The decision, C.B, T.G.B and B.G.B v Belair Direct Insurance Company, 2023 ONLAT 22-002265 of Adjudicator Tavlin Kaur (released on July 25, 2023), reaffirmed that spouses and dependents of insured persons injured in accidents are only entitled to benefits for psychological injury if the named insured sustained a physical injury in the accident. This case concerned a dispute between the spouse and children of the insured person and an insurer about insurance benefits under the Statutory Accident Benefits Schedule (SABS). In April of 2019, Ms. G (mother) and her friend were on a walk when an impaired driving struck her friend, who was killed as a result. Ms. G was deemed as physiologically catastrophically impaired, having witnessed this incident. The applicants (Ms. G’s spouse and children), filed an application with the LAT, claiming that Ms. G’s catastrophic impairment has caused each of them to also suffer psychological and/or mental impairments themselves.
Section 3(1)(a) of the SABS defines an insured person as “the named insured, any personal specified in the policy as a driver and, if the named insured is an a individual, the spouse and dependent of the named insured”. However, the SABS limits benefits for psychological injuries for spouses and dependents to accidents resulting in physical injuries to the named insured. The respondent, Belair Direct submitted that the applicants do not meet the definition of an injured person pursuant to Section 3(1)(a)(ii), as Ms. G did not sustain a physical injury in the accident.
Adjudicator Kaur found that the applicants were not entitled to make a claim under the SABS. The Tribunal first considered whether the applicants suffered a psychological or mental injury as a result of the accident or as a result of physical injury to Ms. G. The LAT was not satisfied that they had suffered such injuries. Adjudicator Kaur found the evidence provided to be hollow. The family submitted a chart which referred to reports and records from psychologists and therapists, none of which made reference to the physiological or mental injury that the applicants claimed to have sustained. The reports and records that the applicants relied on were mainly based on Ms. G’s self-reporting.
The Tribunal then commented on whether Ms. G suffered physical impairments as a result of the accident. Adjudicator Kaur determined that she had not. The medical records showed no evidence of physical injury resulting from the accident. Therefore, Ms. G spouse and dependent’s would not have been entitled to benefits even if they had provided satisfactory evidence deeming them psychologically impaired.
Noah Beiles ([email protected]) is a summer student at ZTGH and author of this blog. If you have a question about a similar file, please contact Eric Grossman at 416-777-5222.
