The Supreme Court of Canada has ruled against the insurer in a case involving the denial of an insurance benefits claim.
Under Ummugulsum Yatar v. TD Insurance Meloche Monnex, et al, Ummugulsum Yatar, who was injured in an automobile accident in 2010, initially received income replacement benefits and housekeeping & home maintenance benefits from her insurer, TD Insurance, before the latter stopped all payments in 2011.
Challenging the denial of her insurance benefits claim, Yatar brought an application before the Licence Appeal Tribunal (LAT) but was unsuccessful. Her request for reconsideration of the LAT decision was also dismissed.
The claimant then brought an appeal on questions of law and an application for judicial review of the LAT reconsideration decision before the Divisional Court, which similarly dismissed both the appeal and the application. The case was elevated further to the Court of Appeal for Ontario, which dismissed Yatar’s appeal as well.
The Supreme Court, however, ruled that the lower courts erred in their decisions.
In the Supreme Court judgment seen by Insurance Business, the judges wrote: “The appeal should be allowed, and the matter remitted to the LAT adjudicator.
“It was an error for the courts below to hold that, where there is a limited right of appeal, judicial review should only be exercised in exceptional or rare cases. The limited right of appeal from LAT decisions to pure questions of law does not reflect an intention by the legislature to restrict recourse to the courts on other questions arising from the LAT’s administrative decision.
“The legislative decision to provide for a right of appeal on questions of law only denotes an intention to subject LAT decisions on questions of law to correctness review, and proceeding with judicial review on questions of fact or mixed fact and law is fully respectful of the legislature’s institutional design choices.
“Furthermore, the LAT adjudicator’s reconsideration decision was unreasonable, as he failed to take into account relevant legal constraints. The matter should be referred back to the LAT adjudicator for reconsideration.”
It was also ruled that Yatar is awarded her costs in the courts payable by TD Insurance.
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