In Goldsmith v The Personal Insurance Company, the Tribunal agreed with Mr. Mortezaei’s submissions that the insurance company relied on boilerplate letters to deny two treatment plans and an assessment, contrary to the requirements of the Statutory Accident Benefits Schedule (“SABS”). Though the Adjudicator concluded that the claimant’s injuries were minor, the Adjudicator ordered payment of incurred medical expenses, plus interest, because the insurer failed to abide by the law.
Under the law in Ontario, an insurance company’s “reasons for denials of benefits must be meaningful to allow the applicant to challenge the decision.” Specifically, an insurer cannot simply state an injured person’s injuries are “minor” because such boilerplate letters are contrary to the consumer protections principles of the SABS.
Read the full decision on CanLIIGoldsmith v The Personal Insurance CompanyPast results are not a guarantee of a similar outcome. Every claim turns on its own facts.
