Tavlin Kaur

The applicant was involved in a motor vehicle accident and sought statutory accident benefits, which the respondent insurer denied.

The respondent scheduled an insurer's examination under section 44 of the Schedule, which the applicant failed to attend, arguing the notice was non-compliant.

The Tribunal found that while the first notice was deficient, the second notice complied with the Schedule's requirements.

Because the applicant failed to provide a reasonable explanation for his non-attendance at the rescheduled examination, he was barred from proceeding with his application under section 55 of the Schedule.

The application was dismissed.

The applicant sought statutory accident benefits after slipping and falling on ice while walking towards her parked vehicle.

She was approximately 10 to 15 feet away from the vehicle with her keys in hand when the fall occurred.

The Licence Appeal Tribunal applied the two-part test for an 'accident' under section 3(1) of the Statutory Accident Benefits Schedule.

While the purpose test was met, the causation test failed because 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 was injured in a motor vehicle accident and sought a non-earner benefit, which the respondent insurer denied.

The applicant filed an application for dispute resolution with the Licence Appeal Tribunal more than nine months after the two-year limitation period expired.

The respondent raised a preliminary issue that the claim was statute-barred.

The Tribunal applied the four Manuel factors under section 7 of the Licence Appeal Tribunal Act and granted an extension of time, finding that the applicant had a bona fide intention to appeal, the delay was explained by her declining function and reliance on counsel, the respondent suffered no prejudice, and the appeal had merit given the applicant's catastrophic impairment designation.

The applicant was injured when he fell off his e-bike after riding over a patch of motor oil on the road.

He sought statutory accident benefits, claiming the oil was spilled during the ordinary use or operation of an automobile.

The Licence Appeal Tribunal found that the applicant failed to establish on a balance of probabilities that the spill originated from an automobile.

As the purpose test was not met, the incident did not qualify as an 'accident' under s. 3(1) of the Schedule, and the application was dismissed.

The applicant, a self-employed individual who had taken maternity leave prior to the accident, sought an income replacement benefit (IRB).

She argued that calculating her pre-accident income based on her last completed taxation year under s. 4(3) of the Statutory Accident Benefits Schedule (SABS) infringed the Human Rights Code on the ground of sex/pregnancy, as her income was reduced during her maternity leave.

The Adjudicator agreed that s. 4(3) had a discriminatory effect but found that the Tribunal lacked the jurisdiction to amend or read in language to the Schedule to craft the remedy sought by the applicant.

The Adjudicator determined the quantum of the IRB based on the applicant's 2016 tax return without deducting the capital cost allowance (CCA), as the current SABS does not mandate such a deduction.

The applicant's claim for an award under O. Reg 664 was dismissed, but interest on overdue benefits was awarded.

The applicant sought funding for catastrophic impairment assessments following two motor vehicle accidents in 2014 and 2016.

The insurer denied the treatment plans.

The Tribunal found that the applicant failed to prove the assessments were reasonable and necessary, as the medical evidence, including clinical notes from treating physicians, showed a history of pre-existing cognitive issues, depression, and anxiety that contradicted the applicant's neuropsychological expert.

The Tribunal also dismissed the claims for an award and interest, finding no evidence of unreasonable delay by the insurer.

The respondent insurer brought a preliminary issue motion to dismiss the insured's application for income replacement benefits, arguing it was statute-barred because she failed to submit a disability certificate (OCF-3) supporting her claim within 104 weeks of the accident.

The Tribunal dismissed the motion, finding that the insured had submitted a completed OCF-3 within the 104-week period.

The Tribunal held that sections 36(2) and (3) of the Schedule only require the submission of a completed certificate, and the issue of whether the certificate supported the substantial inability test was a matter for the substantive hearing.

The applicant requested a reconsideration of a decision denying a motion to convert a videoconference hearing to a written hearing.

The applicant alleged that the adjudicator demonstrated bias, made errors of law, and violated procedural fairness by ordering the hearing to proceed despite the applicant's counsel lacking instructions.

The applicant also sought to introduce new medical evidence regarding her psychological state.

The Tribunal dismissed the reconsideration request, finding no reasonable apprehension of bias, no breach of procedural fairness, and that the new evidence could have been obtained previously and would not have changed the outcome.

The applicant requested a reconsideration of a Tribunal decision which found she was not involved in an accident.

The applicant argued the Tribunal violated procedural fairness by allowing a preliminary issue hearing and erred in law by improperly applying the causation test.

The adjudicator dismissed the request, finding no exceptional circumstances to permit new arguments regarding procedural fairness and concluding that the original decision correctly applied binding jurisprudence on causation.

The applicant sought a non-earner benefit, a special award, and interest following a motor vehicle accident.

The Licence Appeal Tribunal found the applicant's testimony regarding his post-accident impairments and inability to work lacked credibility, noting social media evidence suggesting he owned and operated a restaurant during the disputed period.

The Tribunal preferred the respondent's medical experts, who consistently concluded the applicant did not suffer a complete inability to carry on a normal life.

The application was dismissed in its entirety.

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

The respondent denied certain chiropractic treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued that he suffered from post-concussive syndrome, psychological impairments, and chronic pain, which should remove him from the MIG.

The Tribunal found that the applicant failed to provide compelling medical evidence to support these diagnoses, noting that diagnosing psychological conditions and chronic pain was outside the scope of his chiropractor's practice.

Relying on the respondent's expert reports, the Tribunal concluded the injuries were predominantly minor.

The application for treatment plans and interest was dismissed.

The applicant sought statutory accident benefits after slipping and falling on black ice in a parking lot while reaching to unlock her vehicle.

The respondent brought a motion for a preliminary issue hearing to determine whether the incident constituted an 'accident' under s. 3(1) of the Statutory Accident Benefits Schedule.

The Tribunal applied the two-part purpose and causation test.

While the purpose test was conceded, the Tribunal found the incident failed the causation test.

The ice on the ground was an independent intervening event and the dominant feature of the incident, breaking the chain of causation from the use or operation of the vehicle.

The application was dismissed.

The applicant sought statutory accident benefits following a 2016 motor vehicle accident.

In a prior Tribunal decision, it was determined that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant filed a second application seeking to remove herself from the MIG based on new medical reports.

The Tribunal dismissed the application, finding that the issue was barred by res judicata.

The Tribunal held that the new medical evidence did not conclusively impeach the original results, as the experts relied heavily on self-reporting and one expert lacked the appropriate orthopaedic qualifications.

The respondent's request for costs was denied.

The applicant was injured in a motor vehicle accident and sought various treatment plans for physiotherapy and assessments under the Statutory Accident Benefits Schedule.

The respondent denied the plans.

The Tribunal found the applicant was entitled to a physiotherapy treatment plan of $2,418.00, a functional impairment assessment of $1,988.80, and a physiatry assessment of $2,000.00, noting the respondent failed to provide proper medical reasons for denying the assessments under s. 38(8) of the Schedule.

The Tribunal denied the remaining physiotherapy treatment plans, finding them not reasonable and necessary based on the insurer's examination reports.

The claim for an award under Regulation 664 was dismissed, but interest was awarded on overdue benefits.

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

On the day of the scheduled videoconference hearing, the applicant brought a motion to convert the proceeding to a written hearing, citing psychological conditions that prevented her from participating.

The Tribunal denied the motion, noting the lack of recent medical evidence supporting the need for accommodation and the untimeliness of the request.

When ordered to proceed, the applicant's counsel refused to call evidence without instructions from his client.

Consequently, the Tribunal dismissed the application, finding that the applicant failed to meet her onus of proving that the disputed treatment plans were reasonable and necessary.

The applicant sought a non-earner benefit and funding for physiotherapy following a motor vehicle accident.

The adjudicator found that the applicant failed to prove she suffered a complete inability to carry on a normal life, as she continued to engage in substantially all of her pre-accident activities of daily living.

Furthermore, the adjudicator concluded that the proposed physiotherapy was not reasonable and necessary as a result of the accident, accepting expert evidence that the applicant's accident-related injuries had resolved and her ongoing issues were due to pre-existing osteoarthritis.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming costs for physiotherapy, a physiatry assessment, and a psychological assessment.

The adjudicator found the physiotherapy treatment plan reasonable and necessary as the applicant reported gradual improvement and pain relief.

The physiatry assessment was also approved, supported by medical opinions indicating the applicant suffered from chronic pain syndrome extending beyond the expected recovery period.

However, the claim for a psychological assessment was dismissed because there was insufficient documented evidence of psychological impairments in the family physician's records, and the respondent's psychological assessment finding no impairment was preferred.

Interest was awarded on the overdue payments for the approved benefits.

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

The respondent denied certain psychological and chiropractic treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant failed to prove his injuries warranted removal from the MIG, as there was insufficient evidence of pre-existing conditions, psychological impairment, post-concussive syndrome, or chronic pain.

The Tribunal preferred the respondent's expert reports, which concluded the applicant suffered only uncomplicated soft tissue injuries.

The application for medical benefits, interest, and an award was dismissed in its entirety.

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

The Tribunal found that the applicant's psychological impairment (depression) removed her from the Minor Injury Guideline.

However, the Tribunal dismissed her claim for an income replacement benefit, finding that her gynecological issues were pre-existing and not caused by the accident, and that her musculoskeletal and psychological impairments did not result in a substantial inability to perform the essential tasks of her employment as an Uber Eats driver.

Claims for an attendant care assessment and a special award were also dismissed.

The applicant sought entitlement to a social work assessment and occupational therapy services following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove the treatment plans were reasonable and necessary.

The Tribunal preferred the respondent's psychological assessment over the applicant's physiatry report regarding the need for a social work assessment, and found insufficient evidence to support the disputed duration of occupational therapy sessions.