Tavlin Kaur

The respondent insurer sought to bar the applicant from proceeding with her application for statutory accident benefits, arguing she failed to attend multiple scheduled Insurer's Examinations.

The Tribunal reviewed the notices of examination and found they did not comply with section 44(5) of the Schedule, as they failed to provide specific medical reasons or refer to the applicant's medical conditions.

Consequently, the preliminary issue was dismissed, and the applicant was not statute-barred from proceeding to a hearing.

The applicant was involved in a motor vehicle accident in October 2019 but did not notify the respondent insurer or submit an application for accident benefits until September 2021.

The respondent raised a preliminary issue that the applicant was barred from proceeding due to his failure to comply with the timelines in s. 32 of the Statutory Accident Benefits Schedule and his failure to provide a reasonable explanation for the delay under s. 34.

The applicant argued he did not receive the application forms and was confused about which of his multiple accidents caused his impairments.

The Tribunal rejected this explanation, noting the insurer could not have sent forms without first being notified of the accident.

The Tribunal found the applicant failed to provide a reasonable explanation for the delay and dismissed the application pursuant to s. 55(1) of the Schedule.

The applicant requested a reconsideration of a decision that dismissed her application for statutory accident benefits, including catastrophic impairment assessments.

She argued the Tribunal violated procedural fairness, made errors of fact by ignoring medical evidence, and erred in law regarding the causation test and the interpretation of the Schedule.

The Tribunal dismissed the request, finding that the applicant failed to properly submit her medical evidence for the written hearing, consented to the hearing format, and that the Tribunal correctly applied the 'but-for' test for causation.

The Tribunal affirmed that causation must be established before an insurer is obligated to pay for catastrophic impairment assessments under section 25(1)5 of the Schedule.

The applicant sought statutory accident benefits for transportation expenses related to hip surgery following a motor vehicle accident.

The insurer denied the expenses and requested an insurer's examination (IE).

The applicant refused to attend, arguing the insurer had no right to request an IE without a treatment plan.

The insurer sought to bar the application under s. 55 of the Schedule for failure to attend the IE.

The Tribunal found that while the insurer had the right to request an IE for transportation expenses, the notices of examination provided to the applicant were defective as they lacked specific details about her medical condition.

Consequently, the preliminary issue was dismissed, and the application was permitted to proceed.

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

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

The respondent raised preliminary issues arguing the application was statute-barred due to the expiry of the two-year limitation period and the applicant's failure to attend scheduled insurer examinations.

The Tribunal found that even accounting for the 183-day suspension of limitation periods under O. Reg. 73/20, the application was filed late.

The applicant provided no submissions or evidence to justify an extension of time or to explain his failure to attend the insurer examinations.

The Tribunal dismissed the application as statute-barred.

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

The respondent insurer raised preliminary issues, arguing the applicant was barred from proceeding due to willful misrepresentation of material facts and failure to comply with application timelines.

The Tribunal found no willful misrepresentation, noting inconsistencies in testimony were immaterial or individual recollections.

On the delay issues, the Tribunal found the respondent failed to meet its onus of proof, drawing an adverse inference from the respondent's failure to produce the adjuster's log notes as previously ordered.

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

The respondent insurer sought to bar the applicant from proceeding with her application for statutory accident benefits, arguing she failed to attend multiple scheduled insurer's examinations.

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

As the notices were non-compliant, the insurer could not rely on section 55 to bar the application.

The preliminary issue was dismissed and the application was permitted to proceed.

The applicant sought statutory accident benefits for psychological impairments after a vehicle struck a neighbour's house, causing a natural gas explosion that destroyed multiple homes including hers.

The respondent denied benefits on the basis that the applicant was not involved in an automobile accident.

The Tribunal found that the applicant only witnessed the aftermath of the collision and was not directly involved in the automobile accident.

As she did not meet the definition of an 'insured person' under section 3(1) of the Schedule, the application was dismissed.

The applicant sought statutory accident benefits after a truck drove into her home while she was sleeping upstairs.

She claimed psychological injuries from witnessing the aftermath and physical injuries from a mirror falling on her.

The respondent raised a preliminary issue of whether the applicant was an 'insured person' involved in an 'accident' under section 3(1) of the Statutory Accident Benefits Schedule.

The Tribunal found that the applicant was not involved in the accident, as she only witnessed its aftermath and did not sustain physical injuries directly caused by the use or operation of the vehicle.

The application was dismissed.

The applicant, a truck driver, suffered severe burn injuries to his legs while sleeping in the cab of his parked transport truck with the heater running, ultimately requiring bilateral knee amputations.

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

The Tribunal applied the purpose and causation tests, finding that sleeping in a truck cab and using its built-in heater are ordinary and well-known uses of the vehicle.

The Tribunal rejected the respondent's theories of intervening causes, such as a stroke or a kettle, and concluded the heater was the dominant feature of the injuries.

The Tribunal held the incident was an accident and ordered the matter to proceed to a substantive hearing.

The applicant sought resolution of a dispute regarding the hourly rate at which Attendant Care Benefits (ACB) would be paid, despite the insurer having approved the submitted Form 1s in full.

The insurer raised a preliminary issue arguing the Licence Appeal Tribunal lacked jurisdiction under s. 280 of the Insurance Act because there was no live dispute over entitlement or the amount of the benefit.

The Tribunal agreed, finding that since the insurer approved the ACB in full and there was no denial, there was no dispute within the meaning of s. 280.

The application was dismissed for lack of jurisdiction.

The applicant, who was a minor at the time of the motor vehicle accident, sought a non-earner benefit and medical/rehabilitation benefits.

The insurer denied the benefits, and the applicant filed an application with the Licence Appeal Tribunal more than two years after the denials.

The applicant argued that the limitation period for the non-earner benefit should only commence upon turning 18, relying on the rule of discoverability.

The Tribunal held that the limitation period is triggered by the insurer's refusal to pay, regardless of the applicant's age.

The Tribunal declined to extend the limitation period under section 7 of the Licence Appeal Tribunal Act, finding no bona fide intention to appeal within the time limit, an excessive and unexplained delay, prejudice to the respondent, and a lack of merit.

The application was dismissed as statute-barred.

The respondent insurer brought a preliminary issue motion arguing that the applicant was barred from proceeding with her application for statutory accident benefits because she failed to attend scheduled insurer examinations.

The Tribunal reviewed the notices of examination provided by the insurer and found that they did not comply with the strict requirements of section 44(5) of the Statutory Accident Benefits Schedule, as they failed to adequately set out the medical reasons or the specific provisions of the Schedule relied upon.

Because the notices were deficient, the insurer could not rely on section 55 to bar the application.

The preliminary issue motion was dismissed.

The respondent insurer raised a preliminary issue arguing the applicant was barred from proceeding with her claim for home modification benefits because she failed to attend scheduled insurer examinations (IEs) under section 44 of the Statutory Accident Benefits Schedule.

The applicant argued the IE notices were deficient and that the insurer could not request an IE after the LAT application was filed.

The Tribunal found that while the first IE notice was deficient, the second and third notices complied with the Schedule.

The Tribunal also held that an insurer is not precluded from requesting an IE after a LAT application is filed.

Because the applicant failed to provide a reasonable explanation for her non-attendance at the validly scheduled IEs, she was barred from proceeding under section 55 of the Schedule, and her application was dismissed.

The respondent insurer brought a motion to bar the applicant from proceeding with his claim for income replacement benefits due to his failure to attend insurer's examinations under section 44 of the Statutory Accident Benefits Schedule.

The Tribunal found that the notices of examination provided by the respondent were deficient as they lacked specific medical and other reasons for the examinations, failing to comply with section 44(5).

Consequently, the applicant was not barred from proceeding with his claim.

Both parties' requests for costs were denied.

The applicant sought statutory accident benefits, specifically four treatment plans for physiotherapy, following a 2016 motor vehicle accident.

The respondent argued the claim was res judicata because a prior Tribunal application for the same relief was dismissed in 2019.

The applicant contended that new medical evidence demonstrated a material change in her condition.

The Tribunal found that the four preconditions for res judicata were met and that the fresh evidence did not show a material change or impeach the original results.

The application was dismissed.

The applicant sought statutory accident benefits after a vehicle crashed into his house while he was sleeping in another room.

He claimed to have suffered psychological and emotional injuries as a result of the incident.

The respondent denied the claim on the basis that the applicant was not 'involved' in the accident.

The Licence Appeal Tribunal found that the applicant did not witness the accident, was not physically injured, and was not related to anyone involved in the accident.

Consequently, he did not meet the definition of an 'insured person' involved in an accident under section 3(1) of the Statutory Accident Benefits Schedule.

The application was dismissed.

The applicant sought statutory accident benefits following two separate motor vehicle accidents in 2017 and 2018.

The respondent raised a preliminary issue that the applications were statute-barred for missing the two-year limitation period under s. 56 of the Schedule.

The Tribunal found that the application for the 2017 accident was filed out of time and dismissed it, as the applicant did not request an extension under s. 7 of the LAT Act.

However, the Tribunal found that the application for the 2018 accident was filed within the limitation period, as the period was extended by 183 days due to the pandemic under O. Reg. 73/20.

The applicant was permitted to proceed with the 2018 accident claim.

The applicant sought statutory accident benefits after slipping and falling on an icy parking lot while exiting her vehicle at a dealership.

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

The Licence Appeal 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 icy parking lot was an intervening cause and the dominant feature of the injuries, breaking the chain of causation from the use or operation of the vehicle.

The application was dismissed.

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

The respondent insurer refused the claim on the basis that the applicant failed to submit the Application for Accident Benefits (OCF-1) within the 30-day period prescribed by the Statutory Accident Benefits Schedule.

The applicant argued that the insurer failed to provide the OCF-1 form and that her medical conditions and life circumstances provided a reasonable explanation for the delay.

The Tribunal found that the applicant failed to submit the OCF-1 within the prescribed timelines and did not provide a reasonable explanation for the delay of over four years.

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