Mould damage caused indirectly by rain seepage may not be covered by an all risk policy

The Court granted an insurer’s appeal from a judgment finding that it was liable to its insured under the terms of a broad-form, all-risk policy of insurance, to cover the costs of mould remediation and prevention to an apartment complex owned by the insured.

Minox Equities Ltd. v. Sovereign General Insurance Co., June 16, 2010, Manitoba Court of Appeal, R.J. Scott C.J.M., M.A. Monnin and F.M. Steel JJ.A.

The insured owned a housing complex, for which it purchased a broad-form, all-risk policy of insurance from Sovereign-General Insuance Co. between 1993 and 2003. The Complex was built in 1977 and within two years there were reports of water leaking into some apartments via vents and light fixtures. These problems continued and a persistent mould problem developed. The mould problem was addressed on an ongoing basis with bleach treatments and by replacing damaged drywall and carpeting as necessary. No insurance claims were made with respect to this damage.

In 2001, it was discovered that some of the mould was toxigenic and further investigation revealed that the toxigenic mould originated from a “mould amplification site” within the building. Mould remediation and elimination of conditions leading to mould propagation, such as replacement of doors and windows, was recommended. Following further investigation, the insured submitted two proofs of loss in late 2002, for $8,585 and $646,000 respectively. The insurer denied coverage of both proofs of loss, on the basis that the build-up of humidity causing the mould growth was not the result of a risk or peril; and exclusions against latent defect or improper design and seepage of water or dampness of atmosphere applied. The insurer also stated that the insured had failed to report the loss on a timely basis. The insured subsequently started this action. 

At trial, the judge determined that the evidence established that there was seepage of water through doors or windows, that there was the entrance of rain, snow or sleet through doors or windows, and that there was dampness of atmosphere in the Complex, all of which contributed to excess humidity and moisture within the units of the Complex. He also determined that moisture was an essential ingredient for the development of mould. However, because the evidence established that mould would not inevitably result from moisture or humidity problems, the trial judge was unable to conclude that the excessive moisture was a direct or indirect cause triggering the appearance of the mould. On that basis he concluded that the loss was not excluded under the policy.

On appeal, the Court found that the trial judge had erred in his interpretation and application of the exclusion clause. The Court noted that the use of the phrase "directly or indirectly" generally connotes that both the direct and consequential losses of an event are captured. Thus, as long as the evidence indicated that mould was a direct or consequential result of the seepage, rain, and humidity, then the exclusion clauses would apply, absent other issues. In this case, the evidence, as found by the trial judge, was clear that the seepage, rain, and humidity present in the Complex led to the moisture and humidity conditions which were so conducive to mould growth. Even if the mould was the result of concurrent causes, the use of the phrase "directly or indirectly caused" in the exclusion clauses, allowed the exclusion clauses to apply. Therefore, even though the evidence indicated that the right temperature, adequate food, and mould spores needed to be present, the evidence also established that moisture was a prerequisite for mould growth.

It was clear that the seepage, rain and humidity problems within the Complex contributed at least indirectly to the growth of mould within the Complex and consequently, the exclusion clauses applied. In the result, the Court allowed the appeal, holding that the insurer was not liable to the insured to cover the costs of mould remediation and prevention.

This case was digested by Emily M. Williamson and edited by David W. Pilley of Harper Grey LLP.

An insurance company must follow up on evidence after the initial decision to deny a claim is made. If they do not punitive damages may be assessed against them.

Appeal by the insurer from a jury’s award of punitive damages dismissed. By not following up on all the evidence relevant to the claim, withholding critical information from the adjuster engaged to investigate the claim and allowing the adjuster to present the results of the investigation in a partisan, biased and un-objective manner, the insurer’s actions were exceptional. A reasonable jury could have concluded that an award of punitive damages was rationally required to punish the insurer’s conduct.

Kings Mutual Insurance Co. v. Ackermann, [2010] N.S.J. No. 255, May 4, 2010, Nova Scotia Court of Appeal, J.W.S. Saunders, M.J. Hamilton and J.E. Fichaurd JJ.A.

The insureds were insured for damage to their dairy barn for the peril of a “windstorm", among other perils. On October 3, 2003, the insureds notified the insurer that their barn had been damaged by hurricane Juan. Upon receiving notice of the loss, the insurer hired an independent adjuster, who in turn hired a professional structural engineer to give his opinion on the damage to the barn and its cause. The insurer’s engineer concluded that “the structural condition of the building had not been affected by the passing of hurricane Juan”. The insureds also hired a structural engineer who found that the barn had, in fact, been damaged by hurricane Juan.

On April 6, 2004, The insureds provided the adjuster with three letters dealing with damage to the barn; one from each of the insured, Leaonard MacPhee, a carpenter, and Brian Chapman, also a carpenter. Both Mr. MacPhee and Mr. Chapman noted that they had witnessed the barn both prior to and after the hurricane and that there was no structural damage to the barn, that they noticed, prior to the hurricane. The insurer did not follow up with, or interview, any of these witnesses.

Prior to hurricane Juan, a safety survey report was conducted, indicating that the barn was in “good” repair and suitable for insurance coverage. This report was forwarded to the adjuster  by the insurer shortly after the claim was made. However, the insurer never forwarded the “post-Juan” survey report, which was conducted on June 1, 2004, to the adjuster. Further, the author of these reports, an investigator employed by the insurer, was never interviewed in connection to the claim.

On July 19, 2004, the insureds submitted their proof of loss and their claim was denied by the insurer. The insureds brought an action, which was heard before a civil jury. The jury awarded the insureds the full amount of their insurance coverage, together with punitive damages, in the amount of $55,000. The jury specifically made a finding of bad faith in relation to the coverage denial and found that the insurer’s conduct offended its sense of decency.

On appeal, the court found that on the facts of the case, the insurer’s failure to instruct its adjuster to follow up with the various witnesses, each of whom had first hand knowledge of the pre hurricane state of the barn, was tantamount to ignoring relevant evidence. The court also noted that several comments made in the adjusters report, showing disdain for the insureds’ counsel and expert, and making comments about the mounting costs to the insureds, indicated that the investigation was not undertaken in an unbiased and objective manner. Therefore, the court found that the evidence before the jury supported its finding of bad faith. A reasonable jury could have concluded that an award of punitive damages was rationally required to punish the insurer’s misconduct.

This case was digested by Natasha D. Morley and edited by David W. Pilley of Harper Grey LLP.

 

 

Inaccurate statements about insurance coverage made by an insurance adjuster may create a claim for negligent misrepresentation.

An action by a homeowner ("Cole") against her insurer ("Aviva") was allowed in part where Cole was entitled to damages resulting from the failed sale of her property based on misrepresentations by the insurance adjuster that her property was being completely cleaned up.

Cole v. Aviva Insurance Co. of Canada, [2010] N.J. No. 149, April 21, 2010, Newfoundland and Labrador Supreme Court - Trial Division, R.M. Hall J.

Cole's claim against Aviva arose out of the leakage of furnace oil from an oil tank that was located outside the residential dwelling house of Cole but within the boundaries of her lot.  When Cole discovered the oil leak, she contacted Aviva which engaged Mr. Frank Power, the principal of an insurance adjusting firm known as Adjusters Incorporated Ltd. to adjust the claim.  Cole testified that Frank Power assured her that the oil spill would be completely cleaned up.  She maintained that he represented that any oil which had leaked out of her tank would be cleaned up, regardless of whether it remained on her premises or had flowed onto the property of neighbours.  This assurance was made to her despite the fact that her insurance policy with Aviva did not cover cleanup of her own property.

Some time subsequent to the oil spill, Cole decided to list her property for sale.  Cole's real estate agent was advised of the oil spill and advised Cole to obtain a clearance certificate from her insurance company certifying the spill had been cleaned up.  Cole was unable to obtain such a certificate as there remained some residual contamination from the oil spill.

In reviewing the policy, the court found that the oil spill caused property damage to the subsurface water which gave rise to a "legal liability" as contemplated by the Premises Liability section of the policy.  Therefore, Aviva was liable to compensate Cole for the clean up costs insofar as it related to remediating the contamination of the groundwater.  Aviva had taken steps to complete that clean up and, therefore, complied with the conditions of the policy.

Cole also claimed that she relied to her detriment upon the representations made by Frank Power on behalf of Aviva.  The court agreed that Frank Power negligently misrepresented to Cole that the spill would be "completely cleaned up" and that Cole suffered damage by reason of this misrepresentation in that she relied upon the work being completed and a clearance certificate being obtained and incurred expenses in making arrangements to purchase another property.  The court found that expenses incurred on the basis of these negligent misrepresentations included $500 on the loss in the sale of old appliances and U-Haul expenses of $305.  In the result, the plaintiff's claim for negligent misrepresentation against Aviva was allowed and the plaintiff was awarded $805.

This case was digested by Jonathan D. Meadows and edited by David W. Pilley of Harper Grey LLP.

Aggravated damages do not constitute a new cause of action.

The plaintiff insureds were successful on their application to amend their Statement of Claim to plead aggravated damages in connection with their insurer’s refusal to pay benefits, as the court held that this did not constitute a new cause of action.

Dimartino v. Gacek, [2010] O.J. No. 1453, April 12, 2010, Ontario Superior Court of Justice, C.J. Horkins J.

The insureds had brought an action with respect to injuries they suffered in an motor vehicle accident.  Prior to beginning the lawsuit, the plaintiffs requested accident benefits through their own insurer and were denied.  The plaintiffs commenced the civil action claiming damages against the tortfeasor and entitlement and payment of various accident benefits against their insurer.  As the civil action progressed, the plaintiffs continued to request benefits and attend mediations with their insurer as required by the Insurance Act.  The insurer paid some benefits but continued to deny most of the plaintiffs’ claims.  On the first day of trial the plaintiffs brought a motion to amend their Statement of Claim to claim aggravated damages.

The insurer resisted the motion on the basis that the proposed amendment was a new cause of action and the two year limitation period set out in the Insurance Act had expired.  It argued that, as the limitation period had expired, there was a presumption of prejudice that would result from the amendment that could not be compensated for with costs or an adjournment.  The judge rejected the insurer’s argument and allowed the amendment.  He found that a claim for any type of damages, including aggravated damages, is not a cause of action but rather is a remedy and “does not stand alone”.

To determine if a pleading raises a new cause of action one must look at whether substantially all of the material facts giving rise to the cause of action have previously been pleaded or whether new facts are sought to be added that are relied upon to support a new cause of action.  A new cause of action is not asserted if the amendments simply plead an alternative claim for relief arising out of the same facts previously pleaded.  In this case, the factual situation that entitled the plaintiffs to assert their claim against the insurer was the existence of a policy of insurance issued by the insurer, the plaintiffs' entitlement to claim accident benefits under this policy, the insurer’s handling of the claims, and its decision to deny the benefits.  The proposed amendment to claim aggravated damages was founded upon the same factual situation.  The fact that the claim for aggravated damages would focus more on the insurer’s handling of the claims and the basis for the denial did not mean that the claim for aggravated damages should be treated as a new cause of action.

The insurer also relied on an earlier decision in which a plaintiff brought a claim for damages for “the insurer’s bad faith conduct in prematurely terminating her weekly benefits”.  However, the wording of the applicable limitation provision had changed since that time.  The earlier limitation provision read:

A proceeding in a court or an arbitration proceeding in respect of no-fault benefits must be commenced within two years after the insurer’s refusal to pay the benefit claimed or within such longer period as may be provided in the No-Fault Benefits Schedule.

In that case, the Court of Appeal upheld the motion judge’s finding that the plaintiff’s characterisation of the insurer’s refusal as bad faith conduct was merely an attempt to circumvent the mandatory requirements of the dispute resolution scheme in the Insurance Act through the guise of linguistic reformulation.  It found that her allegations, distilled, were that the refusal was inappropriate in the circumstances, which was the very issue contemplated for resolution under the No-Fault Benefits Scheme and that her claim was clearly subject to the two year limitation period.

In the instant case, the applicable limitation provision was:

A mediation proceeding or evaluation under section 280 or 280.1 or a court proceeding or arbitration under section 281 shall be commenced within two years after the insurer’s refusal to pay the benefit claimed.

The judge specifically noted that the phrase “in respect of”, present in the earlier limitation provision and also in the current provision regarding dispute resolution, was notably absent from the current limitation provision and provided good reason not to follow the earlier case.  In addition, he noted that no action had been started within the limitation period as it had been in this case.

Finally, the judge noted the practical implications of accepting the insurer’s argument that all claims must be commenced within two years of the denial of benefits.  Given that an insured is statutorily required to mediate before bringing an action, there could well be delay in moving a civil action forward.  An insured might not obtain sufficient disclosure about the insurer’s conduct until well after the expiration of the two year period.  Particulars necessary to justify a claim for punitive or aggravated damages might not be revealed until documentary or oral discovery in the civil action.  Alternatively, the conduct that might cause an insured to consider such an amendment might arise later in the relationship and again well after the limitation period had expired.

In the result, the judge allowed the amendment and granted the insurer a right of further examination for discovery dealing solely with the amendment.

This case was originally summarized by Emily M. Williamson and edited by David W. Pilley of Harper Grey LLP.

In Saskatchewan damages arising from a motor vehicle accident are capped by the no fault legislation.

An application by the Plaintiff for determinations of questions of law arising from a claim to recover the difference between the amount that would have been awarded as damages at common law versus the amount he had received under the no fault scheme.

Acton v. Britannia (Rural Municipality, No. 502), March 9, 2010, Saskatchewan Court of Queen's Bench, G.N. Allbright J.

The Plaintiff was involved in a motor vehicle accident in which he sustained catastrophic injuries.  As a result, the Plaintiff received benefits under the no fault provisions of the Automobile Accident Insurance Act, R.S.S., 1978, c. A-35 (the "Act”).  This included income replacement benefits, living assistance benefits and reimbursement for certain expenses.  The amount of the benefits the Plaintiff received under the no fault provisions were less than the maximum entitlement under the Act.  The Plaintiff commenced an action claiming for the difference between the amount he would have been awarded as damages at common law and the amount he had been paid and would continue to be paid under the Act.  It is in relation to that claim the Plaintiff sought a determination of law with respect to a number of issues.

Firstly, the Court was asked to assess whether a claim for “economic loss” could be pursued pursuant to s. 103(1)(a)(iii) of the Act where the benefits of Division 3 and Division 7 do not and will not exceed the maximum benefits prescribed in s. 112(3) of the Act.  The Court answered that question in the negative.  The aggregate limit for expenses must be exceeded before the right to claim for economic losses will arise.  The claims for those losses are limited to the scope of Part VIII of the Act.  The Court rejected the argument that the Plaintiff had a right to claim for economic losses if any portion of his claim was not paid for by the insurer.

The Plaintiff also sought to recover benefits from the Defendants which were not paid by the Insurer.  The Court held that the appropriate mechanism to seek reimbursement for such additional costs was within the appeal provisions in the legislation.

The Court found that the Plaintiff was not in a position to pursue a benefit to fund a substitute worker to carry out the work on his farm.  He had opted to receive an income replacement benefit based upon his employment earnings rather than pursuing a benefit to fund a substitute worker.

This case was originally summarized by Kim Yee and edited by David Pilley of Harper Grey LLP.

Although an insurer may be required to defend an insured for direct losses, the duty to defend may not extend to consequential losses.

Intact Insurance Company was unsuccessful in seeking a declaration that it was required to defend an action  for direct damage only, and that it was not obliged to defend or indemnify for damages relating to consequential damage, as the court held that it was not clear whether the loss would be found to be a direct physical loss or damage, or whether the exclusion for liability for consequential damage would apply.

Intact Insurance Co. v. Keith Hart Holdings Ltd., [2010] B.C.J. No. 281, February 18, 2010, British Columbia Supreme Court, G.D. Burnyeat J. In Chambers

South Caribbean Supplies ("South Caribbean") sued Keith Hart Holdings ("Keith Hart") for damages to poles that were being transported from New Westminster to the Yukon Territories.  The poles, valued at $18,000 were damaged in an accident to the extent that they were of no value for the purpose they were intended. South Caribbean had to purchase other poles to replace the lost ones.  Keith Hart was not able to transport the new poles, so South Caribbean paid a third party $41,000 to carry the replacement poles and demanded from Keith Hart those costs and the cost of the replacement poles ($20,000). Keith Hart refused to pay either amount.

Keith Hart held a policy with Intact Insurance Company ("Intact"), which stated in part that the policy did not cover liability or expense for delay, loss of market or loss of use or any other indirect or consequential loss of any kind.

Intact sought a declaration that this policy required it to only provide a defence to the action with respect to direct damage and not for any liability for damages relating to consequential damage.  Burnyeat J. stated that it was clear that at least some of what was claimed by South Caribbean was covered by the policy and that it was necessary for Intact to defend those claims. However, Intact could not call upon Keith Hart to obtain its own independent counsel with respect to claims that potentially fell outside of the policy.

Keith Hart was not entitled to be represented by separate counsel in court in the action commenced by South Caribbean.  Citing Nicholls v. American Home Assurance Co., [1990] 1 S.C.R. 801, Burnyeat J. noted that while it was not necessary to prove that the obligation to indemnify will in fact arise in order to trigger the duty to defend, there was still a duty on Intact to defend the entire action of South Caribbean.  Parties would be subject to an assessment after the action was concluded with respect to costs which were payable by Intact and costs which were payable by Keith Hart.

Burnyeat J. also stated that it was not clear at this stage whether the costs of transporting replacement poles would be determined as being a direct physical loss, or whether an exclusion for liability or expense or any other indirect or consequential kind of loss would apply. The Judge, citing Black's Law Dictionary, noted that direct damages are damages that follow immediately upon the act done.  Damages which arise naturally or ordinarily from breach of contract; are damages which, in the ordinary course of human experience, can be expected to result from breach.  Here it may well be that the trier of fact will conclude that additional carriage charges would be incurred whether or not Keith Hart could undertake the carriage of the replacement poles because such costs would be within the reasonable contemplation of South Caribbean and Keith Hart.  This would ultimately be the determination of the trial judge, and as such the petition of Intact Insurance was dismissed.

This case was originally summarized by Neil J. MacDonald and originally edited by David Pilley.

Nova Scotai's cap on non-monetary damages arising from motor vehicle accidents was upheld by Court of Appeal

These were two unsuccessful appeals which were heard together of a decision dismissing a challenge to the statutory and regulatory cap on damages for minor injuries arising from motor vehicle accidents.

Hartling v. Nova Scotia (Attorney General), [2009] N.S.J. No. 599, December 15, 2009, Nova Scotia Court of Appeal, M. MacDonald C.J.N.S., M.J. Hamilton and D.R. Beveridge JJ.A.

This matter concerns two appeals which we heard together challenging the province’s addition of s. 113B of the Insurance Act, R.S.N.S., c. 231 (the “Act”) and the corresponding regulations. The legislative changes capped non-monetary damages for “minor injuries” at $2,500.00.

The appellants in the first appeal appealed a dismissal of their challenge of the minor injury legislation on the following bases:  (1) the definition of a minor injury discriminates against individuals with certain types of pain and discomfort, and is therefore contrary to s. 15(1) of the Canadian Charter of Rights and Freedoms (the “Charter”); (2) s. 113B(1)(a) of the Act discriminates on the basis of gender by disproportionately affecting women with minor injuries as a result of an automobile accident; (3) the Limitation Regulations discriminate against individuals suffering from certain forms of chronic pain, as compared to individuals who are not deemed to have minor injuries; and (4) the regulations expand beyond what the legislation intended.

The government’s position was that the legislation is constitutionally valid and reflects public policy designed to contain sky-rocketing insurance premiums.

The Court dismissed the first appeal and held that the legislation is valid and is not discriminatory as contemplated by the Charter. The regulations do not run afoul with the Act. The Court found that the Appellants were treated differently from other automobile accident victims who avoid the cap on the enumerated ground of a physical disability. The Appellants are disadvantaged by the minor injury cap because of the monetary limit and because they will be denied an independent judicial assessment and the right to seek full recovery for their injuries from a wrongdoer. However, the disadvantages do not trigger s. 15 of the Charter. The evidence fell short of establishing that the legislation perpetuates or is a result of prejudice or stereotyping sufficient to trigger s. 15 of the Charter. The legislation is sufficiently attentive to the appellants’ needs, capacity, and circumstances. The Appellants’ ability to seek recovery for wage loss, costs of future care, legal costs and/or aggravated and punitive damages remains intact.

With respect to discrimination on the basis of gender, the Court held that any disadvantages in that regard are due to pay equity issues unrelated to minor injury cap. The legislation does not trigger s. 15 of the Charter in this respect.

The regulations' expansive definition of the scope of a minor injury was consistent with the Insurance Act and the clear legislative intent to reduce rapidly rising premiums.

In the second appeal, the Appellant asserted that individuals who have purely mental injuries, such as post-traumatic stress disorder, would be discriminated against because of the wording of the legislation which could be read to mean that mental injuries would automatically be deemed to be a “minor injury”. The Court of Appeal denied her leave to appeal on the basis that her appeal was moot. The Chambers judge in the court below had found that her post-traumatic stress disorder was a physical rather than a mental injury.

This case was originally summarized by Kim Yee and originally edited by David W. Pilley.

Contingencies must be applied to a deduction of future entitlement to insurance benefits.

The Defendant sought and was awarded a deduction from a cost of future care award pursuant to 83(5) of the Insurance (Vehicle) Act.

Sauer v. Scales, [2009] B.C.J. No. 2490, December 11, 2009, British Columbia Supreme Court, B.I. Cohen J.

The Plaintiff stated that ICBC had initially paid some chiropractic and physiotherapy expenses under Part 7 of the Act, but then discontinued benefits on the basis that the accident did not cause the injuries. The Plaintiff argued that the application was therefore an abuse of process and the Defendant should be stopped from seeking the deduction.The Plaintiff was injured in a motor vehicle accident and received a tort award from the Defendant. The Defendant sought a deduction from the cost of future care award pursuant to s. 83(5) of the Insurance (Vehicle) Act, R.S.B.C. 1996, c. 231 (the “Act”). The Defendant argued that the costs of future care covered by Part 7 of the Act are to be deducted from an award of damages regardless of whether the Plaintiff has claimed for or received benefits under Part 7. The Defendant took the position that all of the items enumerated in the cost of future care award, except for $5000 which was awarded for upkeep of the family cabin, were expenses which fell under s. 88 of the Act. Section 88 of the Act outlines which benefits ICBC will pay for the event that an insured is injured. An adjuster for ICBC deposed that the Plaintiff had received $7,859.00 as a reimbursement for physiotherapy and an advance of $20,000.00.

The Plaintiff stated that ICBC had initially paid some chiropractic and physiotherapy expenses under Part 7 of the Act, but then discontinued benefits on the basis that the accident did not cause the injuries. The Plaintiff argued that the application was therefore an abuse of process and the Defendant should be stopped from seeking the deduction.

After reviewing a number of authorities, the Court held that Plaintiff’s entitlement to s. 7 benefits had to be estimated and that amount deducted from the tort award. Certain contingencies must be taken into account in doing so. Section 88(1) of the Act states that ICBC is only obliged to pay for “all reasonable expenses incurred by the insured.” The fact that ICBC has the ability to deem certain expenses as unreasonable despite the Court’s award for such items as part of a tort award must be considered. According to the legislation and payment schedules, the amounts permitted for treatments and the frequency of visits for treatments was significantly less than the amounts awarded to the Plaintiff for these items. It was not known whether ICBC would in fact make payments to the Plaintiff beyond the amounts and frequency specified in the legislation and payment schedules. Taking these things into account, the Court held that $25,000.00 was deducted from the award as well as $20,000.00 for the advance.

This case was originally summarized by Kim Yee and originally edited by David W. Pilley.

An insurer may be orderd to pay aggravated damages if recommended benefits are refused without sufficient evidence supporting the denial.

The defendant insurer, was obliged to pay housekeeping and transportation benefits that it had unreasonably withheld from the plaintiff insured. The insurer’s refusal to pay benefits had caused intangible injuries and mental distress that were reasonably foreseeable and the insured was accordingly awarded $25,000 for mental distress.

McQueen v. Echelon General Insurance Co., [2009] O.J. No. 3965, September 28, 2009, Ontario Superior Court of Justice, C.R. Harris J.

 

The plaintiff insured Janey McQueen (“McQueen”) was injured in a rollover motor vehicle accident in January 2004. At the time of the accident, McQueen was not employed and had been receiving disability benefits for 10 years, primarily due to manic depression. She was 35 years old and resided with her husband and 14 year old daughter. Following the accident, the defendant insurer, Echelon General (“Echelon”), paid some benefits but eventually terminated housekeeping benefits, refused to pay transportation benefits, and refused to fund a psychological assessment. McQueen experienced 21 denials of 16 separate benefits over a period of three years and after two failed mediations, brought a suit seeking certain statutory benefits pursuant to the Statutory Accident Benefits Schedule and alleging that Echelon had breached its obligation to act in good faith in handling her claims.

McQueen’s evidence was that prior to the accident, she did the cooking, cleaning, shopping, etc. but that after the accident, she was bedridden for two months and her husband was obliged to leave his job to take care of her and take on the household responsibilities. McQueen obtained a certificate from her family doctor and an occupational therapy assessment which both supported her entitlement to housekeeping benefits. Echelon paid housekeeping benefits until the end of July 2004 and then ceased payments based on a medical report completed by Dr. Kwok, following a half-hour examination of McQueen and without the benefit of seeing the occupational therapy assessment. Echelon also denied McQueen funding for an in-home assessment for housekeeping benefits that was recommended by the occupational therapist, saying it was not “reasonable and necessary.”

The Court found that the onus was on Echelon to provide reasons for the assessment being unreasonable and unnecessary, which it did not do. It further found that McQueen had a substantial inability to carry out housekeeping activities without assistance during the relevant time and that she had established her entitlement to housekeeping benefits on a balance of probabilities. She was awarded benefits of $100 per week for the relevant period.

With regard to McQueen’s claim for transportation benefits, the Court found that these benefits had been denied in spite of the occupational assessment indicating that she required taxi transportation. Dr. Kwok’s report stated that McQueen was not disabled from operating a motor vehicle and Echelon incorrectly assumed that McQueen had a vehicle, though hers had been destroyed in the motor vehicle accident, and denied the benefit. The Court awarded McQueen a transportation allowance of $7,500.

The Court also awarded McQueen the cost of a number of psychological, neurological and occupational therapy assessments that had been recommended but not carried out.

The Court reviewed the law regarding awarding damages for mental distress, citing the BC Court of Appeal and the Supreme Court of Canada decisions in Fidler v. Sun Life Assurance, 2004 Carswell BC 1086 and [2006] 2 SCR 3. The Court held that for an award of damages for mental distress to be appropriate, it must be satisfied that:

a) An object of the contract was to secure a psychological benefit that brings mental distress upon breach within the reasonable contemplation of the parties; and,

b) The degree of mental suffering caused by the breach was of a degree sufficient to warrant compensation.

The Court found that Echelon’s file notes were evidence of an adversarial approach to McQueen ab initio and that in behaving in that manner, Echelon had breached its contract of insurance with McQueen. Echelon adopted this adversarial approach early on, in spite of file notes indicating that McQueen had serious injuries that required treatment and notwithstanding the duty of good faith it owed to McQueen throughout. The Court held that the object of the contract of insurance was to secure psychological benefits to McQueen in the form of peace of mind and that the nature of the contract was such that its breach would bring about mental distress and that this was within reasonable contemplation of the parties. McQueen had endured mental suffering as a result of the breach, which was of a sufficient character to warrant compensation. McQueen was accordingly awarded $25,000 in damages for mental distress.

This case was originally summarized by Emily M. Williamson and originally edited by David W. Pilley.

The owner of a leased commercial premise may be able to claim fire damage from the tenant.

This appeal involved a dispute over which party - the respondent landlord or the appellant tenant - assumed risk for loss occasioned by fire.  The Court of Appeal ruled that by requiring the appellant to contribute to the cost of insurance, the Offer to Lease passed the risk of loss on to the respondent.

1044589 Ontario Inc. (c.o.b. Nantucket Business Centre) v. AB Autorama Ltd., [2009] O.J. No. 3768, September 16, 2009, Ontario Court of Appeal, J.A. Laskin, J.M. Simmons, and R.G. Juriansz JJ.A.

The appellant leased a single unit in a commercial mall owned by the respondent.  A fire occurred in the appellant’s unit, causing damage to the building and its contents, and interrupting the appellant’s business.  The parties brought a motion seeking a determination regarding whether the respondent or its insurer was entitled to claim damages against the appellant.  This question was itself dependant on whether the terms of the Offer to Lease had passed risk of loss caused by the fire on to the appellant or the respondent.  For the purposes of the motion, it was assumed that the appellant’s negligence occasioned the loss.  The Superior Court ruled that the appellant had assumed the risk of loss, and that the respondent was therefore entitled to pursue its claim.

The Court of Appeal disagreed, holding that the respondent had assumed risk of loss.  In so ruling, the Court of Appeal turned to the terms of the Offer to Lease and the Supreme Court of Canada’s decision in Ross Southward Tire Ltd. v. Pyrotech Products Ltd., [1976] 2 S.C.R. 35.  In Ross, the lease contained a condition requiring the tenant to pay for insurance, but did not contain a covenant requiring the landlord to obtain such insurance. The lease did not specifically mention insurance for losses occasioned by fire.  The Supreme Court of Canada ruled that given the terms of the lease, the risk of losses caused by fire passed to the landlord and precluded a subrogated claim against the tenant for damages.  The Court of Appeal found that the Offer to Lease in the case at bar was in substance identical to the lease in Ross, insofar as it required the appellant to contribute to the cost of insurance, but imposed no reciprocal obligation on the respondent.  The Court of Appeal held that if a tenant is required to pay for insurance, it is entitled to the benefit of that insurance.  As a result, in order for the appellant to be deprived of such a benefit, the Offer to Lease must contain a specific term to that effect.

This case was originally summarized by Kim Yee and edited by David W. Pilley.