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Tuesday, February 07, 2017 @ 10:28 AM

AUTOMOBILE INSURANCE - Uninsured or underinsured motorist coverage

Appeal by Sabean from a judgment of the Nova Scotia Court of Appeal setting aside a trial judge decision holding that future Canada Pension Plan (CPP) disability benefits were not to be deducted from the amount payable under Sabean’s excess insurance policy. Sabean was injured in a motor vehicle accident in 2004. In May 2013, a jury awarded Sabean damages for his injuries in the amount of $465,400. The amount he received from the tortfeasor’s insurer was about $382,000, leaving a shortfall of more than $83,000, which Sabean claimed under the excess coverage provisions of his SEF 44 Endorsement with Portage La Prairie Mutual Insurance Company (Portage). Clause 4(b)(vii) of the Endorsement stipulated that amounts recoverable under "any policy of insurance providing disability benefits or loss of income benefits or medical expense or rehabilitation benefits" were to be deducted from the shortfall of the damages awarded in determining the amount payable by the insurer to the eligible claimant. Sabean was entitled to receive future CPP disability benefits. Portage claimed that those amounts were to be deducted as recoverable benefits from a "policy of insurance" under clause 4(b)(vii) in determining the amount payable by Portage. Sabean disagreed. The trial judge in this case found that CPP benefits were not benefits from a "policy of insurance" under the Endorsement and thus would not be deducted from the amount payable by the insurer. The Nova Scotia Court of Appeal disagreed, concluding that the CPP was a "policy of insurance" under the Endorsement. The issue in this appeal was whether the CPP was a "policy of insurance providing disability benefits" within the meaning of clause 4(b)(vii) of the SEF 44 Endorsement. ... [read more]

Monday, February 06, 2017 @ 10:56 AM

SCC benefits ruling seen as consumer win

In a win for consumers and injured plaintiffs across Canada, the Supreme Court has ruled 7-0 that insurers can’t reduce their excess insurance payouts under their auto policies’ standard endorsement form 44 by the amount of plaintiffs’ Canada Pension Plan disability benefits. ... [read more]

Friday, February 03, 2017 @ 3:45 PM

GOODS AND SERVICES TAX (GST) - Exempt supplies - Financial services - Special cases - Insurers - Appeals

Appeal by Great-West Life Assurance Company (Great-West) from the dismissal of its appeals from GST assessments on fees it collected for services provided in connection with group health benefits plans it offered to employers. The benefit plans included coverage for drugs and dental care for employees and their families. Great-West assumed the risk in providing benefits in exchange for an insurance premium with respect to the prescription drug component, while the employer assumed the risk and Great-West earned a service fee for other components of its plans. Emergis provided services to Great-West which involved receiving and adjudicating benefits claims from employees and arranging for benefits to be paid on a real-time basis. Emergis Inc. (Emergis) provided this service by making agreements with pharmacies, pursuant to which pharmacies would fill prescriptions for card-carrying employees covered by Great-West on the understanding that payment would follow from Emergis. Emergis would pay the pharmacies on behalf of Great-West, using Great-West’s funds. Emergis earned a fee for each drug transaction, whether or not the claim was approved. Emergis also provided a call centre for the use of employers and pharmacies, among other services. It was common ground that the services provided by Emergis ... [read more]

Thursday, February 02, 2017 @ 1:34 PM

La Caisse names Thomassin executive VP

La Caisse has appointed Kim Thomassin as executive vice-president, legal affairs and secretariat. ... [read more]

Thursday, February 02, 2017 @ 11:55 AM

Blaney McMurtry announces four new partners

Four associates have become partners of the firm Blaney McMurtry LLP. ... [read more]

Wednesday, February 01, 2017 @ 2:06 PM

In a self-represented world, judges must be the gatekeepers | Gary Joseph

Our adversarial system operates on the premise of passive adjudication.  By this I mean the role of our judges is predominately reflexive as they hear evidence, weigh it and determine disputes based upon what has been presented to them.    Unlike some jurisdictions where judges play an investigative role, our judges must not search out evidence outside of what is presented in court to them by the parties to the dispute.   ... [read more]

Monday, January 30, 2017 @ 11:43 AM

Quick action, proper notice needed for overpayment recovery

An Ontario Superior Court judge has provided some much needed guidance on how to successfully recover overpayments made to claimants under the Statutory Accident Benefits Schedule (SABS). Since the introduction of the notice requirement in the 1996 amendments to the SABS, conflicting decisions have muddied the waters of what constitutes timely and proper notice. ... [read more]

Thursday, January 26, 2017 @ 7:00 PM

Insurance Law - The insurance contract - Interpretation - Coverage provisions and exclusion clauses - Reasonable expectation doctrine

Appeal by the defendant insurer from a summary trial judgment holding that the insurance policy issued to the respondent covered defects and deficiencies in a building. The respondent’s building was damaged as a result of a storm sewer overflow. When drywall was removed to examine the damage, building code violations were discovered and the building was found to be structurally unsound. The City ordered that the building be demolished or, failing that, there had to be a report from a structural engineer as to what steps were required to stabilize it. The appellant refused to pay for the cost of replacing the wood frame building on the basis that it was not covered by the policy. The respondent’s policy excluded any loss caused by the enforcement of bylaws that made it impossible to reinstate the property as it was immediately prior to the loss. A rider to the policy extended coverage, as a result of a peril insured against, for the cost of replacing a building arising from the enforcement of the minimum requirement of any bylaw. The summary trial judge interpreted the phrase “as a result of a peril insured against” to mean that once the water ingress and damage had taken place, the policy was extended to indemnify for the insured peril of bylaw enforcement. ... [read more]

Thursday, January 12, 2017 @ 7:00 PM

When serious injury doesn't pass threshold

How “serious” does a “serious impairment” have to be for a plaintiff to pass the threshold under s. 267.5 of the Insurance Act? What kind of evidence should be advanced by a plaintiff in order to establish a viable future income loss claim? ... [read more]

Thursday, January 12, 2017 @ 7:00 PM

High price paid for delay in filing notice

Is giving notice of an action to an insurer a prerequisite to triggering its obligation to assume the cost of providing a defence? Does the obligation to assume defence costs arise from the time the action is commenced? Is any prejudice suffered by the insurer, arising from late notice, appropriate to consider in this analysis? Recently the British Columbia Court of Appeal addressed these questions in Lloyd’s Underwriters v. Blue Mountain Log Sales Ltd. 2016 BCCA 352. ... [read more]