Regulations should not restrict benefits for those with minor injuries: court
In a recent personal injury case, the Ontario Superior Court of Justice upheld a party’s entitlement to a broader scope of medical and rehabilitation benefits following a motor vehicle accident, including an attendant care benefit assessment.
In Co-Operators Insurance Company v. Bennett, 2024 ONSC 467, the Ontario Superior Court of Justice dismissed an appeal by The Co-operators General Insurance Company and upheld the decision by the Licence Appeal Tribunal (LAT) that established Helen Bennett's eligibility for funding for an attendant care benefit assessment following her involvement in a motor vehicle accident on December 5, 2018.
This case centred on the interpretation of the Statutory Accident Benefits Schedule (SABS). The court scrutinized whether the LAT made a legal error in its interpretation. Both parties acknowledged that the court's review was limited to errors in law and had to adhere to a standard of correctness.
The Ontario Superior Court of Justice found that the LAT correctly interpreted the SABS, dismissing the appeal. The court underscored the LAT's role in adjudicating disputes over statutory accident benefits entitlements under the Insurance Act, which governs motor vehicle legislation in Ontario.
Initially, the insurer categorized Bennett's injuries as minor under the Minor Injury Guideline (MIG), which imposes a cap on recovery. However, evidence of Bennett's pre-existing medical condition warranted her removal from this category, making her eligible for a broader scope of medical and rehabilitation benefits, including the attendant care assessment benefit in question.
The court supported the LAT's interpretation, highlighting that insurance regulations should not restrict benefits for individuals with minor injuries who require more comprehensive treatment due to pre-existing conditions. It noted that being removed from the MIG exempts a claimant from the minor injury cap and the limitations on goods and services set by the MIG.
The court emphasized the need for a case-by-case approach in determining benefit eligibility, ensuring accident victims receive the necessary support for recovery. By dismissing the appeal, the court reinforced the LAT's role in interpreting the SABS fairly and in line with legislative intentions.
The court did not award costs for or against the LAT and ordered The Co-operators General Insurance Company to pay fixed costs of $1,000 all-inclusive to Bennett.
