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The test for post-104-week income replacement benefits requires a contextual analysis of suitable employment without imposing stand-alone requirements for competitive real-world settings or comparable status.
The appellant sought income replacement benefits (IRBs) under the Statutory Accident Benefits Schedule following a motor vehicle accident.
The central issue was the correct interpretation of the test for post-104-week IRBs under section 6(2)(b) of the Schedule.
The appellant argued that the test requires consideration of employment in a competitive, real-world setting comparable in nature, status, and remuneration to the insured's former employment.
The respondent insurer argued that the statutory test does not include such requirements.
The Court of Appeal upheld the lower courts' decisions, holding that while factors such as competitive real-world setting, status, and remuneration are relevant considerations in the evidence-based analysis, they are not stand-alone requirements of the test.
The appellant failed to prove a complete inability to engage in any employment for which she was reasonably suited by education, training, or experience, particularly given evidence that wedding planning remained a viable option.
Application for accident benefits dismissed as claims were either statute-barred or not proven reasonable and necessary.
The applicant sought various statutory accident benefits following a 2015 motor vehicle accident, including attendant care, chiropractic treatment, medication, and multiple assessments.
The Tribunal found that the claims for attendant care and initial chiropractic treatment were statute-barred by the two-year limitation period, and the applicant failed to establish reasonable grounds for an extension.
For the remaining substantive claims, the Tribunal concluded the applicant had not met her burden to prove the treatments and assessments were reasonable and necessary, preferring the evidence of the respondent's medical examiners who opined the applicant had reached maximum medical recovery.
The application was dismissed.
