Ruth Gottfried

The applicant was injured in a motor vehicle accident and received income replacement benefits until they were terminated by the insurer.

The applicant applied to the Licence Appeal Tribunal for ongoing benefits.

The insurer argued the application was statute-barred, but the Tribunal found it was commenced within the applicable time limits.

On the merits, the Tribunal found the applicant lacked credibility, noting he had returned to work as a superintendent for two different employers without disclosing this to the insurer or his own doctors.

Relying on the insurer's assessors and the applicant's employment records, the Tribunal concluded the applicant did not suffer a substantial inability to perform the essential tasks of his employment and dismissed the application.

The respondent insurer brought a preliminary issue seeking to dismiss the applicant's claim for income replacement benefits as statute-barred.

The insurer argued that it sent a letter terminating benefits more than two years before the application was commenced.

The applicant and his counsel denied receiving the termination letter.

The adjudicator applied the discoverability principle and found that the limitation period began to run when the applicant's counsel received a subsequent letter from the insurer indicating that benefits had been stopped.

Based on this date of discoverability, the application was commenced within the two-year limitation period.

The insurer's motion to dismiss was denied, and its request for expenses was dismissed.

The applicant sought income replacement benefits (IRBs) for a one-month period during which she returned to work on modified hours following a motor vehicle accident.

The insurer had terminated IRBs based on insurer examinations concluding the applicant did not suffer a substantial inability to perform her pre-accident employment.

The Tribunal found the insurer's medical evidence more persuasive than the applicant's family doctor's records, noting the applicant had successfully returned to full-time work.

The Tribunal dismissed the claim for IRBs and interest, and denied the insurer's request for costs.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits after a delay caused by an initial application for employment insurance.

The Tribunal found the applicant had a reasonable explanation for the delay and was not disentitled to benefits.

The Tribunal held the applicant suffered a substantial inability to perform the essential tasks of his pre-accident employment due to a neck injury and fractured finger, entitling him to income replacement benefits for the first 104 weeks.

However, he did not meet the complete inability test for post-104 week benefits.

The Tribunal also ordered the insurer to pay several disputed medical and rehabilitation benefits, noting the insurer had incorrectly adjusted the claim under the Minor Injury Guideline despite the applicant's fractured finger.

The applicant's husband died of a fatal arrhythmia shortly after being involved in a motor vehicle accident.

The respondent insurer denied death and funeral benefits, arguing that the deceased's pre-existing coronary artery disease would have inevitably caused a fatal cardiac event independent of the accident.

The Tribunal applied the purpose and causation tests, finding that the stress of the accident triggered myocardial ischemia and a fatal arrhythmia.

The Tribunal preferred the evidence of the applicant's expert cardiologist over the respondent's expert, concluding that the accident was the direct cause of the death.

The applicant and her children were awarded death benefits, funeral benefits, and interest on overdue amounts.

No costs were awarded.

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

The insurer terminated IRBs on April 15, 2014.

The Tribunal first determined that the application was not statute-barred, as the applicant was caught in the transition period between FSCO and the LAT.

On the merits, the Tribunal found the applicant lacked credibility, noting documentary evidence that he had returned to work as a superintendent for two different employers during the period he claimed to be substantially unable to work.

Relying on the insurer's expert assessments and the applicant's employment records, the Tribunal concluded the applicant did not suffer a substantial inability to perform the essential tasks of his employment.

The application was dismissed.

The applicant, a 7-year-old child with cerebral palsy, was abandoned on a school bus for approximately two hours after the driver deviated from the route and parked at her own home.

The applicant suffered psychological injuries and claimed statutory accident benefits.

The respondent insurer brought a preliminary motion arguing the incident did not meet the definition of an 'accident' under the Schedule.

The Tribunal applied the two-part purpose and causation test, finding that the bus was being used for its ordinary purpose of transporting a disabled child to school, and that the use and operation of the bus was the direct cause of the injuries without any intervening act.

The respondent's motion was dismissed.

The applicant sought statutory accident benefits following a 2011 motor vehicle accident.

After multiple adjournments and rescheduling requests by the applicant, neither the applicant nor her representative attended the scheduled teleconference hearing on February 7, 2017.

The Tribunal issued a notice of intention to dismiss the application as abandoned.

Despite the applicant's representative blaming a former scheduling assistant for the non-attendance, the Tribunal found the explanations disingenuous and unsupported by evidence.

The Tribunal concluded that the applicant's repeated failures to attend and communicate effectively constituted an abandonment of the proceeding.

The application was dismissed without a hearing, and no costs were awarded.

The respondent insurer brought a motion to preclude the applicant from proceeding with her application for statutory accident benefits, arguing she failed to attend scheduled insurer's examinations.

The applicant argued the notice of examination failed to set out the medical reasons for the examination as required by section 44(5)(a) of the Schedule.

The Tribunal found that the notice did not provide medical reasons, rendering it invalid.

Consequently, the applicant was not non-compliant and was not precluded from proceeding with her application.

The respondent's request for costs was denied.

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

The respondent denied the benefits based on independent medical examinations.

The Tribunal found that the applicant failed to prove she suffered a substantial inability to perform the essential tasks of her pre-accident employment.

The evidence indicated that the applicant's periods of unemployment were due to temporary layoffs rather than accident-related impairments, and she had actively sought and obtained other employment.

The application was dismissed.

The applicant was injured when his bicycle collided with a transit bus.

He applied for statutory accident benefits, and the respondent insurer approved benefits up to the $3,500 limit for predominantly minor injuries under the Minor Injury Guideline (MIG).

The applicant disputed the amount of his income replacement benefits and sought approval for additional treatment plans, arguing his injuries fell outside the MIG.

The Licence Appeal Tribunal found insufficient evidence to vary the income replacement benefits.

The Tribunal also held that the applicant failed to provide compelling medical evidence of a pre-existing condition that would prevent his recovery within the MIG limits.

The appeal was dismissed.