day trial, the plaintiff sought in excess of $60,000,000 in damages and was awarded $50,000, far less than the Defendants' offers to settle.

A claimant who returned to work post-accident and then discontinued was found to not meet the substantial inability test. The insurer successfully argued the claimant lacked credibility and was an inconsistent historian about past injuries and claims.

The Supreme Court of Canada declined to give leave to appeal, without reasons (as is customary.

Written LAT Hearing confirming "Ferawana" argument did not apply - Application dismissed.

Interesting priority dispute decision dealing with the 'LICO' and 'big picture' approaches to financial dependency for an adult who earned "grey market" cash income prior to the accident.

Successful appeal confirming dismissal of accident benefits claim due to failure to notify the Insurer of the claim within 30 days of the accident.

FSCO Appeal pertaining to an order that the Applicant's paralegal personally pay the costs of a frivolous proceeding.

This FSCO decision confirms an assault is an intervening act breaking the chain of causation between the use of a vehicle for a motoring purpose and the direct cause of the injuries. Despite the contemporaneous use of the insured taxi, this was not an accident under the SABS.

Successful motion to stay a related Small Claims Court matter pending the Insurer's Superior Court action to recover damages for breach of contract & fraudulent misrepresentation from an alleged staged motor vehicle accident and related claim for accident benefits.

A mid-Trial ruling that the Plaintiff's proposed expert accounting witness was not an Expert Witness under the Rules.

Interesting LAT Motion Decision confirming that a recording of an expert made without notice to the expert was not admissible.

FSCO arbitration proceeding dismissing claims for NEBs, MR and a Special Award. The Applicant was ordered to pay $22,340 in costs.

In a precedent setting preliminary issue decision, Kadey Schultz secured a withdrawal of claims for Income Replacement, Attendant Care and Housekeeping Benefits as well as costs of $19,620.36 payable to RBC as a result of the fraudulent claim for IRBs.

Precedent setting Court of Appeal decision confirming proper interpretation of Rule 9 of the Fault Determination Rules.

Superior Court Appeal of a private arbitration decision challenging the correct application of Rule 9 of the Fault Determination Rules. The entire industry awaits the appellate ruling from the Ontario Court of Appeal as hundreds of millions of dollars in potential indemnification claims remain pending.

Successful appeal from a Master's decision requiring the Defendant to answer certain questions and produce documents not covered by a statutory privilege found in the Education Act.

After a 32-day trial, the action was dismissed.

Textbook opposition of motion to set aside registrar's dismissal of the action. Despite solicitor's negligence, the action was restored. $16,500 in costs awarded to the unsuccessful insurer.

Successful motion at the outset of the Arbitration Hearing excluding all of the Applicant's documentary evidence.

Interesting motion to dismiss the personal injury action for delay due to failure to satisfy undertakings and against the background of a WSIB fraud conviction during relevant times.

Appeal confirming the dismissal of the arbitration and costs against the legal representative, personally.

Court of Appeal decision dealing with the AB settlement regulation and enforcement of settlement after the insured discharged their counsel.

FSCO Arbitration Decision dismissing housekeeping benefits claim.

FSCO Appeal confirming s. 33 suspension of benefits and remitting matter back to arbitration to determine whether the Applicant had a reasonable explanation for the s. 33 non-compliance.