Court upholds finding that insurer did not unreasonably withhold or delay payment of benefits
The Ontario Superior Court of Justice has upheld the License Appeal Tribunal’s (LAT) decision denying income replacement benefits to a woman who was injured in a motor vehicle accident.
In Bennett v. Allstate Insurance Company of Canada, 2023 ONSC 2609, Janet Bennett was involved in a motor vehicle accident when she was 58. She sustained significant injuries from the accident and received income replacement benefits (IRB) from Allstate Insurance Company of Canada. The benefits were based on her inability to perform the essential tasks of her employment as a quality control inspector and supervisor in an auto parts manufacturing plant.
However, Allstate terminated her IRB in 2018 because Bennett failed to satisfy the post-104-week test of a complete inability to engage in any employment for which she was reasonably suited by education, training, or experience and which was comparable in status and reward to her pre-accident occupation.
Following further medical examinations and assessments, Allstate decided to reinstate the IRB. Bennett sought an award before LAT between September and November 2018, during which IRB was unpaid. She asserted that Allstate had unreasonably withheld or delayed payments.
The tribunal ruled against Bennett, finding that Allstate did not unreasonably withhold or delay payments. Bennett elevated the case to the Ontario Superior Court of Justice, arguing that the LAT adjudicator committed an error in law in finding that the testimony of Allstate’s experts supported its decision to terminate IRB. Bennett asserted that the experts failed to consider her chronic pain syndrome, which allegedly fell outside their areas of expertise.
The superior court dismissed Bennett’s appeal, finding that it raised no question of law. The court found that the adjudicator identified and applied the correct principles in determining whether Bennett must be granted an award for the period during which IRB was unpaid.
The court found that the issues Bennett raised on appeal were questions of mixed fact and law from which no extricable question of law has been demonstrated. As a result, they are not the proper subject of an appeal.
The court pointed out that Bennett’s arguments primarily relate to the adjudicator’s assessment of the evidence of Allstate’s experts. The court said that the weighing of evidence and weight to be given to expert testimony by a specialized tribunal is a finding of fact and not a determination of a point of law.
The court also found that the evidence in the record, including the cross examination of Allstate’s expert, amply supported the adjudicator’s conclusions. For example, the adjudicator noted that the expert was cross-examined about his ability to diagnose chronic pain. In that context, he gave evidence that he did not see cause for “organically based pain” in Bennett. The court said it was open to the adjudicator to rely on this evidence in finding that Allstate did not improperly rely on its expert’s report to terminate IRB.
The court concluded that the adjudicator found no fact that would amount to an error of law. The adjudicator made no finding unsupported by the evidence or based on an “irrational inference.” Accordingly, the court dismissed Bennett’s appeal.
