Jane Conte

The 92-year-old appellant suffered catastrophic injuries in a motor vehicle accident and sought statutory accident benefits to modify her daughter's home, where she intended to move to receive 24-hour care.

The Licence Appeal Tribunal denied the claim, holding that the appellant first had to prove her existing condominium could not be modified.

On appeal, the Divisional Court found the LAT erred in law by imposing an unlegislated threshold and adopting an unduly narrow interpretation of 'existing home' under section 16 of the SABS.

The appeal was allowed, and the insurer was ordered to pay the claimed benefits immediately.

The moving party insurer sought an extension of time to file materials for leave to appeal and a stay of a Divisional Court order requiring it to pay $365,257 for home modifications under the Statutory Accident Benefits Schedule.

The responding party, a 92-year-old woman with catastrophic injuries, required the funds to modify her daughter's home for her care.

The Court of Appeal granted the unopposed extension of time but dismissed the stay motion.

Applying the RJR-MacDonald test, the court found the insurer failed to establish irreparable harm and that the balance of convenience strongly favoured the responding party given her advanced age, poor health, and immediate need for the benefits.

The 92-year-old appellant appealed a decision of the Licence Appeal Tribunal denying a disputed treatment plan.

The Divisional Court allowed the appeal and, citing exceptional circumstances, declined to remit the matter back to the Tribunal.

Instead, the court ordered the respondent to pay the disputed plan costs of $365,257.00 with immediate effect, noting that further delay would deny the appellant any benefit from the funds.

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

The Licence Appeal Tribunal found the applicant was entitled to treatment plans for physiotherapy and concussion therapy, as they were supported by contemporaneous medical evidence and treating practitioners' records, which outweighed the insurer's examination reports.

However, the Tribunal denied entitlement to occupational therapy and the balance of a psychological assessment due to insufficient evidence.

The applicant's request for an award for unreasonable delay under s. 10 of Reg. 664 was also dismissed, as the insurer reasonably relied on its assessors' opinions.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied her claims for home modifications to her daughter's home under the Statutory Accident Benefits Schedule.

The applicant argued the Tribunal breached procedural fairness by excluding her Personal Support Worker from testifying and by misapplying the evidentiary burden regarding a section 44 assessment.

She also argued the Tribunal erred in law by not interpreting 'existing home' to include her daughter's home.

The Tribunal dismissed the reconsideration request, finding no breach of procedural fairness in excluding a late-identified witness and concluding that the applicant failed to provide sufficient evidence that her current residence could not be modified.

The applicant, who sustained catastrophic injuries in a motor vehicle accident, sought $365,257.00 for home modifications to her daughter's house, arguing her current condominium could not be safely modified.

The respondent had approved $22,825.53 for modifications to her current unit.

The Tribunal dismissed the claim, finding the applicant failed to meet her burden of proving that her current residence could not be modified, as she provided no evidence that the condominium management company had formally denied the proposed modifications.

The Tribunal also dismissed the claim for the balance of a home modification assessment, capping it at the $2,000 statutory maximum, and denied claims for an award and interest.

The applicant requested a reconsideration of a prior Tribunal decision denying certain treatment plans and assessments, relying on over 180 pages of new medical evidence.

The Tribunal dismissed the request, finding that the applicant failed to establish that the new evidence could not have been obtained previously.

The Tribunal noted that a reconsideration is not an opportunity to correct shortcomings in submissions or evidence after a decision has been rendered.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's denial of treatment plans for physiotherapy, assistive devices, an attendant care assessment, and a driver evaluation.

The Licence Appeal Tribunal found that the applicant failed to provide objective medical evidence to establish that the physiotherapy, assistive devices, and attendant care assessment were reasonable and necessary, noting the respondent's unchallenged orthopaedic assessment.

However, the Tribunal granted the treatment plan for a driver evaluation, as it was specifically recommended by the applicant's psychological assessors and uncontradicted by the respondent.

The applicant was also awarded interest on the overdue payment.

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

The adjudicator found the applicant was removed from the Minor Injury Guideline (MIG) because a CT scan confirmed she sustained a fractured pisiform in her left wrist.

The adjudicator approved a $1,596.00 physiotherapy treatment plan as reasonable and necessary, awarding interest on the overdue amount.

However, the claim for a non-earner benefit was dismissed because the applicant failed to submit a completed disability certificate in a timely manner and did not establish a complete inability to carry on a normal life.

The applicant sought entitlement to statutory accident benefits for physiotherapy services following a 2018 motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove the proposed treatment plans were reasonable and necessary.

The Tribunal preferred the evidence of the respondent's insurer's examination assessors, who concluded that further facility-based physical treatment was unlikely to provide any additional therapeutic benefit for the applicant's left elbow injury and chronic pain.

As no benefits were payable, claims for interest and a section 10 award were also dismissed.

The applicant sought statutory accident benefits for chiropractic, physiotherapy, and massage therapy treatments following a motor vehicle accident.

The respondent denied the treatment plans, arguing they were not reasonable and necessary.

The Tribunal excluded the applicant's submissions beyond the 10-page limit set by a prior order.

On the merits, the Tribunal found that while the applicant's goal of pain reduction was reasonable, she failed to provide medical evidence demonstrating the specific treatment plans were necessary.

The Tribunal preferred the respondent's insurer's examinations, which concluded the treatments were not reasonable and necessary due to a lack of objective impairments.

The application was dismissed.

The applicant was struck by a vehicle while walking across a pedestrian crosswalk and sought statutory accident benefits.

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

The Tribunal found that the applicant suffered from chronic pain with a functional disability, removing him from the MIG.

The Tribunal ordered the respondent to pay for the disputed physiotherapy treatment plans and interest on the overdue payments.

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

The insurer denied certain medical benefits and requested a preliminary issue hearing to determine if the applicant was barred from proceeding with her application because she failed to attend section 44 insurer's examinations.

The Tribunal found that the applicant failed to attend multiple scheduled examinations without a reasonable explanation.

Consequently, the applicant was barred from proceeding with her application under section 55 of the Schedule.

The defendant insurer sought leave to appeal a motion judge's refusal to grant summary judgment in an action arising from a motor vehicle accident allegedly caused by an unidentified driver.

The motion judge had concluded that credibility issues prevented summary judgment and that a mini-trial was inappropriate.

The Divisional Court dismissed the motion for leave to appeal, finding no error in principle, no conflicting case law, and no reason to doubt the correctness of the motion judge's discretionary decision.

Following a jury verdict in a statutory accident benefits action, the court determined post‑trial issues concerning transportation expense deductibles, interest on overdue benefits, and costs.

The insurer argued that the statutory 50‑kilometre deductible applied to transportation expenses and sought to call additional evidence, but the court refused and held the deductible did not apply because the insurer had waived it and the insured was unable to drive during the relevant period.

On the issue of interest under the Statutory Accident Benefits Schedule, the court applied appellate authority holding that interest on overdue benefits runs from the date the benefit first became overdue, even if the insurer did not know the correct amount at the time.

The court also considered competing offers to settle and concluded that the plaintiff was the successful party overall.

Costs were awarded to the plaintiff on a partial indemnity basis.

The appellant insurer appealed an arbitration order requiring it to pay attendant care benefits for services provided by an aide or attendant concurrently with co-payment fees charged by a long-term care facility under s. 16(2) of the SABS-1996.

The Director's Delegate dismissed the appeal, finding that the word 'or' in s. 16(2) should be read inclusively, allowing the claimant to receive both types of benefits simultaneously.

The matter was remitted to arbitration for determination of the remaining disputes regarding the claimant's attendant care claim.

The insured was injured in a motor vehicle accident and was determined by a Designated Assessment Centre to have suffered a catastrophic impairment.

The insurer disputed this finding, initiated mediation, and after mediation failed, commenced a court action for a declaration that the insured was not catastrophically impaired.

The motion judge struck the insurer's claim, finding that the Insurance Act provides a complete code for dispute resolution that does not permit an insurer to initiate a court proceeding.

The Court of Appeal dismissed the insurer's appeal, confirming that the statutory scheme requires the insured to initiate court or arbitration proceedings to enforce a disputed catastrophic impairment finding, while protecting the insurer by allowing it to pay only its last settlement offer pending resolution.