Bruce Keay

The applicant was struck by a vehicle while riding his bicycle in 2013 but did not apply for statutory accident benefits until 2019.

The insurer denied the claim on the basis that the applicant failed to notify it of the accident and apply for benefits within the prescribed time limits.

The Tribunal found that the applicant's transient circumstances, including periods of incarceration, homelessness, severe mental illness, and addiction, provided a reasonable explanation for the delay under section 34 of the Schedule.

The applicant was permitted to proceed with his application.

The applicant sought income replacement benefits (IRBs), attendant care benefits, and medical benefits following a motor vehicle accident.

The Tribunal found that the applicant met both the Pre-104 and Post-104 IRB tests due to chronic pain and depression preventing her from returning to her pre-accident employment as a cook, despite her part-time accommodated work at an assisted living residence.

The Tribunal dismissed the claims for attendant care and medical benefits, finding the applicant independent in personal care and no longer in need of the requested assistive devices or occupational therapy.

The applicant was awarded IRBs with deductions for her part-time income, plus interest, but no special award was granted.

The applicant sought income replacement benefits (IRBs), attendant care benefits, and medical benefits following a motor vehicle accident.

The Tribunal found the applicant met both the pre-104 and post-104 week tests for IRBs due to chronic pain and depression, which prevented her from returning to her pre-accident employment as a cook.

However, the Tribunal denied the claims for attendant care and medical benefits, finding the applicant was independent in her personal care and had not utilized previously approved occupational therapy sessions.

The applicant was awarded IRBs subject to deductions for post-accident income, along with applicable interest, but no special award was granted.

The applicant, who was catastrophically impaired in a motor vehicle accident, sought various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal found that a protective cell phone case, an ergonomic lawn chair, a mattress, and the Guideline rate for a registered nurse case manager were reasonable and necessary.

However, claims for a new iPhone, a FitBit, a riding lawnmower, and an increased rate for an acupuncturist were dismissed as not reasonable and necessary.

The Tribunal also denied the applicant's request for a special award and costs.

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

The respondent insurer required an independent psychological examination before determining whether the applicant's injuries fell outside the Minor Injury Guideline (MIG).

The applicant argued this was unreasonable and sought a special award under Regulation 664.

The Tribunal found the insurer acted reasonably in requesting the examination given the lack of recent medical information.

However, the Tribunal ordered the respondent to pay the $200 cost of an updated OCF-3 disability certificate, finding it was an appropriate method for the applicant to notify the insurer of changed impairments.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits.

He previously settled a 2017 application before the Licence Appeal Tribunal, signing a release and settlement disclosure notice that included attendant care benefits 'to date and ongoing'.

He subsequently filed a 2018 application seeking attendant care benefits.

The Tribunal held a preliminary issue hearing to determine if the 2018 claim was barred by the 2017 settlement.

The Tribunal found the settlement documents were unambiguous and clearly released the insurer from ongoing attendant care benefit claims.

The application was dismissed.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits.

The insurer denied the applicant's claim for a non-earner benefit on the basis that she was self-employed at the time of the accident and therefore eligible for an income replacement benefit instead.

The applicant applied to the Licence Appeal Tribunal more than two years after the denial.

The Tribunal found that the insurer's denial was clear and unequivocal, triggering the two-year limitation period.

The Tribunal also declined to extend the limitation period under section 7 of the Licence Appeal Tribunal Act, finding no compelling evidence of a bona fide intention to appeal within the time limit and noting the lack of merit in the claim given the applicant's self-employment status.

The application was dismissed as statute-barred.

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

The insurer denied claims for physiotherapy and an attendant care/in-home assessment on the basis that the applicant's physical injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's significant physical injuries were related to pre-existing conditions and subsequent surgeries, not the accident.

The Tribunal concluded the treatment plans were not reasonable and necessary, and dismissed the application.

Claims for an award and costs were also dismissed.

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

The insurer raised a preliminary issue arguing the applicant's appeal was statute-barred under s. 56 of the Statutory Accident Benefits Schedule for failing to commence it within the two-year limitation period.

The Tribunal found that subsequent correspondence from the insurer rendered the initial denial equivocal, extending the limitation period.

Alternatively, the Tribunal held that the applicant met the criteria for an extension of time under s. 7 of the Licence Appeal Tribunal Act.

The insurer's request to bar the appeal was denied.

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

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

The applicant contended that her post-April 2016 impairments, including lower back issues requiring surgery, were caused by the accident and thus her injuries were not predominantly minor.

The Tribunal found that the applicant's later impairments were the result of pre-existing degenerative conditions, not the accident, relying on the uncontroverted opinion of the respondent's orthopedic assessor.

The Tribunal concluded the applicant's injuries were subject to the MIG and dismissed her claims for medical expenses, interest, and a special award.

The applicant was injured in a motor vehicle accident and sought income replacement benefits.

The insurer paid benefits for a period before sending a notice of refusal on March 5, 2015.

The applicant filed an application with the Tribunal on March 6, 2017.

The insurer brought a preliminary motion arguing the application was statute-barred for missing the two-year limitation period by one day.

The Tribunal dismissed the motion, finding that the limitation period does not begin to run until the applicant receives the notice of refusal.

Under the Statutory Accident Benefits Schedule, notice sent by regular mail is deemed received on the fifth business day after it is sent, meaning the limitation period had not expired when the application was filed.

The applicant sought statutory accident benefits, including non-earner benefits, medical benefits for chiropractic services, and compensation for damaged eyeglasses.

The applicant failed to attend the scheduled in-person hearing despite receiving proper notice.

As the applicant bore the burden of proof and presented no evidence, the Licence Appeal Tribunal dismissed the claims in their entirety.

The applicant failed to attend the scheduled arbitration hearing regarding statutory accident benefits.

The insurer brought a motion to dismiss the application for arbitration.

The arbitrator found that the applicant had been notified of the proceedings and was aware that failure to attend would result in a motion to dismiss.

The application was dismissed, and the insurer was awarded $500 in expenses.

The appellant appealed a Small Claims Court decision dismissing her claim for vehicle damage and awarding the respondent insurer damages on its counterclaim for a staged accident.

The appellant argued the trial judge misapprehended the evidence and failed to find a conspiracy against her.

The Divisional Court applied the standard of palpable and overriding error for findings of fact, concluding the trial judge's findings were reasonable and supported by the evidence.

The appeal was dismissed.

The appellant was injured in a motor vehicle accident and received income replacement benefits.

After the insurer terminated her benefits, she signed a full and final release in exchange for a lump sum.

She later sued the insurer for breach of contract, bad faith, and mental distress without first returning the settlement funds or proceeding to mandatory mediation.

The Court of Appeal upheld the summary judgment dismissing her action, confirming that her claims were 'in respect of' statutory accident benefits and therefore subject to the mandatory mediation scheme under the Insurance Act.

The defendant insurer brought a motion for summary judgment to dismiss the plaintiff's action for statutory accident benefits, arguing it was statute-barred because the plaintiff failed to mediate her claim and failed to return settlement funds prior to commencing the action.

The plaintiff brought a cross-motion for partial summary judgment for ongoing income replacement benefits.

The court granted the defendant's motion, finding that the failure to mediate and return the settlement funds deprived the court of jurisdiction.

The plaintiff's cross-motion was dismissed on the merits due to contradictory evidence regarding her disability.

The appellant settled her claims against her insurer in 2003 and signed a final release.

After a 2004 action to set aside the settlement was dismissed on consent, she commenced a second action in 2009 alleging conspiracy to cause economic harm.

The Court of Appeal upheld the summary judgment dismissing the 2009 action, finding that the six-year limitation period had expired based on the appellant's own pleadings, and that she had led no evidence to support the conspiracy claim.

The appellant appealed an order refusing leave to amend her Statement of Claim to add her insurer as a defendant.

The proposed amendment sought a determination of catastrophic impairment.

The motion judge held that while multiple applications for catastrophic impairment are not strictly precluded under s. 40(4) of the Statutory Accident Benefits Schedule, a subsequent application under the same sub-paragraph requires evidence of a material change in circumstances.

Finding no such change, the motion judge refused the amendment.

The Court of Appeal agreed with the motion judge's interpretation and found no error in her decision to refuse the amendment based on the record before her.

The appeal was dismissed.

The appellant appealed an order dismissing his application for the assessment of legal accounts.

The Court of Appeal dismissed the appeal, finding that the accounts of one respondent had already been assessed a decade ago, and there was no basis for ordering a reassessment.

Furthermore, the appellant provided no evidence to warrant any order against the other respondent.

The appellant, a victim of a motor vehicle accident, had her statutory accident benefits terminated by the respondent insurer.

The insurer's notice of termination advised her of the right to seek mediation but did not outline the full dispute resolution process or the relevant limitation periods.

After unsuccessful mediation, the appellant filed an action more than two years after the termination.

The Supreme Court of Canada held that the two-year limitation period under the Insurance Act does not begin to run until the insurer provides a valid refusal, which requires adequate compliance with s. 71 of the Statutory Accident Benefits Schedule.

Because the insurer failed to inform the appellant of the complete dispute resolution process, including the right to arbitrate or litigate and the applicable time limits, a proper refusal was not given, and the limitation period was not triggered.

The appeal was allowed.