Geoffrey L. Keating

The appellant slipped and fell on black ice while holding her key fob and reaching to unlock her car door.

She applied for accident benefits, which the insurer initially paid but later disputed by raising a preliminary issue that the incident was not an 'accident' under s. 3(1) of the SABS.

The Licence Appeal Tribunal found the incident was not an accident.

On appeal, the Divisional Court held that the LAT did not err in allowing the preliminary issue to be raised late, but erred in law in its causation analysis.

The court found the appellant was engaged in the ordinary use of her vehicle and the ice was not an intervening cause, concluding the incident met the definition of an accident.

The applicant sought payment for three chiropractic treatment plans and an award under the Statutory Accident Benefits Schedule following a 2017 motor vehicle accident.

The Tribunal found the applicant was entitled to the first treatment plan of $1,423.60 because the insurer failed to provide a proper written denial within the required time limit under section 38 of the Schedule.

The remaining two treatment plans were denied, as the Tribunal accepted the respondent's orthopaedic assessment that the applicant's ongoing shoulder issues, which arose after a significant gap in treatment, were not attributable to the accident.

The claim for an award was dismissed for lack of evidence, but interest was awarded on the approved plan.

The applicant requested reconsideration of a decision dismissing his application for accident benefits after he failed to file submissions.

The applicant argued that the missed deadline was due to the inadvertence of his former representative, who experienced two family deaths.

The Tribunal found that dismissing the application without submissions, after denying a motion for an extension of time, resulted in a material breach of procedural fairness.

The reconsideration was granted in part, and a new written hearing was ordered for the non-earner benefits and other issues, while the request regarding catastrophic impairment was dismissed as it had been previously withdrawn.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's denial of two physiotherapy treatment plans and a portion of a psychological treatment plan.

The respondent argued the applicant was barred from proceeding with one physiotherapy claim due to non-attendance at an insurer's examination, but the Tribunal found no prejudice as the applicant attended a subsequent examination.

On the merits, the Tribunal dismissed the application, finding the physiotherapy plans were not proven reasonable and necessary given the lack of objective medical evidence and an unopposed independent medical examination.

The Tribunal also upheld the respondent's reduced hourly rate for the psychological services provided by an unregulated social worker.

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

The respondent denied various treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the respondent's notices for insurer's examinations were insufficient, so the applicant was not barred from proceeding.

However, the Tribunal concluded that the applicant failed to prove he suffered from chronic pain with functional impairment or a psychological impairment.

Therefore, the applicant's injuries remained subject to the $3,500 MIG limit, and the application for treatment plans beyond that limit was dismissed.

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

The respondent classified the applicant's injuries as minor and subject to the Minor Injury Guideline (MIG) and its $3,500 funding limit, denying several treatment and assessment plans.

The applicant argued she suffered from chronic pain and psychological injuries outside the MIG.

The Tribunal found the applicant's physical injuries were minor and her ongoing pain was related to a pre-existing condition (polymyalgia rheumatica), not the accident.

The Tribunal preferred the respondent's medical experts over the applicant's assessor, concluding the applicant did not sustain accident-related chronic pain or psychological impairments.

The application was dismissed, and no interest or award was granted.

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

The matter was scheduled for a written hearing, but the applicant failed to file any submissions or evidence by the ordered deadline.

A subsequent motion by the applicant to extend the deadline or convert the hearing format was denied.

As the applicant failed to meet his evidentiary burden, the application was dismissed.

The applicant requested a reconsideration of a decision denying retroactive attendant care and housekeeping benefits, a chiropractic treatment plan, and interest.

The applicant alleged the adjudicator committed a material breach of procedural fairness, exhibited bias, and made errors of fact and law.

The Licence Appeal Tribunal dismissed the request, finding that the applicant failed to establish a reasonable apprehension of bias and was improperly attempting to use the reconsideration process to reweigh evidence and re-litigate the merits of the case.

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

The respondent denied several treatment plans 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 chronic pain syndrome and psychological impairment.

The Tribunal found insufficient medical evidence to support a diagnosis of chronic pain syndrome.

The Tribunal also preferred the respondent's psychological assessment over the applicant's, concluding there was no clinically significant psychological impairment.

As the applicant's injuries were predominantly minor and the $3,500 MIG limit was exhausted, the application for further benefits and a section 10 award was dismissed.

The applicant sought statutory accident benefits after slipping and falling on a snowbank while attempting to enter a taxi.

The respondent denied benefits on the basis that the incident was not an 'accident' under s. 3(1) of the Statutory Accident Benefits Schedule.

The Tribunal applied the purpose and causation tests, finding that while the purpose test was met, the causation test failed because the snowbank was an intervening act and the dominant feature of the incident.

The application was dismissed.

The applicant sought reconsideration of a Licence Appeal Tribunal decision regarding his entitlement to attendant care benefits.

He argued the Tribunal violated procedural fairness and erred in law by denying an adjournment, refusing to admit new evidence after the hearing, misinterpreting section 42(12) of the Statutory Accident Benefits Schedule regarding the submission of a new Form 1, and failing to address arguments raised in his reply submissions.

The adjudicator dismissed the request, finding no violation of procedural fairness or errors of law that would have changed the outcome of the original decision.

The applicant sought retroactive attendant care benefits (ACBs), housekeeping and home maintenance benefits (HKHM), chiropractic services, and occupational therapy services following a 1997 motor vehicle accident that resulted in a catastrophic impairment.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove that the delay in submitting a retroactive Form 1 was due to urgency, impossibility, or impracticability, as required by the Morrissey decision.

The Tribunal also found no evidence that the ACB or HKHM expenses were actually incurred.

Furthermore, the requested chiropractic treatment and a one-year golf membership were deemed not reasonable and necessary based on the medical evidence.

Claims for a section 10 award, interest, and costs were also dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including an income replacement benefit (IRB) and a psychological assessment.

The respondent argued the IRB claim was barred by res judicata due to a prior Tribunal decision.

The Tribunal found the IRB claim was barred from February 4, 2020 onward, but not for the preceding period.

The Tribunal awarded an IRB from November 1 to December 2, 2019, because the respondent failed to provide a timely denial notice under s. 36(5)(b) of the Schedule.

The claim for the unapproved portion of a psychological assessment was dismissed as the applicant failed to prove it was reasonable and necessary.

An award under s. 10 of Regulation 664 was denied, but interest was granted on the overdue IRB.

The applicant, a pedestrian injured in a motor vehicle accident, sought medical and rehabilitation benefits under the Statutory Accident Benefits Schedule.

The respondent insurer denied a treatment plan for chiropractic services and a chronic pain assessment, arguing the $65,000 non-catastrophic policy limit was exhausted.

The Tribunal found the insurer's denial notices failed to comply with section 38(8) of the Schedule, as the limit was not fully exhausted at the time of the denials.

The Tribunal concluded both treatment plans were reasonable and necessary.

The insurer was ordered to pay the chiropractic treatment plan in full and the chronic pain assessment up to the remaining policy limit, plus interest.

The applicant's request for a special award was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including an income replacement benefit (IRB) and funding for assessments.

The insurer denied the benefits, arguing the applicant suffered predominantly minor injuries.

The Licence Appeal Tribunal found that the applicant suffered from chronic pain causing functional impairment, removing her from the Minor Injury Guideline and entitling her to $65,000 in medical and rehabilitation benefits.

The Tribunal awarded the IRB and the cost of a chronic pain assessment, but denied funding for a psychological assessment and a special award for unreasonable delay.

The applicant was struck by a backhoe while walking on the shoulder of a highway and sought statutory accident benefits.

The respondent insurer denied benefits, arguing the backhoe was a road-building machine and therefore exempt from the definition of an automobile.

The Tribunal applied the Adams test and the Highway Traffic Act definitions, finding that the backhoe was being operated outside the prescribed regulations for an off-road excavator.

Consequently, it was classified as a mobile equipment vehicle, which falls under the enlarged definition of an automobile.

The Tribunal concluded the backhoe was an automobile for the purposes of the Schedule.

The appellant insurer appealed a preliminary issue decision of the Licence Appeal Tribunal (LAT) regarding whether the respondent's slip and fall incident constituted an 'accident' under the Statutory Accident Benefits Schedule.

The LAT intervened to raise a preliminary issue regarding the Divisional Court's jurisdiction to hear an appeal from an interlocutory decision.

The Divisional Court dismissed the appeal for want of jurisdiction, confirming that appeals lie only from final decisions of the LAT to prevent fragmentation and delay.

The court also declined the parties' joint request to convert the appeal into an application for judicial review.

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

The insurer denied several treatment plans for physiotherapy, psychological services, and a chronic pain assessment, arguing the applicant's physical injuries fell within the Minor Injury Guideline (MIG) and the psychological treatment plans were excessive.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove that his pre-existing conditions or accident-related physical injuries precluded maximal recovery within the MIG.

The Tribunal preferred the insurer's expert evidence, which found no objective physical impairments and concluded the proposed psychological treatments and chronic pain assessment were not reasonable and necessary.

The applicant was catastrophically injured in a motor vehicle accident and sought statutory accident benefits, including custom orthotics and attendant care benefits (ACBs).

The respondent denied the orthotics and partially denied the ACBs.

The Tribunal found the orthotics were reasonable and necessary, noting the respondent's notice was proper but the medical evidence supported the claim.

Regarding ACBs, the Tribunal weighed competing Form 1 assessments, finding the applicant's assessor recommended excessive hours while the respondent's assessor failed to account for the applicant's psychological impairments and lack of motivation.

The Tribunal awarded ACBs at $3,121.57 per month.

Claims for a Regulation 664 award were dismissed, but interest was awarded on overdue payments.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming catastrophic impairment, income replacement benefits, and various medical and assessment costs.

The Licence Appeal Tribunal found that the applicant did not meet the threshold for catastrophic impairment under either Criterion 7 (55% whole person impairment) or Criterion 8 (marked impairment in three spheres of functioning), preferring the evidence of the respondent's assessors.

The Tribunal also dismissed the claims for income replacement benefits, an accounting report, catastrophic assessment costs, and social worker treatment, finding them either unsupported by evidence or exceeding allowable rates.

The applicant was precluded from disputing a treatment plan due to failing to attend an insurer examination.

However, the Tribunal granted the cost of assistive devices, finding them reasonable and necessary to help the applicant with housekeeping tasks.