Statutory Accident Benefits Schedule matters (SABS)

The applicant sought various statutory accident benefits following a motor vehicle accident, including physiotherapy services, an attendant care assessment, and a functional ability evaluation.

The respondent denied the benefits, relying on insurer's examinations which indicated the applicant had reached maximal recovery and returned to work.

The Licence Appeal Tribunal found that the applicant failed to prove on a balance of probabilities that the proposed treatment plans and assessments were reasonable and necessary.

The Tribunal dismissed all claims for benefits, interest, a section 10 award, and costs.

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

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

The Tribunal found that the applicant failed to provide sufficient medical evidence of chronic pain, psychological injury, or a pre-existing condition that would warrant removal from the MIG.

The Tribunal also dismissed the claim for a non-earner benefit, as the applicant did not provide evidence comparing his pre- and post-accident activities to establish a complete inability to carry on a normal life.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought payment for four treatment plans for chiropractic and physiotherapy services under the Statutory Accident Benefits Schedule.

The respondent insurer denied the plans, arguing the applicant's physical injuries fell under the Minor Injury Guideline and relying on an insurer's examination report.

The Tribunal found that the applicant had been removed from the Minor Injury Guideline for psychological injuries, which did not preclude treatment for physical injuries.

Relying on clinical notes and records that consistently documented the applicant's ongoing neck, back, and shoulder pain, the Tribunal concluded all four treatment plans were reasonable and necessary.

The applicant was awarded the cost of the treatment plans plus interest.

The applicant sought payment for the unapproved balances of two treatment plans for psychological services following a motor vehicle accident.

The Tribunal found that the applicant failed to prove the reasonableness and necessity of the higher hourly rate for a social worker under the first plan, and failed to provide evidence justifying a psychologist follow-up fee in the second plan.

The Tribunal also found the insurer's denial complied with section 38(8) of the Schedule.

The application was dismissed, with no entitlement to interest or an award.

The applicant and respondent both requested reconsideration of a previous Licence Appeal Tribunal decision.

The applicant sought reconsideration regarding the denial of income replacement benefits and treatment plans, while the respondent challenged the finding that the applicant was involved in an 'accident' and not subject to the Minor Injury Guideline.

The adjudicator found that neither party met the high threshold for reconsideration under Rule 18.2, as both were attempting to re-litigate issues and re-weigh evidence already considered.

Both requests for reconsideration were dismissed.

The applicant sought statutory accident benefits for home modifications totaling $777,467.00 following a motor vehicle accident that resulted in a spinal cord injury.

Prior to the submission of the treatment plan, the applicant's family sold their pre-accident home and purchased a new bungalow.

The Tribunal found that the proposed modifications were for a home the applicant no longer resided in, and no assessment was provided for the new bungalow.

The Tribunal dismissed the application, concluding the applicant failed to prove the modifications were reasonable and necessary, and denied claims for interest and a special award.

The applicant requested a reconsideration of a previous Tribunal decision which found she was not catastrophically impaired.

The applicant argued the Tribunal breached procedural fairness by limiting her testimony time and erred in law by misinterpreting Criterion 8 and allowing an expert to testify outside the scope of his report.

The Tribunal dismissed the request, finding no breach of procedural fairness as the hearing was managed efficiently under the Statutory Powers Procedure Act.

The Tribunal also found no errors of law or fact that would have changed the outcome, noting the applicant was attempting to re-litigate the weight assigned to the evidence.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits for physiotherapy and an attendant care assessment.

The respondent denied the benefits.

The Tribunal found that the applicant failed to prove on a balance of probabilities that the treatment plans were reasonable and necessary, noting that the applicant's family doctor records did not mention accident-related pain and the respondent's examiner found no musculoskeletal impairments.

The Tribunal also found the respondent's denial letter was sufficient under s. 38(8) of the Schedule.

The application was dismissed, and claims for interest and an award were denied.

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

The matter proceeded to a written hearing.

The applicant's representative withdrew, and the applicant failed to respond to multiple Tribunal communications or file any written submissions.

The Tribunal proceeded with the hearing in the applicant's absence pursuant to section 7(2) of the Statutory Powers Procedure Act.

The application was dismissed as the applicant failed to meet the evidentiary burden to demonstrate entitlement to the claimed benefits.

The applicant sought entitlement to various treatment and assessment plans for psychological and chiropractic services following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove on a balance of probabilities that the proposed plans were reasonable and necessary.

The Tribunal preferred the evidence of the respondent's section 44 assessors, who concluded that the applicant suffered only minor physical strains and did not meet the criteria for a psychological diagnosis, over the applicant's self-reported complaints and the reports of his treating practitioners.

The applicant sought medical and rehabilitation benefits following a motor vehicle accident, arguing that chronic pain and psychological impairments warranted removal from the Minor Injury Guideline (MIG).

The adjudicator found that the applicant failed to prove on a balance of probabilities that his injuries fell outside the MIG.

The medical evidence indicated large gaps in treatment and an intervening fall that caused significant injuries, breaking the causal link to the accident.

Furthermore, the adjudicator preferred the respondent's psychological assessment, which found no accident-related psychological disorder.

As the applicant remained within the MIG, the disputed treatment plans and claim for interest were dismissed.

The applicant sought various statutory accident benefits following a 2017 motor vehicle accident.

The Tribunal dismissed the claims for increased income replacement benefits, finding that 100% of the applicant's CPP-D benefits were properly deducted from the base amount.

Claims for treatment plans and housekeeping were also dismissed for lack of evidence.

However, the Tribunal found the applicant was entitled to attendant care benefits at the rates set out in the approved Form-1, despite the submitted invoices claiming higher rates.

The Tribunal also ordered a 10% award under s. 10 of Regulation 664, finding the insurer unreasonably withheld payment of the approved attendant care benefits after receiving sufficient documentation.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's determination that his injuries fell within the Minor Injury Guideline (MIG).

The applicant claimed removal from the MIG was warranted due to chronic pain and psychological impairments.

The Tribunal found the applicant failed to establish chronic pain with functional impairment, placing little weight on his expert's diagnosis because it did not address functional limitations.

The Tribunal also preferred the respondent's psychological assessment over the applicant's, finding no psychological impairment.

The application was dismissed, and the disputed treatment plans and interest were denied.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied her non-earner benefits for a specific period due to her failure to submit a completed disability certificate (OCF-3) under s. 36(3) of the Schedule.

The applicant argued that the Tribunal erred in its strict interpretation of s. 36(3), asserting that the provision should not apply to an incapable applicant, and that the Tribunal failed to properly consider the Human Rights Code and the Charter.

The Vice-Chair dismissed the reconsideration request, finding that the applicant was attempting to re-litigate arguments made at the initial hearing and had failed to establish any error of law or fact under Rule 18.2(b).

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

The adjudicator found that the applicant was statute-barred from disputing a chronic pain assessment because she failed to file an application within the two-year limitation period after receiving valid denials from the insurer.

The adjudicator also dismissed claims for a psycho-vocational assessment, finding the applicant had returned to her pre-accident employment, and for psychological services, as the applicant failed to justify the need for longer sessions at a higher rate than approved.

A claim for chiropractic services was denied because the expense was incurred before a treatment plan was submitted.

Claims for interest and an award were consequently dismissed.

The applicant was involved in a motor vehicle accident and notified the respondent the following day, but explicitly denied sustaining any injuries.

Over five months later, the applicant submitted an application for accident benefits.

The respondent denied the claim on the basis that the applicant failed to provide notice of an intention to claim benefits within seven days, as required by section 32(1) of the Schedule.

The Tribunal found that the applicant did not comply with the notice requirement and failed to provide a reasonable explanation for the delay, rejecting arguments based on a language barrier and a belief that the injuries would resolve.

Consequently, the applicant was statute-barred from proceeding with the application.

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

The issues in dispute included entitlement to two physiotherapy treatment plans and a special award for unreasonable delay.

The Tribunal found the applicant was not entitled to the July 6, 2022 treatment plan as it lacked sufficient evidence of being reasonable and necessary.

However, the Tribunal approved the January 31, 2023 treatment plan, finding it corroborated by contemporaneous medical evidence.

The claim for a special award was dismissed as the insurer's conduct did not rise to the level of being excessive or imprudent.

The applicant sought attendant care benefits, interest, and an award following a motor vehicle accident.

The Tribunal found that the applicant was not entitled to additional attendant care benefits because the 260-week period for claiming such benefits had expired and the non-catastrophic monetary limit of $65,000 had been exhausted.

The applicant's preliminary motion to exclude the respondent's Insurer Examination report was also denied because the applicant had attended and participated in the examination without protest.

The application was dismissed.

The plaintiff moved for partial summary judgment seeking rescission of a settlement and release relating to statutory accident benefits following a motor vehicle accident, arguing the insurer failed to comply with disclosure requirements under s. 9.1(2) of O. Reg. 664 (Settlement Regulation).

The court held that the insurer’s notice did not adequately explain the commuted value calculation of weekly benefits and therefore failed to satisfy the regulatory disclosure requirements intended to permit meaningful comparison between periodic and lump-sum benefits.

As a result, the insured was entitled to rescind the settlement under s. 9.1(4).

The court rejected the insurer’s argument that the action was statute-barred due to lack of evidence of a clear refusal to pay benefits triggering the limitation period.

However, the action was stayed until the insured repaid the settlement funds received.

The plaintiff brought a motion under Rule 6.01 of the Rules of Civil Procedure seeking an order that an accident benefits action be tried together with a related tort action arising from the same motor vehicle accident.

The court considered whether the proceedings shared common questions of law or fact and whether trying them together would promote efficiency and avoid inconsistent findings.

Applying factors relating to expediency, convenience, potential prejudice, and overlap of witnesses and expert evidence, the court found that the actions arose from the same accident and involved overlapping issues regarding injuries and damages.

The court concluded that hearing the matters together would reduce duplication of witnesses and trial time without causing meaningful prejudice.

The motion was granted and the actions were ordered to be tried together.