Case information

Insurance — Motor vehicle accident — Denial of entitlement to benefits — Statutory pre-requisites for coverage — Administrative law — Boards and tribunals — Licence Appeal Tribunal — Standard of review — Procedure — Natural justice — Applicant injured in motor vehicle accident and seeking reimbursement for medical treatment services for injuries — Expenses incurred prior to submitting proposed treatment plans to insurer for approval — Insurer denying entitlement to benefits — Adjudicator dismissing applicant’s motion to add issues to hearing and ruling applicant not entitled to reimbursement for expenses — Adjudicator dismissing request for reconsideration of decision — Courts upholding adjudicator’s decisions — Whether insurers should be permitted to issue insufficient notices of denial of insurance benefits or payments — Whether judicial review of insurer’s duty of notice should be mandatory — Whether to owe deference to procedural decisions that deprive insured opportunity to present case fully and fairly — Whether deferral of hearing of motion to add issues was breach of procedural fairness — Whether adjudicating tribunal should be permitted to intervene in appeal of decisions — Insurance Act, R.S.O. 1990, c. I.8, s. 280 — Statutory Accident Benefits Schedule — Effective September 1, 2010, O. Reg. 34/10, s. 38 — Licence Appeal Tribunal Act, 1999, S.O. 1999, c. 12, Sched. G, s. 11.

Case summaries are prepared by the Office of the Registrar of the Supreme Court of Canada (Law Branch). Please note that summaries are not provided to the Judges of the Court. They are placed on the Court file and website for information purposes only.

The applicant, Silverio Pereira, was injured in a 2015 motor vehicle accident, and sought benefits from his insurer, the respondent, Aviva General Insurance Company (“Aviva”). Mr. Pereira submitted to Aviva two chiropractic treatment plans for his injuries, for which he had already incurred expenses; Aviva denied coverage for both plans. Mr. Pereira then applied to the intervener, Ontario’s Licence Appeal Tribunal (“LAT”), for adjudication and resolution of the dispute, seeking an order that he was entitled to such services. A written hearing was scheduled for July 13, 2020, with submissions due by July 6. After Aviva had served and filed its responding submissions, Mr. Pereira brought a motion to add new claims to the dispute and the hearing. The adjudicator ordered the motion to be heard at the same time as the hearing on the issues.

The LAT adjudicator dismissed Mr. Pereira’s motion to add new issues to the hearing, and dismissed Mr. Pereira’s application for relief. The same adjudicator then dismissed his request for reconsideration. A panel of the Divisional Court of the Superior Court of Justice unanimously dismissed Mr. Pereira’s appeal from the reconsideration decision and from the original decision refusing him relief. The Court of Appeal refused Mr. Pereira leave to appeal.