Tavlin Kaur

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

The insurer denied the benefits, arguing the applicant failed to notify them of his intention to apply within the prescribed seven-day period under section 32(1) of the Schedule.

The applicant argued he reported the accident the next day and the insurer failed to provide the necessary forms.

The Tribunal found the applicant did not report any injuries or intention to seek benefits until nearly two years later.

The Tribunal concluded the applicant's explanation for the delay was not credible or worthy of belief, and therefore he was barred from proceeding with his application.

The applicant sought statutory accident benefits after slipping and falling on snow and ice while walking towards his remotely started vehicle in a restaurant parking lot.

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

The Tribunal applied the purpose and causation tests, finding that while the purpose test was met, the causation test failed because the snow and ice constituted an intervening act that broke the chain of causation.

The application was dismissed.

The applicant requested a reconsideration of two previous Tribunal decisions regarding his entitlement to income replacement benefits.

The Tribunal dismissed the request regarding the first decision because it was filed out of time.

The Tribunal dismissed the request regarding the second decision, finding no breach of procedural fairness and no error of law or fact.

The Tribunal concluded that the applicant was attempting to re-litigate his case and that the doctrine of res judicata had been properly applied.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that found he was bound by a settlement agreement and precluded from proceeding to the Tribunal.

The applicant alleged the Tribunal breached procedural fairness, demonstrated a reasonable apprehension of bias, and made errors of law regarding the statutory requirements of an accident benefits settlement.

The adjudicator dismissed the request, finding no breach of procedural fairness, no cogent evidence of bias, and no errors of law or fact, concluding that the applicant was attempting to re-litigate his case.

The applicant, an Uber driver, was waiting in his vehicle when he was assaulted by an unidentified man and bitten by a dog during a carjacking.

He applied for statutory accident benefits.

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

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

The use or operation of the automobile was not the direct cause of the injuries; rather, the assault and dog bite were an intervening act and the dominant feature of the incident.

The application was dismissed.

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

The respondent insurer denied several treatment plans.

The applicant filed an application with the Tribunal more than two years after the denials.

The respondent argued the application was statute-barred.

The Tribunal found that two of the denial letters were invalid because they failed to provide adequate medical reasons, meaning the limitation period was not triggered for those plans.

For the remaining valid denials, the Tribunal exercised its discretion under section 7 of the Licence Appeal Tribunal Act to extend the limitation period, finding that there was merit to the appeal and no prejudice to the respondent.

The applicant was permitted to proceed to a substantive hearing on all disputed treatment plans.

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

The respondent insurer denied the benefits and argued the applicant was statute-barred from proceeding because he failed to commence his application within the two-year limitation period under section 56 of the Schedule.

The Tribunal found that the respondent's denial letters for psychological, chiropractic, and chronic pain assessments were defective because they relied on vague, boilerplate language that failed to provide clear medical reasons as required by section 38(8) of the Schedule and the principles in Smith v. Co-operators.

Consequently, the defective notices did not trigger the limitation period, and the applicant was permitted to proceed with his claims.

The applicant requested a reconsideration of a decision finding she was not an insured person under the Schedule and therefore ineligible for benefits.

She argued the Tribunal violated procedural fairness and made errors of fact and law by relying on medical records and a Statement of Claim that did not mention a vehicle's involvement, rather than her sworn testimony.

The Tribunal dismissed the request, finding no breach of procedural fairness as the medical records were properly before it, and no errors of fact or law, concluding the applicant was attempting to relitigate the case.

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

The respondent denied a treatment plan for physiotherapy services, and the applicant filed an application with the Tribunal after the two-year limitation period had expired.

The Tribunal found that the respondent's denial letter was valid and triggered the limitation period.

However, applying the four-factor test under section 7 of the Licence Appeal Tribunal Act, the Tribunal exercised its discretion to extend the limitation period, noting that there was some merit to the appeal and the respondent did not suffer prejudice due to the delay.

The applicant was permitted to proceed with his application.

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

The respondent denied benefits, arguing the applicant failed to notify them of his intention to apply within the prescribed timelines under section 32(1) of the Schedule.

The Tribunal found that the applicant had a reasonable explanation for the delay, as he suffered a traumatic brain injury with memory loss and likely did not remember receiving information about accident benefits.

The Tribunal concluded that the hardship to the applicant outweighed any prejudice to the respondent, allowing the application to proceed.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision which found she was not an 'insured person' under section 3(1) of the Statutory Accident Benefits Schedule.

The applicant argued the Tribunal made errors of law and fact, violated procedural fairness, and failed to consider priority dispute rules under O. Reg. 283/95.

The adjudicator dismissed the request, finding it was an attempt to re-litigate the case and that the priority dispute issue was outside the Tribunal's jurisdiction for this hearing.

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

The insurer denied two treatment plans and the applicant applied to the Tribunal after the standard two-year limitation period.

The Tribunal held a preliminary issue hearing to determine if the claims were statute-barred.

Applying the Smith test, the Tribunal found the denial for the physiotherapy plan was clear and unequivocal, triggering the limitation period, and declined to extend it under section 7 of the LAT Act.

However, the denial for the chiropractic plan was found deficient and boilerplate, failing to trigger the limitation period.

The applicant was permitted to proceed with the chiropractic claim but barred from the physiotherapy claim.

The applicant sought statutory accident benefits after slipping and falling on ice while exiting her vehicle at a gas station.

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

The Licence Appeal Tribunal applied the purpose and causation tests, finding that while the purpose test was met, the causation test failed.

The Tribunal concluded that the ice was an intervening cause and the dominant feature of the injuries, not the use or operation of the automobile.

The application was dismissed.

The applicant requested a reconsideration of a preliminary issue decision that found he was not involved in an accident.

The applicant argued that his failure to file submissions for the preliminary issue hearing was due to inadvertence and that dismissing his application without his submissions was unfair.

The Tribunal dismissed the request, finding that inadvertently missing a deadline does not constitute new evidence or grounds for reconsideration under Rule 18.2.

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

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

The applicant submitted his application over five months later.

The Tribunal found that the applicant did not provide a credible or reasonable explanation for the delay, noting he had been involved in another accident two weeks prior and was familiar with the process.

The application was dismissed.

The applicant sought statutory accident benefits after slipping and falling on a snowbank while attempting to enter a taxi.

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

The Tribunal applied the purpose and causation tests, finding that while the purpose test was met, the causation test failed because the snowbank was an intervening act and the dominant feature of the incident.

The application was dismissed.

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

In a previous application, the Tribunal determined the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant subsequently filed a second application seeking a catastrophic impairment designation.

The respondent argued the second application was barred by res judicata.

The Tribunal found that the issues in the two applications were different and that a previous MIG finding does not indefinitely preclude an applicant from applying for a catastrophic designation if their condition deteriorates.

The preliminary issue motion was dismissed.

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

The respondent denied the non-earner benefit and a psychological assessment, and argued the applicant was barred from proceeding due to failing to file an OCF-10 election form and missing the two-year limitation period.

The Tribunal found the respondent failed to provide the required notice for the OCF-10 election.

The Tribunal also applied O. Reg. 73/20, which extended limitation periods by 183 days due to the COVID-19 pandemic, and further exercised its discretion under s. 7 of the LAT Act to extend the limitation period, finding the delay was minor and the applicant had a bona fide intention to appeal.

The applicant sought statutory accident benefits for psychological injuries sustained after her husband suffered a medical incident (stroke and cardiac arrest) while driving, which resulted in a collision.

The respondent denied benefits on the basis that the applicant was not an 'insured person' under section 3(1) of the Schedule.

The Tribunal found that there was no medical evidence proving the applicant's husband sustained a physical injury as a result of the accident, as opposed to the medical incident itself.

Consequently, the applicant did not meet the definition of an insured person under section 3(1)(a)(ii) and the application was dismissed.

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

The parties entered into a full and final settlement for $13,000.

The applicant subsequently applied to the Tribunal to dispute the settlement, arguing that rehabilitation benefits were not included.

The respondent argued the Tribunal lacked jurisdiction because the applicant had not returned the settlement funds.

The Tribunal agreed, finding that under section 9.1(8) of Regulation 664, an applicant must return the money received as consideration for a settlement before applying to the Tribunal.

As the applicant failed to do so, the application was dismissed for lack of jurisdiction.