Traders General Insurance Company v. Rumball, 2025 ONCA 656
Reading time: 3 minutes (approx.)
By: Hayley Gardner (Articled Clerk)
The appellant in this matter, Ms. Rumball, was involved in a motor vehicle accident that she claimed left her unable to return to her job as an educational assistant. She applied to her insurer, Traders General Insurance Company, for income replacement benefits under Ontario’s Statutory Accident Benefits Schedule (“SABS”) and was initially denied.
Under SABS, income replacement benefits are payable to an insured person who sustains a disability that causes them to suffer a substantial inability to perform the essential tasks of their pre-disability employment. This test applies to eligibility for the first 104 weeks following the onset of the disability.
104 weeks post-disability, a more stringent test applies. Income replacement benefits are only payable beyond two years if the insured person suffers a complete inability to engage in any form of employment for which they are reasonably suited by education, training, or experience.
Ms. Rumball had suffered psychological impairments, soft tissue injuries, and subsequent chronic pain as a result of her accident. She asserted that she was unable to return to her position as an educational assistant.
The License Appeal Tribunal, which handles disputes regarding entitlement under SABS, heard the case and decided that Ms. Rumball was entitled to income replacement benefits for a period of 104 weeks following her accident. However, the Tribunal also found that Ms. Rumball was not substantially unable to engage in any form of employment for which she was reasonably suited by education, training, or experience. Thus, she was not entitled to income replacement benefits beyond 104 weeks.
The Ontario Superior Court of Justice had dismissed the appeal of the Tribunal’s decision, and the Ontario Court of Appeal subsequently agreed. Before the Court of Appeal, Ms. Rumball had argued that the test for post-104 week benefits should consider employment in a competitive, real-world setting that also takes into account the remuneration and status of the employment options. Traders General Insurance Company, on the other hand, argued that this interpretation was not consistent with the jurisprudence nor the legislation.
Ultimately, the Court of Appeal found that the Adjudicator at the Tribunal had properly considered the test for entitlement to post-104 week income replacement benefits. The test does not require that there be suitable alternate employment available to the insured which is comparable in status and wage to their previous employment. However, it does require a reflection upon all the relevant evidence. In this case, this included a consideration of Ms. Rumball’s testimony, medical evidence called by both parties, Ms. Rumball’s volunteer work, caregiving activities for her father, her work as an educational assistant, and her self-employment as a wedding planner.
The Court of Appeal went on to confirm that the onus is on the insured to prove their entitlement to benefits and that Ms. Rumball had failed to meet this onus. Specifically, the Court of Appeal stated that the medical evidence was not sufficiently up to date, that the medical experts were not privy to a detailed work history which would allow them to offer opinions regarding the type of work she could perform, and that Ms. Rumball had failed to call evidence from a vocational expert.
