ACCIDENT AND SICKNESS INSURANCE - Benefits - Exclusions - Pre-existing conditions - Statutory conditions

Law360 Canada ( February 25, 2025, 8:17 AM EST) -- Appeal and judicial review application by Appellant from the decision and reconsideration decision of Respondent Licence Appeal Tribunal ("Tribunal") regarding his entitlement to no-fault accident benefits from Respondent TD Insurance Company ("TD"). The appellant was involved in a motor vehicle accident when his car was rear-ended while he was in a drive-through lane. Following the accident, he sought no-fault accident benefits from his insurer, TD, under the Statutory Accident Benefits Schedule ("SABS") pursuant to the Insurance Act. The dispute centred on whether the appellant's injuries were minor and thus subject to a $3,500 funding limit for medical and rehabilitation benefits as per the Minor Injury Guideline ("MIG"). The appellant argued that his injuries were not minor, claiming he suffered from chronic pain and that his pre-existing neck and shoulder pain was aggravated by the accident. He sought additional benefits beyond the $3,500 limit, including costs for physiotherapy, psychological assessment, and chronic pain assessment. TD denied the claims, asserting that the appellant's injuries fell within the MIG. The Tribunal dismissed the appellant's application, finding that his injuries were predominantly minor. The Tribunal did not find compelling evidence to support the appellant's claims of chronic pain or that his pre-existing conditions were exacerbated by the accident. The appellant appealed the Tribunal's decision, arguing that the Tribunal erred in law and fact, failed to defer to medical experts, and breached procedural fairness....
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