Amit Kwatra

The applicant insurer sought repayment of $8,768.91 in income replacement benefits paid to the respondent, alleging she received Employment Insurance or maternity benefits without disclosing them.

The respondent argued she received the Canada Recovery Caregiving Benefit, which does not constitute gross employment income under the Schedule.

The Tribunal found the insurer failed to prove the benefits were paid as a result of error, wilful misrepresentation, or fraud, as the evidence showed the respondent did not receive Employment Insurance during the relevant period.

The application for repayment was dismissed.

The applicant sought an award under s. 10 of Regulation 664, alleging the respondent unreasonably delayed or withheld payment for a psychological assessment treatment plan.

The respondent had initially denied the plan because it would exceed the $50,000 statutory limit for medical and rehabilitation benefits.

Once the applicant confirmed he would not use remaining funds from previously approved plans, the respondent approved the treatment plan.

The Tribunal found the respondent's actions were not excessive, imprudent, stubborn, unyielding, or immoderate, and dismissed the claim for an award.

The applicant sought judicial review of a Director's Delegate decision confirming an Arbitrator's finding that he was not catastrophically impaired following a motor vehicle accident.

The applicant argued the Arbitrator erred in law by relying on surveillance evidence, the applicant's presentation at the hearing, and a psychiatrist's report.

The Divisional Court dismissed the application, finding that the issues raised were questions of fact and the weighing of evidence, not errors of law, and that the Director's Delegate's decision was reasonable.

Aviva Insurance Canada requested a reconsideration of a Licence Appeal Tribunal decision which found that N.F.'s application for accident benefits was valid despite missing a police report.

Aviva argued that the application was incomplete and therefore barred.

The Executive Chair dismissed this argument, finding that under section 32(7) of the Statutory Accident Benefits Schedule, an application does not need to be perfectly complete to trigger an insurer's obligation to respond, provided it is functionally adequate.

The Tribunal's finding that Aviva was precluded from relying on the Minor Injury Guideline due to improper denial notices was upheld.

However, the Tribunal's order was varied to explicitly dismiss N.F.'s claim for a non-earner benefit due to a lack of evidence.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including medical benefits, examination expenses, and an income replacement benefit (IRB).

The insurer denied the claims, arguing the injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's physical and psychological injuries were minor and did not warrant removal from the MIG.

The Tribunal preferred the evidence of the insurer's expert psychologist over the applicant's social worker regarding psychological impairments.

Furthermore, the Tribunal concluded the applicant did not suffer a substantial inability to perform the essential tasks of his employment, dismissing the claim for an IRB.

All claims and the request for interest were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including non-earner benefits and various medical and rehabilitation benefits.

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant did not suffer a complete inability to carry on a normal life, as surveillance and medical evidence showed she retained significant functional abilities.

Furthermore, the Tribunal concluded the applicant's injuries were predominantly minor and she failed to prove a pre-existing medical condition that would exempt her from the MIG cap.

As the $3,500 cap was exhausted, the claims for additional medical benefits and examination costs were dismissed.

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

The insurer denied the claim on the basis that the application was incomplete because the applicant did not provide a police report.

The Tribunal found that the applicant was not barred from commencing the application under s. 55 of the Schedule, as she had notified the insurer as soon as practicable and a police report was not mandatory in these exceptional circumstances.

The Tribunal further held that the insurer failed to properly deny several treatment plans under s. 38(8) of the Schedule, rendering them payable.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits from the Motor Vehicle Accident Claims Fund, which later transferred the claim to the respondent insurer.

The insurer argued the application was barred under s. 55 of the Schedule because the applicant failed to notify the Fund within seven days and submitted an incomplete application lacking a police report.

The Tribunal found the applicant notified the Fund as soon as practicable and that a police report was not mandatory since the Fund had sufficient information to determine if a benefit was payable.

Furthermore, the Tribunal held that the insurer failed to provide proper notice under s. 38(8) when denying the treatment plans, as it did not provide medical reasons or state that the Minor Injury Guideline applied.

Consequently, under s. 38(11), the insurer was prohibited from applying the Minor Injury Guideline and was ordered to pay for all the disputed treatment plans.

The applicant failed to attend the scheduled arbitration hearing regarding her claim for statutory accident benefits following a motor vehicle accident.

Her legal representative requested to be removed from the record due to a breakdown in the solicitor-client relationship, which the arbitrator granted.

As the applicant did not appear and presented no evidence to support her claims, the application for arbitration was dismissed.

The insurer was awarded $1,000 in expenses due to the applicant's repeated failure to attend proceedings and examinations.

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

After failing to attend a rescheduled pre-hearing, and failing to provide notice of new representation, the insurer moved to dismiss the application.

The arbitrator dismissed the application for arbitration due to the applicant's non-attendance and failure to present evidence.

The insurer was awarded $1,500 in expenses.