Kimberley Tye

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

The respondent denied several treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's psychological injuries, including post-traumatic stress disorder and major depressive disorder, took him outside the MIG.

The Tribunal ordered the respondent to pay for the disputed psychological and physical treatment plans, as well as the cost of a psychological assessment, finding them reasonable and necessary.

The applicant's claim for a special award for unreasonably delayed payments was dismissed due to lack of evidence.

The appellant appealed a Small Claims Court decision dismissing her action against her insurer.

She sought repayment of deductibles and increased insurance premiums after the insurer found her at fault for two motor vehicle collisions under the Fault Determination Rules.

The Divisional Court dismissed the appeal, finding no palpable and overriding error in the trial judge's conclusion that the appellant failed to prove the insurer incorrectly applied the rules or adequately proved her damages.

The insurer appealed an arbitrator's decision allowing the insured to proceed to arbitration for income replacement benefits despite missing the two-year limitation period.

The Director's Delegate upheld the arbitrator's finding that the insurer's initial refusal of benefits was invalid because it failed to provide the insured with the required information to make an informed election between caregiver and income replacement benefits.

The insured also had a reasonable explanation for her delay in providing complete employment information.

The appeal was dismissed.

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

The insurer denied her claim for an income replacement benefit (IRB) and argued her subsequent application for arbitration was barred by the two-year limitation period.

The arbitrator found that the insurer failed to provide the applicant with the required information and forms to make an informed election between an IRB and a caregiver benefit.

As a result, the insurer's refusal was invalid, and the limitation period did not begin to run.

The arbitrator also held that while the applicant delayed in providing full employment information, she had a reasonable explanation, though benefits were suspended for a specific period due to the delay.

The applicant was injured in a motor vehicle accident and commenced a court action for accident benefits.

She later filed an Application for Arbitration at FSCO to determine catastrophic impairment and amended her court action to seek enhanced benefits.

The insurer argued the arbitration should be dismissed due to the outstanding court action.

The arbitrator held that the applicant could proceed to arbitration, provided she confirmed within thirty days that she sought leave to withdraw or discontinue her court action.

The arbitrator also permitted the applicant to add her other accident benefits claims to the arbitration.