Mental or Behavioural Catastrophic Impairment under Ontario’s Accident Benefit Regime

Posted by on November 14, 2013 under Accident Benefits, News Comments are off for this article

A recent arbitration decision in Mujku v State Farm provides a useful analysis for determining catastrophic impairment due to a mental or behavioural disorder under the Statutory Accident Benefits Schedule. The applicant, Mrs. Mujku, was injured in a rear end collision in November, 2005. The collision itself, by all accounts, was relatively minor: The vehicle sustained $703.34 worth of damage and Mrs. Mujku suffered soft tissue injuries. Following the collision, Mrs. Mujku’s pain steadily worsened and her mental health deteriorated. Eventually, Mrs. Mujku was diagnosed with a number of recognized mental and behavioural disorders, including, a major depressive disorder and a pain disorder with associated psychological factors.

Arbitrator Jeffrey Rogers decided that Mrs. Mujku met the definition of catastrophic impairment due to mental or behavioural disorder under the Statutory Accident Benefits Schedule. In order to be found catastrophically impaired, an applicant must have a marked impairment in one of four areas of functioning: 1) activities of daily living; 2) social functioning; 3) concentration, persistence and pace; or 4) deterioration or decompensation in work or worklike settings.  Read more of this article »

Practical Strategies Webinar: Auto Insurance Law Impacting You and Your Clients

Posted by on May 22, 2013 under Accident Benefits, Automobile Insurance, Case Law, Insurance Companies Comments are off for this article

The Practical Strategies webinar aired on April 30, 2013.

This webinar will update you on how lawyers and health care providers are coping with the evolving challenges of working in the constantly changing auto insurance system. You will learn strategies that will benefit you and your clients, including:

  • Establishing “incurred expense” and “economic loss” in attendant care claims.
  • Recent developments in catastrophic impairment.
  • Common pitfalls in clinical note taking and report writing.
  • Preparing for giving evidence in the Courtroom.
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Court Ruling: Defendant Rental Car Company Must Remain in Action

Posted by on March 26, 2013 under Accident Benefits, Automobile Insurance, Case Law, Insurance Companies Comments are off for this article

Mr. Smith suffered serious injuries in a single vehicle collision involving a rental car owned by Enterprise Rent-A-Car. Mr. Smith was a passenger in the car and the driver of Mr. Smith’s vehicle held her own insurance policy with liability limits of $1 million.  Enterprise brought a summary judgment seeking to be released from the action, because Enterprise could not be liable for any amount over $1 million.

McLeish Orlando’s associate lawyer, Josh Nisker, successfully defended the motion on behalf of Mr. Smith.

On October 16, 2012, Justice McCarthy of the Ontario Superior Court of Justice ruled that Enterprise was required to remain a party to the action. Justice McCarthy agreed with the plaintiff’s position that the 2006 amendments did not modify the applicable principles of vicarious liability or joint and several liability. Specifically, his honour made the following findings:

  • Legal liability for the accident and legal liability to pay the claim are “distinct considerations.” 
  •  Section 267.12 of the Insurance Act clearly contemplates the “continuing legal exposure” of a lessor for vicarious liability.
  •  The plaintiff clearly had a right of action in vicarious liability against Enterprise and that right of action was not displaced by the operation of section 267.12.
  •  The provisions of the Insurance Act did not prevent the plaintiff from maintaining an action against Enterprise.  

The Smith decision is significant in that it establishes that rental companies must remain parties to an action despite the availability of other insurance. This is especially important to plaintiffs as there will still be an owner’s insurance policy available if the driver’s insurer denies coverage during the litigation.  This ensures that the plaintiff will not be left without an insurance company to satisfy a judgment. 

The full text of the decision may be found online at CanLii Smith v. Smith, 2012 ONSC 5872 (CanLII).

New Lawyer Practice Series Part 3: Plaintiff’s Personal Injury Law

Posted by on March 22, 2013 under Marketing, Our Firm Comments are off for this article

The third part of our blog series entitled: Developing and Funding  a Plaintiff’s Personal Injury Practice.

In this post we will take a look into developing systems for document gathering and file development and its importance through the various stages of litigation.

File Development and Progression

In our office, we have dedicated a lot of thought and energy to developing systems for document gathering and file development.  If you are running your law firm like a business you will realize that it is very important for files to move as quickly as possible through the various stages of litigation.  This is what your client wants and this is also in your best financial interest as all or nearly all of your retainers will be on a contingency basis whereby you are not receiving fees or recovering your disbursements until the case in concluded.  In the majority of injury cases, you will not be able to get an opinion on the prognosis for the future from a physician until two years has passed from the date of injury.  You should plan to have your case at discovery at or near the two year anniversary of the incident to allow you to set the case down shortly after discovery. 

 The document gathering process in motor vehicle litigation is essential.  The documents are essential to prepare the client for discoveries and avoid inconsistencies and credibility issues at trial. Productions also provide the building blocks necessary to obtain complete and consistent expert opinion.   Read more of this article »

Insurance Bureau of Canada Misinforms Officials, OTLA Taking Action

Posted by on March 15, 2013 under Automobile Insurance, Community, Disability Benefits, Insurance Companies, News Comments are off for this article

The Ontario Trial Lawyers Association has recently sent out a newsletter to every MPP in Ontario regarding the Insurance Bureau of Canada misinforming officials about insurance premiums, claims cost and profits.

McLeish Orlando stands behind  OTLA in ensuring that MPP officials are well informed. See below for the newsletter sent out by OTLA.

Read more of this article »

Pastore v. Aviva: A Single Mental & Behavioural Disorder is Sufficient for Catastrophic Impairment

Posted by on September 27, 2012 under Accident Benefits, Case Law Comments are off for this article

The Ontario Court of Appeal released the Pastore v. Aviva decision today and decided that a marked impairment of a single area or aspect of functioning is enough to designate a person as catastrophically impaired.

In the decision delivered by Justice Feldman, the Court concluded that the Director’s Delegate’s decision to this effect was a reasonable one:

In my view, the decision of the delegate, in which he concludes that the use of “a” in the definition of “catastrophic impairment” in cl. (g) refers to a single functional impairment due to mental or behavioural disorder at the marked level, constituting a catastrophic impairment, is a reasonable decision.  The reasoning process was logical and transparent and the result is within the range

What is also very important is that the impairment does not have to be due “solely” to the mental or behavioural disorder. The marked impairment can be caused by a combination of mental and behavioural disorder as well as physical causes of pain:

Read more of this article »

60-Day Failed Mediation Motions: Insured victims win decisively

Posted by on March 7, 2012 under Accident Benefits, Case Law, Insurance Companies Comments are off for this article

There is good news to report to anyone who has unjustifiably been denied access to any statutory accident benefit that they have applied for or has had to deal with a dispute over the determination of catastrophic impairment.

Most people reading this blog will be familiar with the dispute resolution procedure under the Insurance Act.  Most people will recognize that the procedure is badly broken.  Before a dispute can proceed to Court or to a binding Arbitration, a mediation must be held at the Financial Services Commission of Ontario.  If the mediator is unable to resolve the dispute, only then are you able to proceed to a final determination of the issue.  The difficulty is that mediations are being scheduled more than a year from the filing of an application in many instances.

Now for the good news.  Justice Sloan ruled on February 8, 2012 in the case of Cornie v. Security National, that section 19 of the Dispute Resolution Practice Code requires FSCO to conduct a mediation within 60 days of the filing of the Application.  If FSCO is unable to schedule a hearing within this time frame, the mediation is deemed to have failed and the claimant can proceed to a final determination.

In rejecting the defence arguments in the case, Justice Sloan says “The insurance companies take the position that the accident victims must simply wait.  To entertain this argument could mean that an accident victim might have to wait 100, 300 or 500 days for mediation.  I find that submission preposterous.”

Kusnierz: A Return to Combining WPI Scores for Catastrophic Impairment

Posted by on December 23, 2011 under Accident Benefits, Case Law Read the First Comment

Seriously injured accident victims received an early Christmas present from the Ontario Court of Appeal this morning.  The Court released its long-awaited decision on catastrophic impairment in Kusnierz v. Economical Mutual Insurance Company.  In it, the Court reversed the decision of Mr. Justice Lauwers, who had held that assessors could not combine psychological and physical impairment scores to determine an injured person’s Whole Person Impairment (WPI) score.  Instead, the Court adopted the previous practice espoused by Spiegel J. in the 2004 decision of Desbiens v. Mordini.

Justice MacPherson, writing for a unanimous Court of Appeal, set out five reasons in support of its decision to allow the combining of physical and psychological impairment scores.

Read more of this article »

Is a Carjacking An “Accident”?

Posted by on September 7, 2011 under Accident Benefits, Automobile Insurance, Case Law, Claims Denial, Insurance Companies Comments are off for this article

On February 26, 2000, Michael Downer pulled into a Scarborough gas station in his Jeep.  He left the engine on the Jeep running while he sat in the driver’s seat and separated money from his wallet to pay for gas.  When Mr. Downer looked up from his wallet, he saw 3 or four young men around his jeep.  The men began hitting Mr. Downer while pulling him out of the vehicle.  Mr. Downer put the Jeep into reverse to get away from the men.  One of the men tried to force the gear into park while Mr. Downer reversed out of the gas station and then drove off.  A short time later, he became aware that he had suffered injuries in the incident.

Mr. Downer’s insurance company brought a motion to dismiss Mr. Downer’s claim for benefits on the basis that he had not suffered his injuries in an accident.

Was the carjacking an accident?

Read more of this article »

Fight Continues for Access to Benefits for Severely Injured Accident Victims

Posted by on April 18, 2011 under Accident Benefits, Automobile Insurance, Insurance Companies Comments are off for this article

The Ontario government is completing a review on what constitutes a “catastrophic impairment” when a person is injured in a car accident.  The definition is critical: a person who has suffered a catastrophic impairment is entitled to access much greater levels of benefits for care and treatment.  This is not akin to a lottery ticket.  A catastrophically injured person must still prove that the benefits are reasonable and necessary.  All the definition does is raise the ceiling so that the most seriously injured accident victims may gain access to the treatment and care that they legitimately need.  Last week, an expert medical panel completed a review of the definition of catastrophic impairment.  The recommendations are based on a technical review.  In yesterday’s Toronto Star, Dale Orlando wrote an article urging the Ontario government to consider not just rigid technical definitions but also to consider the real needs of severely injured individuals.

The text of the article is reproduced below:

‘Catastrophic impairment’: What’s at stake

Published On Sun Apr 17 2011

Dale Orlando
President of the Ontario Trial Lawyers Association

“If any changes are to be made to this definition of injury, the government should ensure that everyone who needs the additional level of coverage has access to it. It is important to remember that, just because someone is deemed to be catastrophically impaired, that does not confer an automatic right to benefits. They must demonstrate need on an ongoing basis in order to receive benefits from their insurer.”

Read more of this article »