Tavlin Kaur

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

The respondent raised preliminary issues regarding the applicant's failure to respond to a section 33 request for information and failure to attend insurer's examinations (IEs).

The applicant also brought a motion to strike the respondent's reply submissions for being one day late.

The Tribunal dismissed the motion to strike, finding no prejudice.

The Tribunal deferred the section 33 issue to the substantive hearing.

However, the Tribunal found the applicant failed to attend scheduled IEs without a reasonable explanation after the respondent provided a compliant notice, barring her from proceeding with the claim for a $1,970.80 chiropractic treatment plan.

The applicant sought statutory accident benefits after slipping on ice while attempting to enter her vehicle in a parking lot.

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 test, finding that while the purpose test was met, the causation test was not.

The Tribunal concluded that the ice on the ground was an intervening cause and the dominant feature of the incident, breaking the chain of causation.

The application was dismissed.

The applicant sought statutory accident benefits after being injured when thrown from an all-terrain vehicle (ATV).

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

The Tribunal applied the Grummett test and found that the ATV was not an automobile in common parlance, was not defined as an automobile in an insurance policy, and did not fall within an enlarged definition of automobile under any relevant statute because the applicant failed to prove the incident occurred on a roadway where insurance would be required.

The application was dismissed.

The applicant sought to rescind a 2002 settlement agreement for statutory accident benefits, arguing the Settlement Disclosure Notice (SDN) did not comply with Regulation 664.

The Tribunal found that the respondent substantially complied with the regulation, and any deficiencies in the SDN were merely technical and did not warrant setting aside the settlement.

The application was dismissed.

The applicant, a taxi driver, sought statutory accident benefits after being assaulted by a passenger who refused to pay the fare.

The respondent denied the 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 test, finding that while the incident arose out of the ordinary use of an automobile, the assault was an intervening act that severed the chain of causation.

The application was dismissed as the injuries were not directly caused by the use or operation of the automobile.

The applicant was injured in a motor vehicle accident while in the course of her employment.

She applied for accident benefits, but the insurer argued she was statute-barred under s. 61 of the Statutory Accident Benefits Schedule because she was entitled to WSIB benefits.

The applicant claimed she had elected to pursue a tort action, which would allow her to claim accident benefits under the s. 61(2) exception.

The Tribunal found that the applicant's election to sue in tort was not made in good faith, noting significant delays in pursuing the tort action, failure to notify the WSIB promptly, and ongoing appeals for WSIB benefits.

The Tribunal concluded the tort election was made solely for the purpose of claiming accident benefits, rendering her statute-barred.

The application was dismissed.

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

The respondent insurer argued the applicant was barred from proceeding with her application under section 55 of the Schedule due to her failure to attend 35 scheduled insurer examinations.

The Tribunal reviewed the notices of examination and found them all deficient under section 44(5) of the Schedule for failing to specify the medical reasons, the specific provisions relied upon, or the credentials of the assessors.

Because the notices were non-compliant, the applicant was not statute-barred from proceeding with her application.

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

The respondent insurer argued the applicant was statute-barred under s. 55 of the Statutory Accident Benefits Schedule from disputing her catastrophic impairment designation because she failed to attend scheduled s. 44 insurer's examinations.

The Tribunal found that the respondent's notices of examination did not comply with the strict requirements of s. 44(5), as they lacked clear medical reasons and failed to specify the assessors' designations.

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

The applicant sought statutory accident benefits following an incident where he was driving his motorcycle and got into a physical altercation with another driver due to road rage.

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

The Licence Appeal Tribunal applied the two-part Greenhalgh test and found that while the purpose test was met, the causation test was not.

The physical altercation was an intervening act and the dominant feature of the injuries, not the use or operation of the motorcycle.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident but failed to notify the respondent insurer within the seven-day timeline prescribed by section 32(1) of the Schedule.

The applicant argued the delay was reasonable due to psychological distress over his son's criminal proceedings and lack of access to insurance documentation.

The Tribunal found the applicant failed to provide sufficient evidence, such as medical records, to substantiate his psychological distress and noted he had the insurance information at the time of the accident.

The Tribunal concluded there was no reasonable explanation for the delay, finding the respondent would be prejudiced if the application proceeded.

The application was dismissed as statute-barred under section 55(1)1 of the Schedule, and no costs were awarded to either party.

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

The respondent insurer raised a preliminary issue, arguing the applicant was statute-barred from proceeding with his application under s. 55 of the Schedule for failing to attend scheduled insurer's examinations.

The Tribunal found that the respondent's notices of examination failed to comply with the strict requirements of s. 44(5) of the Schedule, as they did not refer to the applicant's medical condition, the specific provisions relied upon, or the credentials of the examiners.

Consequently, the preliminary issue was dismissed, and the applicant was not barred from proceeding to a hearing on the substantive issues.

The respondent raised a preliminary issue arguing that the application for a catastrophic impairment designation was moot because the applicant had passed away.

The Tribunal applied the Borowski test for mootness and found that there was no longer a live controversy, as the applicant had not exhausted lower benefit limits and could not access future benefits post-mortem.

The applicant's counsel provided no submissions to persuade the Tribunal to exercise its discretion to hear the moot case.

The application was dismissed.

The applicant requested a reconsideration of a Tribunal decision that found her application for statutory accident benefits was statute-barred.

The Tribunal had previously found that the insurer failed to provide the applicant with the OCF-1 application forms, but still barred the application under section 32(5) of the Schedule.

On reconsideration, the adjudicator held that the Tribunal committed an error of law, as the 30-day time limit to submit the OCF-1 does not begin to run until the forms are received.

The reconsideration was granted and the matter was ordered to proceed to a substantive hearing.

The applicant sought statutory accident benefits after sustaining injuries when her husband assaulted her while she was driving, causing her to lose control of the vehicle and hit a curb.

The respondent insurer raised a preliminary issue of whether the incident constituted an 'accident' under section 3(1) of the Statutory Accident Benefits Schedule.

The Tribunal applied the two-part purpose and causation test, finding that while the purpose test was met, the causation test was not.

The Tribunal concluded that the assault was an intervening act and the dominant feature of the injuries, breaking the chain of causation from the use or operation of the automobile.

The application was dismissed.

The respondent insurer brought a motion to dismiss the applicant's claim for attendant care benefits, arguing she failed to comply with section 46.2(1) of the Statutory Accident Benefits Schedule by not providing requested information, including tax returns of her service provider.

The Tribunal found that the applicant had provided sufficient information to determine the incurred benefits, including a breakdown of services and the provider's curriculum vitae.

The Tribunal held that the requested tax returns were not relevant to proving the benefits were incurred.

The motion was dismissed, and the applicant was permitted to proceed to a hearing.

The applicant sought dispute resolution for statutory accident benefits following a motor vehicle accident.

The respondent raised a preliminary issue, arguing the applicant was statute-barred under s. 55 of the Schedule for failing to attend s. 44 insurer examinations.

The Tribunal found that only one of the four Notices of Examination complied with the requirements of s. 44(5).

Consequently, the applicant was barred from proceeding with claims for the Minor Injury Guideline determination and medical and rehabilitation benefits, but was permitted to proceed with the claim for income replacement benefits.

The applicant sought accident benefits for a motor vehicle accident that occurred on March 21, 1999.

The respondent insurer first became aware of the accident on July 23, 2020, over 20 years later.

The respondent brought a preliminary issue hearing arguing the applicant was statute-barred from proceeding for failing to submit an application for benefits within the prescribed timelines.

The Tribunal found that the applicant failed to notify the respondent within 30 days of the accident and failed to submit an OCF-1 application within the prescribed timelines.

The applicant did not provide a reasonable explanation for the delay.

The application was dismissed.

The applicant was involved in a motor vehicle accident and retained counsel shortly after, but failed to notify the insurer of her intention to apply for statutory accident benefits until nearly a year later.

The insurer denied the claim due to non-compliance with the time limits in section 32 of the Schedule.

The Licence Appeal Tribunal found that the applicant's reliance on her former lawyer did not constitute a reasonable explanation for the delay.

Consequently, pursuant to section 55(1)1 of the Schedule, the applicant was barred from proceeding with her claim, and the application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing his injuries fell outside the Minor Injury Guideline (MIG) due to pre-existing rheumatoid arthritis, psychological impairments, and chronic pain.

The Tribunal found the applicant's rheumatoid arthritis was in remission and did not prevent maximal recovery.

The Tribunal preferred the respondent's expert evidence, concluding the applicant did not suffer from a psychological impairment or chronic pain syndrome that would warrant removal from the MIG.

The applicant's physical injuries were deemed predominantly minor.

The disputed treatment plans were deemed reasonable and necessary only up to the remaining MIG limits.

The applicant's claim for a special award was dismissed for failing to provide particulars.

The applicant sought income replacement benefits following a 2017 motor vehicle accident.

A previous Tribunal decision had already determined the applicant's entitlement to these benefits was nil, and the applicant did not appeal or request reconsideration.

The applicant filed a second application for the same benefits.

The Tribunal applied the doctrine of res judicata, finding that the four preconditions were met and no exceptions applied.

The appeal was dismissed as the issue had already been finally determined.