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Accident Benefits Archives

FSCO Arbitrator Recognizes 60-Day Timeline for Mediations

A recent decision by FSCO Arbitrator Jeffrey Rogers supports that a mediation can be deemed to have failed if it has not been mediated within the 60 day timeframe noted in both The Insurance Act as well as The Dispute Resolution Practice Code. In the decision, Leone and State Farm, Arbitrator Rogers states the following:

Judge Declares Mediation "Failed" if not Mediated within 60 Days

A decision from the Superior Court of Justice of Ontario was released that declares a mediation by the Financial Services Commission of Ontario (FSCO) failed if it has not been mediated within 60 days of the application being submitted. In Cornie v. Security National [2012 ONSC 905], which was heard with three other similar cases, Justice J.W. Sloan renders the following decision:

FSCO Releases Cost of Goods Guidelines

The Financial Services Commission of Ontario (FSCO) has released guidelines on the costs of goods.  The Guideline was developed as a result of a recommendation by the Auto Insurance Anti-fraud Task Force in its interim report regarding measures that should be undertaken as soon as possible. Pertinent sections are quoted below:

The Toronto Sun explores the human side of the "catastrophic" debate

A story written in the Toronto Sun looks at the current debate over the definition of catastrophic impairment and details the ongoing battles of Robert Kusnierz, whose recent Ontario Court of Appeal win supported the combining of physical and psychological impairments for determining a whole body impairment. You can read the article in full by clicking here.

Toronto Star: Fight fraud, but not at the expense of legitimate claimants

The Toronto Star has published an article about the need to find balance between fighting fraudulent accident benefits claims and providing necessary goods and services for legitimately injured clients. You can read this article by clicking here.

FSCO Revises HCAI Guidelines

The Financial Services Commission of Ontario (FSCO) has released a bulletin which will revise the guidelines for the Health Claims for Automobile Insurance (HCAI) system, effective December 1, 2011. These changes include:

Personal Insurance Hit With $28,000.00 Special Award

In a recent arbitration decision through the Financial Services Commission of Ontario (FSCO), The Personal Insurance Company of Canada was subjected to a $28,000.00 special award for unreasonably withholding accident benefits from their insured. In Hoang and Personal, Arbitrator Denise Ashby found that The Personal unreasonably withheld payment for lost educational expenses and the costs of rehabilitation support worker services for Christopher Hoang, an 11 year-old boy who suffered a catastrophic brain injury from a motor vehicle accident. Arbitrator Ashby noted that The Personal failed to reasonably assess the medical information available and acted unreasonably in denying his claim.  She noted that The Personal's reliance on insurer's examinations, "...in the face of the overwhelmingly consistent opinions and reasoning of the [treatment] Team and the other professionals who followed Christopher, amounts to an unreasonable disregard of the available information relating to the two rehabilitation benefits."

FSCO Allows Application for Accident Benefits almost 2.5 years after MVA

A recent Arbitration decision from FSCO has allowed for an application for accident benefits to be submitted approximately 2.5 years after the motor vehicle accident. In S.R. and State Farm the insured developed mental health impairments of depression and anxiety as a direct result of caring for her husband who sustained a brain injury and a personality change in December 2001 in a motor vehicle accident. While she retained counsel, she instructed him to take no steps in the matter. It was only after her husband's tort and accident benefits claims were settled that she could focus on herself, obtain medical treatment and avail herself of accident benefits. Arbitrator Alves accepted that this was a reasonable explanation for the delay in claiming accident benefits.

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