Karina Kowal

The applicant, who was catastrophically impaired in a 2002 motor vehicle accident, sought payment of $22,200 for a new camper trailer as a rehabilitation benefit.

The respondent denied the claim, arguing the expense was incurred before a treatment plan was submitted and was not reasonable and necessary.

The Licence Appeal Tribunal found that while the respondent did not waive its right to rely on s. 38(2) of the Schedule, the claim failed on its merits.

The applicant had already returned to camping for 14 years, and the new trailer was not essential for his rehabilitation or reintegration.

The application was dismissed.

The applicant requested a reconsideration of a preliminary issue decision that barred her claims for attendant care, housekeeping/home maintenance benefits, and transportation expenses.

The Tribunal found that the applicant was attempting to reargue the issue regarding the full and final release for the attendant care and housekeeping benefits.

For the transportation expenses, although the parties agreed no binding settlement was reached, the Tribunal found the claim was time-barred under s. 56 of the Statutory Accident Benefits Schedule as it was brought more than two years after the denial.

The request for reconsideration was dismissed.

The applicant sought statutory accident benefits following a 1996 motor vehicle accident.

The insurer raised preliminary issues, arguing that the applicant's claims for attendant care, housekeeping, transportation, and home modifications were barred by full and final releases and the two-year limitation period.

The Tribunal held that the claims for attendant care, housekeeping, and transportation were captured by validly executed full and final releases and could not proceed.

However, the claim for home modifications was a rehabilitation benefit specifically excluded from the release.

Furthermore, the claim for home modifications was not time-barred because the insurer's 2010 denial was not clear and unequivocal, and the effective denial date for the new treatment plan was October 25, 2017.

The home modifications claim was permitted to proceed to a substantive hearing.

The 79-year-old applicant sought non-earner benefits following a motor vehicle accident.

The insurer paid benefits until January 28, 2017, but terminated them based on multidisciplinary assessments indicating the applicant no longer suffered a complete inability to carry on a normal life.

The Tribunal applied the Heath framework and found that, due to successful physiotherapy and psychotherapy, the applicant had recovered sufficiently to engage in substantially all of his pre-accident activities.

The Tribunal also found the applicant non-compliant for failing to attend a scheduled insurer examination in September 2018, providing an independent basis for termination.

The application was dismissed.

The applicant sought statutory accident benefits following a 2016 motor vehicle accident.

The respondent denied the claims, arguing the injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant failed to provide compelling evidence of a pre-existing condition that would prevent maximal recovery within the MIG limits.

The Tribunal ordered the respondent to pay the disputed $116.40 treatment plan balance, provided funds remained within the MIG limit, along with applicable interest.

The Tribunal also ordered the applicant to pay $500 in costs for unreasonable conduct, as the applicant's submissions improperly focused on a separate, fully settled 2017 accident.

The applicant sought statutory accident benefits following a motor vehicle accident.

After the applicant failed to attend two scheduled case conferences, the respondent brought a motion to dismiss the application as abandoned.

The Tribunal ordered written submissions on the motion, but the applicant failed to provide any submissions despite follow-up from the Tribunal.

The Tribunal drew an adverse inference, found that the applicant had been given ample opportunity to participate, and granted the respondent's motion, dismissing the application as abandoned.

The applicant, who suffered catastrophic impairments in a motor vehicle accident, sought payment for a new camper trailer as a rehabilitation benefit under the Statutory Accident Benefits Schedule.

The insurer denied the claim.

The Licence Appeal Tribunal found that the applicant failed to demonstrate the camper trailer was reasonable and necessary to reduce the effects of his disability or facilitate his reintegration, as he had already returned to his pre-accident camping activities years prior.

The application for the camper trailer was dismissed.

The applicant was injured while driving a dirt bike at a closed course competition and sought statutory accident benefits.

The respondent denied the claim on the basis that the dirt bike was not an 'automobile' under the Schedule.

The Tribunal held that the dirt bike was exempt from the requirement to be insured under section 2(1)(e) of O. Reg. 863 under the Off-Road Vehicles Act, as it was driven at a closed course competition.

Consequently, the dirt bike did not meet the definition of an automobile, and the applicant was not involved in an 'accident' entitling him to benefits.

The application was dismissed.

The applicant sought payment of $2,200 for an attendant care assessment and Form 1 following a motor vehicle accident.

The insurer denied the treatment plan.

The Licence Appeal Tribunal found that while the insurer is liable to pay reasonable fees for such an assessment, the expense must first be incurred by the insured.

Because the applicant had not incurred the expense, and there was no evidence the insurer unreasonably withheld or delayed payment to justify deeming it incurred, the claim was dismissed.

Claims for interest and costs were also dismissed.