Ulana Pahuta

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

The respondent denied various treatment plans in 2018 and 2019.

The applicant submitted her application to the Tribunal in 2023, beyond the two-year limitation period under s. 56 of the Schedule.

The applicant argued the denials were invalid for failing to provide medical reasons.

The Tribunal found the respondent's Explanation of Benefits provided clear and unequivocal denials with sufficient reasons, triggering the limitation period.

The Tribunal declined to extend the limitation period under s. 7 of the LAT Act, finding the applicant failed to demonstrate a bona fide intention to appeal, and the delay was significant.

The application was dismissed as statute-barred.

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

In a previous decision, the Tribunal determined the applicant's injuries fell within the Minor Injury Guideline (MIG) and that MIG limits were exhausted.

The applicant subsequently submitted new treatment plans and filed a second application seeking removal from the MIG.

The respondent raised res judicata as a preliminary issue.

The Tribunal found that the four preconditions for res judicata were met and that the new medical evidence submitted did not establish a material change in circumstances to warrant waiving the doctrine.

The application was dismissed.

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

The respondent insurer denied the benefits and requested the applicant attend insurer's examinations under s. 44 of the Schedule.

The applicant failed to attend the scheduled examinations and did not provide a reasonable explanation.

The Tribunal held that the applicant was statute-barred from proceeding with her application pursuant to s. 55(1)2 of the Schedule.

The application was dismissed.

The applicant requested a reconsideration of a preliminary issue decision which found she was not involved in an 'accident' under the Schedule.

She argued the Tribunal breached procedural fairness by refusing to admit her affidavit evidence, and erred in law by failing to apply binding caselaw and by considering her tort Statement of Claim.

The Tribunal dismissed the request, finding no breach of procedural fairness because the applicant had previously consented to an order stating no affidavits would be filed.

The Tribunal also found no error of law, as the caselaw was either considered or distinguishable, and the Statement of Claim was properly admitted as evidence of her perspective on the incident.

The applicant, a taxi driver, sought statutory accident benefits after an unidentified pedestrian shattered his driver's side window, causing glass to enter his eyes.

The respondent insurer denied benefits, arguing the incident was an assault and not an 'accident' under s. 3(1) of the Schedule.

The Tribunal applied the purpose and causation tests, finding that the vehicle was being used for its ordinary purpose and that the vehicle itself was the instrument of injury.

The Tribunal concluded the incident met the definition of an accident and ordered the matter to proceed to a substantive hearing.

The applicant was involved in a motor vehicle accident and received medical benefits.

The respondent insurer later determined no accident occurred, alleged wilful misrepresentation, and requested repayment of $3,806.09.

The applicant applied to the Tribunal to dispute the repayment request.

The respondent argued the application was statute-barred under s. 56 of the Schedule because it was filed more than two years after the repayment request.

The Tribunal held that the repayment request was not a 'refusal to pay' a benefit under s. 56, and therefore the two-year limitation period did not apply.

The applicant was permitted to proceed to a substantive hearing.

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

The insurer denied the claim because the applicant failed to submit a completed OCF-1 application within the prescribed timelines under the Schedule.

The Licence Appeal Tribunal held a preliminary issue hearing to determine if the applicant was statute-barred.

The Tribunal found that the applicant did not provide a reasonable explanation for the delay, as ignorance of the law and unsubstantiated claims of severe injuries or COVID-19 were insufficient.

The application was dismissed as statute-barred.

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

The respondent denied the benefits because the applicant failed to notify them of her intention to apply until 137 days after the accident, well beyond the seven-day limit under section 32(1) of the Schedule.

The Tribunal found that the applicant did not provide a credible or reasonable explanation for the delay under section 34, noting her lack of corroborating medical evidence for claimed latent injuries and her admission of knowing about the claims process from her sister.

The application was dismissed as statute-barred.

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

The respondent denied the benefits because the applicant failed to notify it of his intention to apply within the seven-day period prescribed by section 32(1) of the Schedule.

The applicant argued that his delay of three months was reasonable because he does not like to complain.

The Tribunal found this explanation unreasonable and held that the applicant failed to establish a basis for waiver or estoppel under section 131 of the Insurance Act.

The application was dismissed as statute-barred.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision regarding statutory accident benefits.

The applicant argued the adjudicator erred in calculating the non-earner benefit entitlement period, violated procedural fairness by relying on unargued caselaw, erred in applying s. 38(14) of the Schedule, and exhibited bias.

The Tribunal granted the request in part, correcting a two-day error in the non-earner benefit start date.

The remainder of the request was dismissed, as the Tribunal is expected to apply binding caselaw and relevant statutory provisions regardless of whether the parties raise them.

The applicant sought attendant care benefits following a motor vehicle accident.

The respondent denied the claim, and the applicant applied to the Tribunal.

The respondent argued the application was barred by the two-year limitation period under s. 56 of the Schedule.

The Tribunal found that the claim for pre-104 week benefits was statute-barred as it was not filed within two years of the clear denial.

However, applying the discoverability principle from Tomec, the Tribunal held that the limitation period for post-104 week benefits did not run while the applicant's catastrophic impairment designation was stayed and dismissed pending appeal.

Therefore, the claim for post-104 week benefits was not statute-barred.

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

The insurer raised two preliminary issues: whether the applicant was barred from claiming a non-earner benefit for failing to submit an OCF-10 election, and whether he was barred from all claims for failing to attend an insurer's examination.

The Tribunal held the applicant was barred from pursuing the non-earner benefit because the OCF-1 and OCF-3 indicated potential entitlement to multiple benefits, making the OCF-10 mandatory.

However, the applicant was not barred from pursuing the remaining claims because the insurer's notice of examination failed to provide sufficient medical reasons, rendering it non-compliant with section 44(5) of the Schedule.

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

The respondent denied the benefits in June 2017.

The applicant filed an application with the Tribunal in May 2023, nearly six years later.

The Tribunal found that the respondent's denial was clear and unequivocal, triggering the two-year limitation period under s. 56 of the Schedule.

As the applicant did not file submissions or request an extension under s. 7 of the LAT Act, the Tribunal declined to extend the limitation period and dismissed the application as statute-barred.

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

The respondent denied several treatment plans, and the applicant applied to the Tribunal outside the two-year limitation period.

The preliminary issue was whether the applicant was barred from proceeding.

The Tribunal found that four of the respondent's denial notices were invalid because they lacked specific medical reasons, thus failing to trigger the limitation period.

However, two denial notices were valid, and the applicant failed to establish reasonable grounds for an extension under section 7 of the LAT Act.

The applicant was barred from proceeding with two treatment plans but allowed to proceed with the remaining ones.

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

The insurer denied the benefits in June 2018, citing insufficient documentation.

The applicant filed her application with the Tribunal in April 2023, nearly five years later.

The Tribunal found the insurer's denial was clear and unequivocal, triggering the two-year limitation period under section 56 of the Statutory Accident Benefits Schedule.

Applying the Manuel factors, the Tribunal declined to extend the limitation period under section 7 of the Licence Appeal Tribunal Act, finding significant delay, prejudice to the insurer, and a lack of evidence supporting the merits of the claim.

The application was dismissed as statute-barred.

The applicant sought statutory accident benefits after slipping and falling on ice while opening the trunk of a vehicle.

The respondent denied benefits, arguing the incident was a slip and fall on ice and not an 'accident' under the Schedule.

The Tribunal applied the purpose and causation tests, finding that the mechanics of opening the trunk created a significant fall risk that was the dominant feature of the incident.

The Tribunal concluded the incident met the definition of an 'accident' under s. 3(1) of the Schedule.

The applicant sought a non-earner benefit after her daughter was involved in a motor vehicle accident.

The respondent raised a preliminary issue that the applicant was statute-barred from proceeding with her claim because she failed to submit a disability certificate (OCF-3) within 104 weeks post-accident.

The Tribunal found that the language in section 36 of the Statutory Accident Benefits Schedule is compulsory and bars an applicant from pursuing a claim if the OCF-3 is submitted after the 104-week eligibility period.

The applicant was therefore barred from proceeding with her claim.

The respondent's request for costs was denied.

The applicant sought statutory accident benefits for psychological impairments following the death of his step-son in a motorcycle accident.

The respondent insurer raised two preliminary issues: whether a step-parent qualifies as an 'insured person' under the Schedule, and whether the applicant was barred from claiming benefits under s. 61 because he was receiving Workplace Safety and Insurance Act (WSIA) benefits for PTSD related to his work as a paramedic.

The Tribunal applied a purposive approach to statutory interpretation, finding that the undefined term 'child' in the Schedule includes a step-child, making the applicant an insured person.

The Tribunal also found the applicant was not barred by s. 61, as the basis for his WSIA claim (work-related trauma) differed from his accident benefits claim (psychological injuries from the step-son's death).

The matter was ordered to proceed to a substantive hearing.

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

He failed to notify the insurer of his intention to apply for benefits within the seven-day time limit prescribed by section 32(1) of the Schedule, submitting his application over a year later.

The Tribunal found that the applicant did not provide a credible or reasonable explanation for the delay, rejecting his arguments that he was unaware of his injuries or his right to claim benefits.

The application was dismissed as statute-barred.

The applicant sought statutory accident benefits after being assaulted by the driver of a vehicle and subsequently pushed out.

The respondent denied benefits on the basis that the incident did not meet the definition of an 'accident' under s. 3(1) of the Schedule.

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

The Tribunal concluded that the applicant's injuries were directly caused by an intervening act—the various assaults perpetrated by the driver—rather than the use or operation of the automobile.

The application was dismissed.