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Appeal - Remedy - Remitting. Wilson v. Intact Insurance Company [remedies of full or partial remitting]
In Wilson v. Intact Insurance Company (Ont Div Ct, 2025) the Ontario Divisional Court allowed an insured's joint appeal/JR, this from a LAT SABS ruling that denied them catastrophic impairments benefit.
Here the court considered the remedial issue of (what can be called) 'full' or 'partial' remitting:E. CONCLUSIONS
[47] The reviewable errors I have found under Criterion 6 are sufficient to require a new hearing as they could affect the outcome. Given the circumstances, the new hearing should be before a different adjudicator.
[48] The applicant has requested that if reviewable errors are found, this Court should make a determination that the applicant has a catastrophic impairment and then remit the matter to the tribunal to determine what level of benefits should then flow from that. There are a number of problems with that. First, the role of fact-finding does not sit easily with this court, which is working solely through a “paper” record. That is particularly problematic where factors in various categories are interlinked and the area is highly specialized. Further, the appropriate level of benefits is linked to the degree of impairment found and the determination of benefits should therefore be determined by the same decision maker. Again, that is not an appropriate role for this court.
[49] In addition to the 24% for double vision, Dr. Quaid assessed a further 10% impairment for other visual impairments. The Adjudicator did not allow anything for those either. Given that the visual deficits will need to be determined in a new hearing, I consider it is unnecessary for me to elaborate further on the additional deficits found by Dr. Quaid. The new adjudicator will need to hear the evidence on all of the visual impairments in any event.
[50] Likewise, I have not dealt with the issue of Criterion 7 because of its interaction and dependency on the assessment scores from Criterion 6.
[51] Although I have found that deference is due to the findings of the Adjudicator in other categories, the new adjudicator does not owe the same deference to the original findings. Many of these factual issues overlap and many are dependent on credibility findings and other findings of fact from the applicant’s evidence. Unless the parties can come to some agreement as to levels of impairment in some categories, this cannot be done by cutting and pasting. A new hearing before a new adjudicator is required with respect to all issues.
[52] Accordingly, the decision and reconsideration decision of the Adjudicator is quashed and a new hearing is ordered before a different adjudicator.
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