S.M. V. Unica Insurance Inc. – A Welcomed Clarification On Special Awards

Earlier this year, I wrote an article entitled "Surprising Special Award Against Insurer" based on the case of Malitskiy v. Unica Insurance.¹ Among other things, that case found that an insurer cannot simply rely on the opinion of an assessor when determining a claimant's needs.

Instead, the adjudicator held that the insurer should have considered all relevant medical evidence and should have followed-up with the assessors for clarification of the claimant's needs.

The failure to do so resulted in a finding that the partial denial of benefits by the insurer to be "imprudent, inflexible, and immoderate" and the Licence Appeal Tribunal ordered a special award in the amount of 25%.