The Licensing Appeals Tribunal in the recent decision of [The Applicant] by his Guardian, K.R. vs. Unifund Assurance Company, 2019 Carswell Ont 7818 considered this very question.
The Applicant was catastrophically injured in a collision on August 19, 2019. As a result of the collision the Applicant was in a coma until his death a year later. As a result, the Applicant was required to apply to have a Guardian appointed to manage his affairs.
The Applicant sought to claim the costs of obtaining the Guardianship Order from his motor vehicle insurance company as a “rehabilitation benefit” under the Statutory Accident Benefits Schedule.
The Respondent refused to pay for the costs to obtain the Order because no Treatment Plan had been submitted prior to the expense having been incurred.
The matter proceeded to the Licensing Appeal Tribunal for a determination of whether the expenses were payable. The Licensing Appeal Tribunal held the Applicant was not entitled to reimbursement for the legal fees incurred to obtain the Guardianship Order because the Applicant failed to submit a Treatment Plan in advance as required by section 38(2). The Licensing Appeals Tribunal did not make a determination as to whether or not such expenses would meet the definition of a “rehabilitation benefit”.
For now, lawyers and clients should ensure that where a Guardianship Order is required a Treatment Plan is submitted prior to the Order being obtained to confirm that the insurer is prepared to agree to pay the expenses. If not, it appears that insurers have the right to refuse to pay for these expenses under the Statutory Accident Benefits.
For more information regarding the issues addressed in this blog post, please feel free to contact me directly.
Associate – Personal Injury and Litigation Law Group
Disclaimer: This article is provided as an information resource. This article should not be relied upon to make decisions and is not intended to replace advice from a qualified legal professional. In all cases, contact your legal professional for advice on any matter referenced in this document before making decisions. Any use of this document does not constitute a lawyer-client relationship. Please note that this information is current only to the date of posting. The law is constantly changing and always evolving.