In the recent decision of Ayr Farmers Mutual Insurance Company v. Wright, 2016 ONCA 789 the Ontario Court of Appeal confirmed that insurers who sought a determination on the issue of whether an “accident” as defined in the Statutory Accident Benefits Schedule had occurred could not proceed by way of application to the Superior Court.  The Court held that the mandatory scheme for resolving disputes found in sections 279 to 283 of the Insurance Act (prior to the April 1, 2016 amendments) governed all disputes concerning entitlement to statutory accident benefits, including whether a claimant was involved in an “accident”.  As such, these issues had to be mediated further to section 281(2) of the Act, and following a failed mediation it was the insured who could choose to bring a proceeding in a court of competent jurisdiction or refer the issues in dispute to an arbitrator under section 282 for resolution.  An insurer was limited to requesting the insured’s consent to submit the issue to arbitration.

In the course of its analysis the Court employed the modern approach to statutory interpretation, and emphasized the purpose and intention of the legislation and the scheme created by sections 279 to 283.  In doing so, the Court confirmed that an “insured person” as identified in those sections encompassed all persons claiming entitlement to benefits under the Schedule.  This interpretation was found to be consistent with the language of the definition of “insured person” contained in s. 279(3) of the Act, and with the legislature’s intention to create a comprehensive, expeditious and efficient dispute resolution scheme.

The April 1, 2016 amendments to the Act have removed the mandatory mediation requirement and the option to commence a court proceeding regarding a dispute over entitlement to statutory accident benefits.  Instead, section 280 of the Act now requires all disputes (a) in respect of an insured person’s entitlement to statutory accident benefits or (b) in respect of the amount of statutory accident benefits to which an insured person is entitled to proceed before the Licence Appeal Tribunal.

As such, we can anticipate that the wide scope of application of sections 279 to 283 of the Act identified in Ayr Farmers Mutual Insurance Company v. Wright will similarly apply to the jurisdiction of the Licence Appeal Tribunal as established in section 280 of the Act, and that disputes over whether a claimant was injured in an “accident” as defined in the Schedule will have no choice but to proceed before the Tribunal.

Further, Ayr Farmers Mutual Insurance Company v. Wright can be read as establishing that all coverage issues are similarly prohibited from adjudication by the courts, and are instead required to be heard and determined by the Licence Appeal Tribunal. Access to the courts will be limited to judicial review or appeal.  Where the LAT is still in its infancy, it remains to be seen whether this will result in the expeditious and efficient dispute resolution scheme contemplated by the legislature.

If you have a question about this blog or a similar file, please contact Eric Grossman at 416-777-5222