Executive Summary: Key Legal and Evidentiary Issues

• Dispute centered on the plaintiff's entitlement to income replacement benefits under Saskatchewan’s no-fault auto insurance scheme.

• SGI denied benefits during several time periods, arguing lack of employment and employability post-accident.

• Plaintiff needed to prove on a balance of probabilities that he would have been employed but for the accident.

• Medical and employment evidence, including T4 slips, were used to assess work capacity and intention.

• Some claims were barred due to failure to appeal SGI’s earlier decision within statutory limitation periods.

• Court found SGI erred in several assessments and awarded benefits for multiple periods, with costs to the plaintiff.

Facts and outcome of the case

Nathan Wuttunee was seriously injured as a pedestrian in a 2005 motor vehicle accident. At the time, he was not formally employed, though he had a history of sporadic work. Saskatchewan Government Insurance (SGI) provided some income replacement benefits in the years that followed but denied them for several key periods, asserting Mr. Wuttunee was not working or seeking work at the time of the accident, and was later capable of returning to work. Mr. Wuttunee challenged multiple SGI decisions in consolidated actions.

The court examined SGI’s denial of benefits for six distinct time periods, evaluating whether Mr. Wuttunee met the criteria under sections 113 and 140 of The Automobile Accident Insurance Act and related regulations. The court applied a summary judgment procedure, with both parties presenting extensive affidavit and expert medical evidence. The key issue was whether Mr. Wuttunee, considering his circumstances, would have been employed if the accident had not occurred, and whether his injuries precluded him from returning to suitable work.

For the first 180 days post-accident, the court found that although Mr. Wuttunee lacked formal employment documents, his T4s and consistent employment in adjacent years showed he likely would have been employed. He was therefore entitled to benefits during that period. For the period from December 2005 to December 2006, the court again ruled in his favor, noting limited employment and ongoing symptoms as proof of substantial disability. However, SGI's denial of benefits from January 2007 to February 2008 was upheld, based on evidence of increased employment and physical capacity.

SGI had paid benefits from 2008 to 2011 but terminated them in May 2011, based on a fitness report. The court ruled that this termination could not be revisited because Mr. Wuttunee had failed to appeal SGI’s May 2010 decision within the 90-day limit set by law. As such, he was barred from claiming benefits for the period from May 2011 to August 2014. However, the court found SGI erred in denying benefits from August 2014 to February 2015. Although SGI considered him seasonally unemployed, the court ruled that he remained unfit for his previous heavy labor job and SGI had failed to assess or assign suitable employment, entitling him to benefits.

Finally, for the period from May 2017 to the present, the court accepted that Mr. Wuttunee continued to be unable to perform physical work, and SGI’s own expert acknowledged his unsuitability for industrial jobs. The court found no suitable employment had been assigned under the legislation and ruled that benefits should continue to be paid.

In conclusion, the court awarded Mr. Wuttunee benefits for four of the six contested periods and costs of the action. The judgment provides a thorough analysis of the burden of proof in no-fault insurance claims, the evidentiary standard in summary proceedings, and the impact of legislative limitation periods on access to benefits.