6 total
Income replacement benefits denied because the self-employed applicant failed to prove the quantum of his income loss.
The self-represented applicant sought income replacement benefits (IRBs) following a motor vehicle accident.
The Tribunal admitted late-filed evidence from both parties, prioritizing a liberal interpretation of the rules and the consumer protection mandate of the Schedule.
While the Tribunal found that the applicant's shoulder injury caused a substantial inability to perform the essential tasks of his self-employment at a pizza restaurant, the application was ultimately dismissed.
The applicant failed to provide sufficient financial evidence or an accountant's report to prove the quantum of his accident-related income loss.
Application for accident benefits dismissed; applicant failed to prove injuries warranted removal from the Minor Injury Guideline.
The applicant sought statutory accident benefits following a motor vehicle accident.
The respondent denied the claims on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).
The applicant argued for removal from the MIG due to pre-existing knee and psychological conditions, as well as accident-related chronic pain and psychological impairment.
The Tribunal found insufficient medical evidence to establish that any pre-existing condition would prevent maximal medical recovery within the MIG, nor was there sufficient evidence of chronic pain with functional impairment or a psychological injury.
The application was dismissed, and the disputed treatment plans were denied.
Insurer entitled to repayment of $8,400 in IRBs because respondent drove with a suspended license.
The applicant insurer sought repayment of $8,400 in Income Replacement Benefits (IRB) paid to the respondent following a motor vehicle accident.
The insurer argued the respondent was disqualified from receiving IRBs under s. 31(1)(a)(ii) of the Schedule because he was driving with a suspended license at the time of the accident.
The respondent failed to participate in the written hearing.
The Tribunal found the insurer provided proper notice under s. 52 and established the respondent's license was suspended prior to the accident for medical reasons.
The Tribunal ordered the respondent to repay the $8,400 plus applicable interest.
Limitation period extended for non-earner benefits due to negligible delay; attendant care claim premature.
The applicant was involved in a motor vehicle accident and sought non-earner benefits (NEBs) and attendant care benefits (ACBs) from the respondent insurer.
The insurer denied the benefits and raised a preliminary issue that the applicant was statute-barred from proceeding with her application for failing to appeal within the two-year limitation period.
The Tribunal found that the ACB claim was not properly before it because the applicant had never submitted an Assessment of Attendant Care Needs (Form-1), meaning no valid denial could have been made.
Regarding the NEB claim, the Tribunal found the insurer's denial was clear and unequivocal, triggering the limitation period.
However, the Tribunal exercised its discretion under section 7 of the Licence Appeal Tribunal Act to extend the limitation period, noting the applicant's bona fide intention to appeal, the negligible six-business-day delay, the lack of prejudice to the insurer, and the potential merit of the claim.
The applicant was permitted to proceed with her NEB claim.
Claim for income replacement benefits and insurer's claim for repayment of overpayment both dismissed.
The applicant sought income replacement benefits (IRBs) following a motor vehicle accident, claiming a substantial inability to perform the essential tasks of her employment as a personal support worker.
The respondent denied the IRBs and sought repayment for an alleged overpayment.
The Tribunal found that the applicant failed to prove a substantial inability to work, as the medical evidence indicated she was engaging in modified work duties and failed to delineate her essential tasks.
The Tribunal also dismissed the respondent's claim for repayment, finding insufficient evidence to prove the overpayment was actually advanced and received.
Both the applicant's claim and the respondent's claim for repayment were dismissed.
Settlement reached during litigation enforced despite insurer sending unnecessary cooling‑off notice.
The defendants brought a motion to enforce a settlement agreement relating to accident benefits arising from a motor vehicle accident.
The plaintiff argued the settlement occurred during the mediation process and therefore triggered the two‑day cooling‑off period under Regulation 664, s. 9.1(1)(5) of the Insurance Act, permitting rescission.
The court found that the settlement was reached in the context of litigation between represented parties and not as part of the statutory mediation process.
Relying on appellate authority emphasizing that the settlement disclosure notice regime protects self‑represented parties rather than litigants represented by counsel, the court held the cooling‑off period did not apply.
The settlement agreement was therefore binding and enforceable.
