David Wallace

The applicant, who suffered a catastrophic impairment including a leg amputation in a motor vehicle accident, sought $607,445 for home modifications to his mother's residence.

The insurer denied the benefit.

The Licence Appeal Tribunal found that the mother's residence did not qualify as the applicant's "existing home" under s. 16 of the Schedule, as evidence showed he lived with his stepfather prior to the accident.

Furthermore, the Tribunal held there is no authority under the Schedule to redirect home modification funds into a trust for a future home purchase.

The Tribunal also dismissed the insurer's preliminary motion to dismiss the application for the applicant's failure to attend an Examination Under Oath, noting the Schedule does not prescribe dismissal as a penalty for such non-compliance.

The claims for an award and interest were dismissed.

The Applicant sought statutory accident benefits following a 2010 motor vehicle accident, claiming entitlement to attendant care benefits of $6,000 per month, extensive home modifications, and alternative housing.

The Tribunal found the Applicant entitled to attendant care benefits up to $3,589.07 per month based on her mental and behavioural impairments, but noted no expenses had been incurred to date.

The claims for home modifications and alternative housing were dismissed, as the Applicant's physical impairments did not warrant them and her primary challenges were related to disorganization and clutter.

The Tribunal also found the housing assessment was subject to the $2,000 funding limit.

The Applicant was awarded $1,000 in costs due to the Respondent's failure to provide a timely copy of the hearing transcript and for exceeding submission page limits.

The applicant, who suffered a traumatic brain injury and mobility issues after being struck by a vehicle as a pedestrian, sought $415,334.00 in statutory accident benefits for extensive home modifications.

The proposed modifications included an elevator, a therapy room, and wheelchair-accessible features.

The Licence Appeal Tribunal found that the majority of the proposed modifications were not reasonable or necessary because they were predicated on the applicant using a wheelchair, whereas she actually used a walker.

The Tribunal approved modifications for a rear entrance, deck, intercom, and alarm system, but denied the elevator and additions.

The Tribunal also dismissed the applicant's claim for a special award, finding the insurer acted reasonably.

The applicant, who sustained catastrophic injuries rendering him a tetraplegic in a motor vehicle accident, sought a rehabilitation benefit for the construction of a new home.

The parties agreed that building a new home was more reasonable than renovating the applicant's existing home.

The Tribunal considered section 16(4)(c) of the Statutory Accident Benefits Schedule, which limits the cost of a new home to the notional cost of renovating the existing home.

The Tribunal preferred the applicant's expert evidence regarding the estimated renovation costs and awarded $64,615.00 in addition to the previously approved amount.

The Tribunal also found that, as a status Indian residing on a reserve, the applicant was exempt from paying HST on the construction costs.

The applicant, who was seriously injured in a motor vehicle accident, sought statutory accident benefits for home modifications under section 15 of the Statutory Accident Benefits Schedule.

The parties disputed whether a property owned by the applicant's family, which they were allegedly planning to move into before the accident, qualified as his 'existing home.' The parties also disputed whether the insurer was required to pay for remedial work, such as mould removal and structural repairs, necessary before the home modifications could proceed.

The arbitrator found that the property was the applicant's 'existing home' because the Schedule allows flexibility in choosing a home and the applicant had a reasonable connection and settled intention to live there.

However, the arbitrator ruled that the insurer was not required to pay for the remedial work, as it was not required to reduce or eliminate the effects of any disability resulting from the accident.

The applicant sustained severe mobility impairments following a motor vehicle accident and sought $60,291.10 from her insurer for the costs of moving from her multi-level home to a single-level bungalow.

The insurer denied the claim, arguing that the applicant could still ambulate and later asserting that she failed to submit a formal treatment plan before incurring the expense.

The arbitrator found that the move was a reasonable and necessary accommodation under section 15(5)(i) of the Statutory Accident Benefits Schedule.

The arbitrator also held that the insurer was estopped from relying on the procedural defence regarding the treatment plan due to its conduct.

A special award of $25,000 was granted against the insurer for unreasonably withholding benefits.

The applicant, who suffered paraplegia in a motor vehicle accident, applied for statutory accident benefits.

The arbitrator found that the applicant was entitled to weekly income benefits post-156 weeks because her injuries continuously prevented her from engaging in substantially all of her pre-accident activities.

The arbitrator also awarded care benefits of $250 per week, finding that her husband reasonably lost this gross income in caring for her.

Claims for a new wheelchair, shower modifications, and counselling were granted as reasonable and necessary rehabilitation expenses, while claims for a new home, a modified van, and a power scooter were denied.

The applicant's request for a special award was dismissed as the insurer's conduct was not found to be unreasonable.