The lawyers at Aaron Waxman & Associates are experienced with Disability, Personal Injury and Employment claims.
In January of 2012, the case of Zefferino v. Meloche Monnex was heard in the Ontario Superior Court of Justice in front of Justice R.B. Reid. This case involved a claim by Mr. Zefferino that his insurance company, Meloche Monnex had failed to properly offer him the opportunity to purchase optional income replacement benefits as part of its policy.
The Court found that while the direct writer of the policy for Meloche did not properly explain optional benefits to Mr. Zefferino, it was unlikely he would have purchased the additional coverage. The claim was dismissed in summary judgement in favour of Meloche Monnex.
Mr. Zefferino appealed the decision and the appeal decision was released on March 1, 2013. The Court of Appeal upheld the decision of the lower court.
At paragraph 9, the decision states:
 In this case, the trial judge … found as a fact, after assessing the evidence in a procedure agreed to by the appellant, that the appellant would not have purchased the additional insurance. We have not been persuaded that the trial judge made any palpable and overriding error in making this finding of fact.
The Court of Appeal was convinced that Zefferino would not have purchased any additional insurance coverage through Meloche Monnex. No evidence was presented to convince either the trial judge or the Court of Appeal judges otherwise.
The decision further states:
 In our view, the trial judge carefully reviewed the relevant facts and reached a conclusion that was open to him. He noted that the appellant had never before purchased anything other than basic automobile insurance coverage and that according to the insurer’s records, the appellant’s wife indicated that optional coverage was declined because there was no need. He also drew, permissibly in our view, an adverse inference against the appellant because his wife, who dealt with the respondent’s representatives, provided no evidence about her dealings with those respondents.
The decision of the Court of Appeal can be found here.
It is important to remember that this case is dealing with an auto insurance claim from the pre- September 1, 2010Statutory Accident Benefits Schedule (SABS) regime.
As of September 1, 2010, drastic changes were made to the SABS including changes to the medical/rehabilitation amounts available, attendant care amounts, the introduction of the Minor Injury Guideline and the elimination of housekeeping and caregiving benefit unless optional benefits are purchased.
Drivers should be aware that there are optional coverages available to them to upgrade their policies to increase their medical/rehabilitation limits and purchase housekeeping and caregiving benefits.
Of course, all insured persons should note that eligibility for these benefits is subject to how the insurance company classifies their injuries. Anyone whose injuries fall into the Minor Injury Guideline is limited to $3,500 of medical benefits. In order to access other benefits purchased under the policy, one must prove their expenses are both incurred (as per theSABS definition) and that their injuries warrant more than $3,500 of medical benefits, housekeeping, caregiving and attendant care assistance.
If you or someone you know has an accident benefits claim that has been denied, you can contact Aaron Waxman and Associates for a free, no obligation consultation. Our team of lawyers is ready to assist you with your legal needs.
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Disability & Personal Injury Blog