Kate Grieves

The applicant sought statutory accident benefits after fracturing his foot while disembarking from a parked shuttle van onto uneven pavement.

The respondent insurer denied benefits, arguing the incident did not meet the definition of an 'accident' under s. 3(1) of the Schedule.

The Tribunal applied the purpose and causation tests, finding that disembarking is an ordinary use of a vehicle and that this use was a direct cause of the injuries, despite the uneven surface also being a contributing factor.

The Tribunal concluded the incident was an accident.

The applicant requested a reconsideration of a Tribunal decision which found she was not involved in an 'accident' under the Statutory Accident Benefits Schedule.

The applicant argued the incident occurred in two phases and the Tribunal made an error of fact regarding the size of rocks thrown at her.

The Tribunal dismissed the request, finding the applicant was attempting to re-litigate her initial arguments and failed to show how the characterization of the rocks impacted the overall conclusions.

The respondent insurer requested a reconsideration of a preliminary issue decision which found that the applicant was an 'insured person' under the Schedule because she and the catastrophically injured person were sisters.

The respondent argued the Tribunal erred in fact and law, asserting the evidence supported a finding that they were cousins.

The Tribunal dismissed the request, finding that the respondent improperly attempted to re-weigh evidence and raise new case law that was not presented at the initial hearing.

The applicant applied for statutory accident benefits following a motor vehicle accident.

The Tribunal scheduled a written hearing after the applicant failed to attend a case conference.

However, it was later discovered that the Tribunal had incorrectly recorded the applicant's email address, resulting in the applicant not receiving any notices, including the Notice of Case Conference and Notice of Hearing.

The adjudicator found that the applicant did not receive notice as required by the Statutory Powers Procedure Act.

Consequently, the written hearing could not proceed, the Notice of Hearing was vacated, and a new case conference was ordered.

The applicant was involved in a motor vehicle accident while driving for Uber and reported the accident to the insurer the next day, stating he suffered no injuries.

Over a year later, he submitted an application for accident benefits.

The insurer denied the claim due to late notice.

The Tribunal found that the applicant failed to notify the insurer of his intention to claim benefits within the seven-day limit under section 32(1) of the Schedule.

The Tribunal rejected the applicant's explanation that he was misled by Uber, finding it lacked credibility and evidentiary support.

The application was dismissed pursuant to section 55(1).

The applicant, a minor, sought statutory accident benefits for psychological injuries arising from a motor vehicle accident involving her cousin.

The respondent insurer denied benefits, arguing the applicant was not an 'insured person' under the Schedule because cousins are not listed family members.

The Tribunal applied the modern approach to statutory interpretation and found that the applicant's mother had a de facto parent-child relationship with the cousin, making the applicant and the cousin 'sisters' for the purposes of the Schedule.

The Tribunal concluded the applicant is an insured person and eligible for benefits.

The applicant was involved in a motorcycle accident and reported it to the insurer the following day.

The insurer denied statutory accident benefits, arguing the applicant failed to provide notice of his intention to claim benefits within seven days and failed to submit his application (OCF-1) within the prescribed time.

The Tribunal found that reporting the accident and the fact that the applicant struck his chest and fell was sufficient to meet the notice requirement under section 32(1) of the Schedule, relying on recent Divisional Court jurisprudence.

Furthermore, because the insurer failed to provide the application forms, the applicant could not be barred for failing to submit them within the 30-day timeline under section 32(5).

The applicant was permitted to proceed to a hearing.

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

The insurer denied the benefits and scheduled insurer's examinations under section 44 of the Schedule.

The applicant failed to attend the scheduled examinations and did not provide submissions for the preliminary issue hearing.

The Tribunal found that the insurer's notices of examination were compliant with the Schedule and provided adequate reasons.

Consequently, pursuant to section 55 of the Schedule, the applicant was barred from proceeding with his application for benefits.

The applicant requested a reconsideration of a preliminary issue decision which found she was not entitled to non-earner benefits prior to submitting a completed disability certificate.

The applicant argued the Tribunal erred by failing to consider the insurer's obligation to communicate the consequences of a delay in submitting the certificate.

The Tribunal dismissed the request, finding the applicant was attempting to re-litigate arguments already addressed in the initial decision and failed to establish an error of law or fact under Rule 18.2(b).

The applicant sought statutory accident benefits after fracturing his foot while disembarking from a parked shuttle van onto uneven pavement.

The respondent insurer denied benefits, arguing the incident did not meet the definition of an 'accident' under s. 3(1) of the Statutory Accident Benefits Schedule.

The Tribunal applied the purpose and causation tests, finding that disembarking is an ordinary use of a vehicle and that the use of the vehicle was a direct cause of the injuries, despite the uneven surface being a contributing factor.

The Tribunal concluded the applicant was involved in an accident.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits.

He failed to notify the insurer of his intention to claim benefits within the seven-day period prescribed by section 32(1) of the Schedule, instead notifying them approximately three months later.

The Tribunal found that the applicant's ignorance of the law and lack of experience with the claims process did not constitute a reasonable explanation for the delay, especially since he had retained counsel within a month of the accident.

The application was dismissed pursuant to section 55(1) of the Schedule.

The respondent insurer raised a preliminary issue arguing that the applicant was barred from proceeding with her claim for statutory accident benefits due to res judicata and failure to attend section 44 insurer's examinations.

The Tribunal found that issue estoppel did not apply because the current application disputed different treatment plans than those addressed in a prior Tribunal decision.

Furthermore, the Tribunal held that the applicant was not non-compliant with section 44, as the insurer had never actually requested examinations for the specific treatment plans currently in dispute.

The applicant was permitted to proceed to a hearing on the substantive issues.

The applicant sought statutory accident benefits after being assaulted by a stranger while stopped at a red light on a motorcycle.

The respondent denied benefits on the basis that the incident was not an 'accident' under s. 3(1) of the Schedule.

The Tribunal applied the purpose and causation test, finding that while sitting on a motorcycle at a red light meets the purpose test, the assault was an intervening act that broke the chain of causation.

The Tribunal concluded that the use or operation of the vehicle was not the direct cause of the applicant's impairments, and dismissed the application.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits.

The respondent insurer scheduled orthopaedic and neurological insurer's examinations in Toronto.

The applicant, who resides in Thunder Bay, failed to attend, citing a medical inability to travel.

The respondent suspended benefits and argued the applicant was barred from proceeding with his application.

The Tribunal found that while the respondent made reasonable efforts to schedule the examinations at a convenient location, the applicant had a reasonable excuse for his non-attendance.

Exercising its discretion under section 55(2) of the Schedule, the Tribunal allowed the application to proceed.

The applicant was sitting in his parked vehicle when he was assaulted by armed assailants attempting to steal his car.

While trying to escape, the applicant put the vehicle in reverse with his leg outside the door, colliding with a dumpster and resulting in the amputation of his leg.

The respondent denied statutory accident benefits on the basis that the incident was an assault, not an accident.

The Tribunal applied the two-part purpose and causation test, finding that reversing the vehicle was an ordinary use of an automobile and was the dominant feature that directly caused the applicant's leg injury.

The Tribunal concluded the incident met the definition of an 'accident' under section 3(1) of the Schedule.

The applicant was riding an e-bike when she lost control and crashed, sustaining injuries including a fractured jaw.

She applied for statutory accident benefits, claiming a third-party vehicle encroached on her path, forcing her to swerve.

The respondent denied benefits, arguing there was no third-party vehicle involved and the incident did not meet the definition of an 'accident'.

The Tribunal found that the evidence, including 911 call transcripts and medical records, supported the applicant's version of events.

The Tribunal concluded that the use or operation of the third-party vehicle directly caused the impairments, satisfying both the purpose and causation tests under section 3(1) of the Schedule.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits.

He notified the insurer of the accident the next day but denied injuries, and did not submit an intention to claim benefits until over six months later.

The insurer denied the claim based on late notice.

The Tribunal found that the applicant failed to comply with the seven-day notice requirement under section 32(1) of the Schedule and failed to provide a reasonable explanation for the delay.

Consequently, the application was dismissed as statute-barred under section 55(1)1.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits.

The respondent denied benefits and closed the file after the applicant failed to submit a completed OCF-1 application within 30 days of receiving the forms.

The applicant submitted the OCF-1 over nine months late, citing language barriers and his daughter's personal issues as reasons for the delay.

The Tribunal found the explanation unreasonable, noting the applicant's prior experience with accident benefits and the daughter's ongoing communication with the adjuster.

The application was dismissed as statute-barred under section 55(1)1 of the Schedule.

The applicant sought to enforce a settlement agreement for statutory accident benefits, alleging she never received the $8,000 settlement funds.

The respondent had issued the funds to the applicant's former lawyer in trust, and the cheque was cashed before the lawyer passed away.

The Licence Appeal Tribunal dismissed the application, finding it lacked jurisdiction under section 280 of the Insurance Act to order the respondent to pay the settlement funds a second time due to the alleged dishonesty of the applicant's own lawyer.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits.

The respondent denied benefits because the applicant failed to submit an application for benefits (OCF-1) within the 30-day time limit prescribed by section 32(5) of the Schedule.

The applicant submitted the form over nine months late, arguing that language barriers and family issues provided a reasonable explanation for the delay.

The Tribunal applied the Horvath test and found the explanation unreasonable, noting the applicant's daughter had communicated with the insurer multiple times and the applicant was familiar with the process from a prior accident.

The Tribunal concluded the applicant was statute-barred under section 55(1)1 of the Schedule and dismissed the application.