Kate Grieves

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

The respondent denied the benefits and the applicant applied to the Licence Appeal Tribunal.

The respondent raised preliminary issues regarding the applicant's failure to notify the insurer within seven days and failure to submit the application for benefits (OCF-1) within 30 days.

The applicant did not file any written submissions for the preliminary issue hearing.

The Tribunal found that the applicant failed to comply with the timelines in section 32 of the Schedule and provided no reasonable explanation for the delay.

The application was dismissed as statute-barred pursuant to section 55(1)1.

The applicant sought income replacement benefits following a motor vehicle accident.

The respondent denied the benefits on October 21, 2021.

The applicant filed an application with the Licence Appeal Tribunal on October 26, 2023, five days after the two-year limitation period expired.

The applicant requested an extension of time under section 7 of the Licence Appeal Tribunal Act.

The Tribunal found that the applicant failed to provide submissions on his intention to appeal within the limitation period or the merits of his appeal, and therefore did not meet his burden to establish that the justice of the case warranted an extension.

The application was dismissed as statute-barred.

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

The respondent insurer denied the benefits, and the applicant applied to the Licence Appeal Tribunal.

A preliminary issue hearing was held to determine if the applicant was statute-barred for failing to notify the respondent of her intention to claim benefits within seven days of the accident.

The applicant argued she was unaware she could claim benefits and had attempted home remedies.

The Tribunal found that ignorance of the law is not a reasonable explanation and noted a lack of evidence for the home remedies.

The Tribunal concluded the applicant failed to provide a reasonable explanation for the delay, prejudicing the insurer.

The application was dismissed as statute-barred.

The applicant sought statutory accident benefits for psychological impairments allegedly resulting from her daughter's motor vehicle accident.

The insurer requested insurer's examinations (IEs) under section 44 of the Schedule to determine entitlement.

The applicant, who had moved to Morocco, failed to attend the scheduled IEs and proposed alternative arrangements not permitted by the Schedule.

The Tribunal found the applicant non-compliant with her obligation to attend the IEs and held that she is barred from proceeding with her application pursuant to section 55 of the Schedule.

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

The respondent insurer denied benefits and argued the applicant was barred from proceeding with her application because she failed to attend multiple insurer's examinations.

The Tribunal found that the notices of examination provided by the respondent were deficient as they failed to include sufficient medical or other reasons as required by section 44(5) of the Schedule.

Consequently, the applicant was not barred from proceeding with her application.

The respondent's request for costs was dismissed.

The applicant sought statutory accident benefits after slipping and falling on ice while exiting a pickup truck he had taken for a test drive.

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

The Tribunal applied the two-part purpose and causation test, finding that exiting a vehicle is an ordinary and well-known activity, and that the use or operation of the vehicle was a direct cause of the injuries.

The Tribunal concluded the applicant was involved in an accident and ordered the application to proceed to a hearing on the substantive issues.

The applicant was a passenger in the rear of a police van while in custody.

She fell asleep, fell over, and struck her head on the metal door, sustaining injuries.

The respondent denied her claim for statutory accident benefits, arguing the incident was not an 'accident' under s. 3(1) of the Schedule because falling asleep was an intervening act.

The Tribunal found that the incident met the purpose and causation tests.

The applicant's use of the vehicle as a passenger was the dominant feature of her injuries, and falling asleep did not break the chain of causation.

The Tribunal concluded the incident was an 'accident' and ordered the application to proceed to a substantive hearing.

The applicant requested reconsideration of a case conference report and order that unilaterally dismissed 26 issues in dispute.

The adjudicator had dismissed the issues on the mistaken belief that they were duplicative of issues in a prior application.

The Tribunal found that it committed a material breach of procedural fairness by dismissing the issues without providing the parties an opportunity to make written submissions, contrary to Rules 3.4 and 3.5 of the Licence Appeal Tribunal Rules.

The request for reconsideration was granted, and the 26 issues were reinstated for case management.

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

The respondent denied benefits because the applicant failed to notify them of the accident within seven days, as required by section 32(1) of the Schedule.

A preliminary issue hearing was held in writing to determine if the applicant was statute-barred from proceeding.

The applicant failed to file any submissions.

The adjudicator found that the applicant did not comply with the notification timelines and, without submissions, failed to establish a reasonable explanation for the delay.

The application was dismissed as statute-barred.

The applicant requested a reconsideration of a preliminary issue decision which found he was not involved in an 'accident' under the Statutory Accident Benefits Schedule after slipping and falling on ice.

The applicant argued the adjudicator erred in applying the causation test and binding case law.

The Tribunal dismissed the request, finding no error of law and noting that the applicant was attempting to re-litigate his case.

The adjudicator correctly applied the binding Divisional Court decision in Porter, which held that a slip and fall on ice is not an accident within the meaning of the Schedule.

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

The insurer denied five treatment plans, and the applicant applied to the Tribunal more than two years after the denials.

The insurer argued the claims were statute-barred under s. 56 of the Schedule.

The Tribunal found that the denial notices for three of the treatment plans were defective as they relied on vague, boilerplate language and failed to identify the applicant's medical conditions, meaning the limitation period was not triggered for those claims.

However, the denial notices for the remaining two plans were valid and clear, and the Tribunal declined to extend the limitation period for them.

The applicant was permitted to proceed to a hearing on the three plans with defective denials.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that awarded $5,550.00 for unreasonably withheld non-earner benefits.

The applicant argued that the adjudicator made an error of law in applying the formula for calculating the special award.

The adjudicator agreed, finding that the formula was incorrectly applied by adding interest after calculating 50% of the withheld benefits, rather than calculating 50% of the total of withheld benefits plus interest.

The adjudicator granted the reconsideration and varied the special award to $8,560.08.

The applicant sought statutory accident benefits following a motor vehicle accident involving her husband.

The respondent insurer raised a preliminary issue that the applicant was barred from proceeding because she failed to submit her application (OCF-1) within 30 days of receiving the forms, as required by section 32(5) of the Schedule.

However, the respondent's submissions focused entirely on section 32(1) regarding late reporting of injuries, which was not the issue identified in the case conference report and order.

The adjudicator found it inappropriate to dismiss the application based on submissions that did not address the specific narrow issue in dispute, and ruled that the applicant was not barred from proceeding.

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

The insurer denied income replacement benefits and three treatment plans in 2019 and 2020.

The applicant filed an application to dispute the denials in October 2023, beyond the two-year limitation period.

The Tribunal found that the insurer's denial notices were valid and compliant with the Schedule, triggering the limitation period.

The Tribunal declined to extend the limitation period as the applicant provided no submissions.

The application was dismissed as statute-barred.

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

The insurer denied benefits and argued as a preliminary issue that the applicant was barred from proceeding to a hearing because he failed to answer questions during an examination under oath (EUO) under s. 33(2) of the Schedule.

The Tribunal held that non-compliance with s. 33(2) relieves the insurer of its obligation to pay benefits during the period of non-compliance under s. 33(6), but it does not bar the applicant from applying to the Tribunal under s. 55.

The applicant was permitted to proceed to a hearing, with the insurer free to raise non-compliance as a defence at the substantive hearing.

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

The respondent denied the benefits on the basis that the applicant had exhausted her non-catastrophic policy limits and had not been determined to be catastrophically impaired.

The Tribunal held that the application for benefits was premature, as the applicant could not be entitled to further benefits without a catastrophic impairment designation.

The claims for benefits were dismissed without prejudice.

However, the Tribunal allowed the applicant to proceed to a hearing on her standalone claim for an award under Regulation 664.

The respondent's request for costs was dismissed.

The applicant was involved in a motor vehicle accident that was also a workplace accident.

He elected to claim WSIB benefits and his claim was accepted.

The respondent raised a preliminary issue that the applicant was barred from claiming statutory accident benefits under section 61 of the Schedule.

The applicant's representative was removed from the record and no submissions were filed on his behalf.

The Tribunal found that the applicant was barred from pursuing his claim for accident benefits because he was entitled to receive WSIB benefits and had not opted out to pursue a tort action.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident but was denied by the respondent insurer.

The respondent scheduled an insurer's examination under section 44 of the Schedule, which the applicant failed to attend on three separate occasions.

The Tribunal found that the notices of examination were compliant with section 44(5) and that the applicant failed to provide a reasonable explanation for his non-attendance.

Consequently, pursuant to section 55(1)2 of the Schedule, the applicant is barred from proceeding with his application to the Tribunal.

The applicant sought statutory accident benefits after slipping and falling on black ice while walking toward his parked vehicle to retrieve his wallet.

The respondent denied benefits on the basis that the incident did not meet the definition of an 'accident' under section 3(1) of the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal found that while the purpose test was met, the causation test was not.

The slip and fall on ice was an intervening act that broke the chain of causation, and the use or operation of the vehicle was not the dominant feature of the incident.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the denial of treatment plans for a bio-feedback assessment, occupational therapy assessments and services, and assistive devices.

The Tribunal found the occupational therapy assessment and portions of the occupational therapy services and assistive devices to be reasonable and necessary, noting that some devices were duplicative of those already provided to the applicant's spouse.

The claim for the bio-feedback assessment was dismissed as the applicant failed to establish entitlement to the denied portion.

The Tribunal also denied the applicant's request for a special award, finding the insurer's conduct was not unreasonable.