Gerald S. George

The respondent insurer requested reconsideration of a preliminary issue decision which found that it had requested Insurer's Examinations more often than reasonably necessary, meaning the applicant was not barred from proceeding with his income replacement benefit claim under s. 55 of the Schedule.

The Tribunal denied the reconsideration request, finding that the preliminary issue decision did not finally dispose of the appeal and therefore fell outside the scope of Rule 18.1.

Furthermore, the Tribunal found no procedural unfairness or error of law, as the insurer's requests for examinations were duplicative and unreasonable, and the applicant had no duty to explain his non-attendance at improperly requested examinations.

The applicant requested a reconsideration of a preliminary issue decision that found his claim for post-104 income replacement benefits (IRBs) was statute-barred due to a pre-emptive denial by the insurer.

The adjudicator granted the reconsideration, applying the recent Court of Appeal decision in Tomec v. Economical.

The adjudicator found that the limitation period is tied to the accrual of the cause of action and subject to discoverability.

Because the applicant was working full-time and not eligible for IRBs at the time of the pre-emptive denial, the cause of action had not yet accrued.

The preliminary decision was reversed, allowing the applicant to proceed with his claim.

The applicants, two brothers who suffered severe burns in a garage explosion while replacing a vehicle's fuel pump, sought reconsideration of a decision finding their injuries did not result from an 'accident' under the Statutory Accident Benefits Schedule.

They argued the adjudicator breached procedural fairness by failing to analyze the Causation Test after finding the Purpose Test was not met, and alleged errors of fact and law regarding the vehicle's operability.

The Licence Appeal Tribunal dismissed the reconsideration request, holding there is no requirement to consider the Causation Test if the Purpose Test fails, and finding no errors of fact or law that would have led to a different conclusion.

The applicant sought post-104-week income replacement benefits (IRBs) following a 2013 motor vehicle accident.

The respondent insurer denied the claim, arguing the applicant failed to dispute its initial 2013 denial within the two-year limitation period.

The applicant argued the 2013 denial was not clear and unequivocal because it used the word 'eligible' rather than 'entitled' and he had not intended to apply for IRBs at that time.

The Tribunal found the 2013 denial was valid, clear, and unequivocal, triggering the limitation period.

The Tribunal also declined to extend the limitation period under section 7 of the LAT Act due to the significant four-year delay and lack of bona fide intention to appeal within the time limit.

The application was dismissed as statute-barred.

An Ontario resident insured by the respondent was injured in a car accident in North Carolina caused by a driver insured by the appellant.

The respondent paid statutory accident benefits and demanded arbitration for loss transfer under s. 275 of the Insurance Act.

The appellant refused, arguing the scheme did not apply because the accident occurred outside Canada and the policy was issued in North Carolina.

The Court of Appeal dismissed the appeal, holding that because the appellant is an Ontario insurer, it is required to arbitrate the claim.

The applicant sought an assessment of legal and agent's fees following the settlement of a dispute over statutory accident benefits.

The insurer disputed the amount of time claimed by the applicant's legal assistants and lawyer.

The arbitrator adopted a global approach to assessing the fees, finding that the time claimed was excessive for the single issue involved.

The insurer was ordered to pay $1,819 in fees and GST.

The applicant was injured in a motor vehicle accident and received statutory accident benefits from the insurer until they were terminated.

The applicant applied for arbitration more than two years after the insurer's refusal to pay further benefits.

The arbitrator held that the application was barred by the two-year limitation period in section 281(5) of the Insurance Act, following a binding decision of the Director's Delegate, despite the applicant's arguments that the limitation period should be interpreted as a rolling one.

The applicant was awarded expenses for raising worthwhile arguments.

The appellant was injured in a motor vehicle accident and received weekly income benefits until the insurer terminated them, claiming he was no longer substantially unable to perform the essential tasks of his employment.

The appellant sought additional benefits, which were denied at arbitration.

On appeal, the Director's Delegate found no error in the arbitrator's assessment of the medical evidence, which included opinions from two physicians that the appellant was capable of returning to work.

The appeal was dismissed and the arbitration decision confirmed.