Court Upholds Disability Benefit

An Ontario Appeals Court has sided with an insured man left disabled after a car accident when his insurance company attempted to limit certain benefits.

After the man was left a paraplegic after a car accident in 2010, he applied for and received benefits under Ontario’s no-fault insurance system. Accident benefits would include loss of income due to inability to work along with other expenses, such as – in his case – someone to perform personal care services for him, called “attendant expenses”.

In this case, the man’s mother took an unpaid leave of absence from her job to care for him full-time. There is a section of the law that provides for this expense, provided that the attendant “sustained an economic loss” as a result of providing the service. In this instance, it seems clear that she did however the insurance company sought to stipulate that could only include her normal working hours.

The insurance company argued that her “economic loss” was only incurred during the hours she normally would have worked. The Appeals Court disagreed, and increased the benefit to include the care he needed beyond the typical 40-hour work week.

  • The decision was based on the principle that any stipulation that limits benefits under an insurance contract should be interpreted liberally in favour of the injured party.
  • In other words, the stipulation about economic loss opened the door to attendant care benefits – but did not limit them.

You vs. The Insurance Company

You buy insurance for accident and disability benefits assuming it will cover the actual expenses you incur. As the case illustrates, however, your insurance company will be looking to limit those benefits in any way that they can – even when your eligibility seems cut and dried.

You need someone in your corner. It’s important to know your rights and we add our expertise in the application of the law. Contact the disability lawyers at Petrillo Law today by calling (905) 949-9433.  We look forward to hearing from you.

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