Source: https://nelliganlaw.ca/articles/?serv=insurance-defence
Timestamp: 2019-04-21 11:05:09+00:00

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Imagine a scenario where a parent is killed in a motor vehicle accident, leaving their significant other and young child behind. The surviving parent is tasked with caring for their family, making funeral arrangements, dealing with estate issues, dealing with their own grief and satisfying daily demands. In the midst of all this, they may also have to consider accident benefits available under their significant other’s policy of automobile insurance and potentially a tort claim against the at-fault driver. In an already difficult situation there is a need to address complex procedural and bureaucratic issues, tight and potentially unforgiving timelines, and significant financial pressures.
Loss Transfer and Laches: It’s Back!
You may recall that in September of 2013, Justice Chiappetta released the decision of Intact Insurance Company of Canada v. Lombard General Insurance Co. of Canada, which held that the equitable doctrine of laches does not apply to loss transfer claims. Laches is an equitable doctrine which, in certain circumstances, prevents the enforcement of a right after a period of delay. On May 27, 2014, Justice Lederman released the decision in Zurich Insurance Company v. TD General Insurance Company, which reached the opposite conclusion.
There have been several developments over the last few months following last year’s Court of Appeal for Ontario decision in Henry v. Gore Mutual Insurance Company, in relation to attendant care benefits under the 2010 Statutory Accident Benefit Schedule – Effective September 1, 2010 (SABS). The first of these was the Financial Services Commission of Ontario (FSCO) Appeal Order in Kevin Simser and Aviva Canada Inc. (Appeal P14-00004), released on January 9, 2014. The second was an amendment to the SABS, which included a new limit on attendant care benefits, and came into effect on February 1, 2014.
In the recent decision of Westerhof v. Gee (Estate), the Ontario Divisional Court has provided much needed guidance with respect to the application of Rule 53.03 of the Rules of Civil Procedure (Expert Witnesses). The court held that the requirements of Rule 53.03 apply to any witness who intends to give opinion evidence at trial.
Under the Statutory Accident Benefits Schedule, Effective September 1, 2010, Ont. Reg. 34/10 an insured person who qualifies for certain benefits must show that an expense was ‘incurred’ in order to receive compensation for services that have been provided.
The starting point to determine whether a loss transfer claim can be made is to look at the type of vehicles involved in the automobile accident. A loss transfer will not be triggered unless there is a difference in the types of vehicles that are covered.
As a result of the amendments to the Statutory Accident Benefits Schedule, under Ontario’s Insurance Act, the legislature has redefined the entitlement criteria for attendant care, housekeeping and home maintenance, and caregiver benefits. To qualify for each of these benefit categories, the insured must have incurred the expense. There are two recent decisions, Henry v. Gore Mutual Insurance Company (“Henry”) and Simser v. Aviva Canada Inc. (“Simser”) on point.
On September 1, 2010, the Statutory Accident Benefit Schedule (the “SABS”) came into effect. Within this regulation, there were a number of changes that have affected an insured’s entitlement to accident benefits and how claims should be evaluated. At the core of these changes was the development of the Minor Injury Guideline (“MIG”), issued in June 2010, which replaced the Pre-Authorized Framework (“PAF”) for minor injuries. In order to provide further guidance to insurance companies and professionals working in the area of automobile insurance in Ontario, the Financial Services Commission of Ontario (“FSCO”) released a revised MIG, which came into effect on November 1, 2011.
A Review of Luther v. Economical: The Financial Service Commission of Ontario’s decision of Luther and Economical discusses the repercussions of insureds refusing to sign assessment centres’ consent forms when attending examinations under the Statutory Accident Benefits Schedule.
SABS Update: Will an Improper Termination of Specified Benefits Result in an Order for Interim Benefits?
When an insurer terminates or refuses to pay statutory accident benefits under the Insurance Act, but fails to provide adequate notice of the dispute resolution process as required by the Statutory Accident Benefits Schedule (“SABS”), what is the consequence?

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