In Sparks v Primmum Insurance Company, the Divisional Court clarified what an insurer must include in a notice denying or reducing accident benefits — and what it need not explain — to trigger the two-year limitation period under the SABS.
accident benefits
The OPCF 47R and Optional Benefits Claims Process: Now What?
Ontario’s new OPCF 47R and optional benefits claims process is now active, but several claims-handling questions remain unresolved, including transition-period policies, insurer elections, reimbursement, file transfers, anti-deflection, limitation issues, and loss transfer.
Medical and Other Reasons” Under the SABS After Varriano: Part 2
Accident benefits notices are facing increasing scrutiny at the LAT, particularly where insurers rely on generic wording or unsupported conclusions. This blog examines how recent decisions, including Varriano, are reshaping the analysis of “medical and other reasons” under the SABS and what adjusters can do to draft more defensible denial notices. It discusses practical drafting strategies, common pitfalls, substantial compliance, and why file-specific reasoning matters more than mechanical wording or templates.
Medical and Other Reasons” Under the SABS After Varriano: Part 1
Learn how Varriano changed SABS notice requirements and when insurers must provide medical and other reasons for accident benefits determinations.
No Crash, No Cash: Divisional Court Denies Bus Injury Benefits
Is a public transit rider entitled to accident benefits for injuries inside the vehicle? The Divisional Court confirms not unless the vehicle collided with “another automobile or any other object”. This decision clarifies when accident benefits are available for bus...
LAT: Is a Mobility Scooter an “Automobile” in Ordinary Parlance?
Mobility scooter or automobile? The Ontario LAT in Bartok v Intact says “automobile” under the ordinary parlance test. A critical look at the decision and its implications for accident benefits and insurance.
When Minor Isn’t Minor: Why Context Matters in MIG Classification
The Divisional Court in Marcelo clarifies that MIG classification is injury-based, not impairment-based. Context is critical in accident benefits files.
The Nexus Test in Ontario Accident Benefits: Wilson and Wais
Two Coachman decisions appear to point in opposite directions on nexus and priority. They don’t. Wilson and Wais reveal a disciplined framework reshaping how accident benefits claims are adjudicated at the LAT.
Court: Coffee Car Coverage Case Confirmed
The Ontario Divisional Court has allowed an appeal in an accident benefits coverage case, confirming that a claimant who was injured from spilled coffee in a McDonald’s drive-through was involved in an automobile “accident”. In Miceli v. TD Insurance, the claimant was...
Ice is Back with a Brand New Accident Benefits Coverage Decision
This article was initially posted in May 2021. Does slipping on ice next to a vehicle come within the definition of accident under Ontario's statutory accident benefits scheme? Ok Stop. Collaborate and, ummmmm .....read. The Divisional Court has weighed into the (Ice)...