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Applicant entitled to post-104 week IRBs as proposed alternative jobs lacked comparable status and income.
The applicant was injured in a 2018 motor vehicle accident and sought ongoing income replacement benefits (IRBs) beyond the 104-week mark, along with medical benefits, an award, and costs.
The respondent denied the IRBs, arguing the applicant could work part-time in alternative roles.
The Tribunal found that the applicant met the post-104 week test for IRBs because the alternative employment proposed by the respondent offered significantly less income and status than her pre-accident work, and her psychological impairments limited her to working only 6 to 10 hours per week.
However, the Tribunal dismissed the claims for metabolic testing, neuromonitoring, and physiotherapy due to insufficient evidence regarding their necessity and reasonable costs.
The claims for a special award and costs were also dismissed.
Application for accident benefits dismissed as proposed treatment plans were not reasonable and necessary.
The applicant was injured in a motor vehicle accident and sought statutory accident benefits for a gym membership, personal training, physiotherapy, and massage therapy.
The respondent insurer partially approved the gym membership and personal training but denied the remainder, relying on an insurer's examination which found no objective evidence of ongoing permanent impairment.
The Tribunal agreed with the insurer's expert that the applicant had reached maximal medical improvement and that further facility-based therapies were not reasonable and necessary.
The application was dismissed, and claims for interest and a section 10 award were denied.
Harmonized sales tax on attendant care services is included within the statutory maximum limits for attendant care benefits under the pre-2019 SABS.
This appeal addressed whether Harmonized Sales Tax (HST) on attendant care benefits was included within the statutory maximums under the Statutory Accident Benefits Schedule (SABS) for accidents occurring before June 3, 2019.
The appellant (insured) argued that HST should be payable in addition to the maximums, while the respondent (insurer) contended it was part of the maximums.
The Court of Appeal upheld the Divisional Court's decision, finding that the relevant SABS provisions were unambiguous and that HST constituted a "reasonable and necessary expense" included within the $6,000 monthly and $1,000,000 total maximums for attendant care benefits.
The court emphasized that the same words in a statute must be given the same meaning throughout.
HST on attendant care services is included within the maximum limits under the pre-2019 SABS.
The insurer appealed a Licence Appeal Tribunal decision regarding attendant care benefits for a catastrophically injured insured.
The issue was whether, for accidents occurring before June 3, 2019, the Harmonized Sales Tax (HST) payable for attendant care services was included within the $6,000 monthly and $1,000,000 total maximum limits under section 19 of the Statutory Accident Benefits Schedule, or payable in addition.
The Divisional Court held that the language of section 19 is unambiguous and that HST must be paid as part of the attendant care benefit, subject to the maximum limits.
The appeal was allowed and the LAT decision was set aside.
Reconsideration dismissed; HST on attendant care services is payable outside the statutory benefit limits.
The respondent insurer requested a reconsideration of a Tribunal decision which found that HST claimed with respect to attendant care services was to be paid outside of the attendant care benefit limits prescribed by the Statutory Accident Benefits Schedule.
The insurer argued the Tribunal made multiple errors of law, including finding that HST is not an 'expense' subject to the limits, relying on non-binding FSCO Bulletins, and misapprehending expert evidence.
The Tribunal dismissed the request for reconsideration, finding no significant errors of law that would warrant a different outcome.
The Tribunal affirmed that interpreting HST as a tax rather than a 'reasonable and necessary expense' is consistent with a plain reading of the Schedule.
HST on attendant care services must be paid outside the statutory accident benefit limits.
The applicant, who was catastrophically impaired in a motor vehicle accident, sought a determination that the HST charged on attendant care services should be paid outside the statutory monthly limit of $6,000.
The respondent insurer had been paying the HST out of the benefit limit.
The Tribunal found that HST is a tax, not a 'reasonable and necessary expense' under section 19 of the Schedule, and therefore must be paid outside of the attendant care benefit limit.
The Tribunal dismissed the applicant's claim for a special award under O. Reg. 664, finding that the insurer's interpretation of the Schedule, while incorrect, was not unreasonable given the lack of explicit guidance on the issue.
