5 total
Res judicata does not bar new LAT application for attendant care benefits based on updated assessments.
The applicant sought attendant care benefits for a period beginning August 1, 2016.
The respondent argued the claim was barred by res judicata due to a prior FSCO arbitration decision that found no benefits were payable beyond December 31, 2013.
The Tribunal held that res judicata did not apply because the current claim was for a new period, based on new Form 1 assessments not considered by the FSCO arbitrator, and the Schedule permits ongoing applications for attendant care benefits when circumstances change.
The application was permitted to proceed to a hearing on the merits.
Spilling hot coffee at a drive-through constitutes an accident under the Statutory Accident Benefits Schedule.
The defendant insurer brought a motion for summary judgment to dismiss the plaintiff's claim for statutory accident benefits.
The plaintiff suffered severe burns when she spilled hot coffee on her lap while receiving it at a drive-through window in her vehicle.
The court applied the purpose and causation tests, finding that using a drive-through is an ordinary use of a vehicle, and that the vehicle's use was a direct cause of the injuries because the plaintiff was seated and restrained by a seatbelt, preventing evasive action.
The defendant's motion was dismissed, and the court concluded the incident met the definition of an accident under the Statutory Accident Benefits Schedule.
Arbitration application dismissed as statute-barred for failing to commence proceedings within the two-year limitation period.
The applicant was involved in a motor vehicle accident and applied for a non-earner benefit, which the insurer denied.
The applicant applied for arbitration more than two years after the denial and more than 90 days after the mediator's report.
The arbitrator held that the insurer's denial was clear and unequivocal, and the applicant was barred from proceeding to arbitration due to the expiry of the limitation period under the Insurance Act and the Statutory Accident Benefits Schedule.
Expenses thrown away due to adjournment ordered payable after the conclusion of the arbitration hearing.
The Applicant was previously granted an adjournment of the arbitration hearing, with an order to pay the Insurer's costs thrown away.
A dispute arose regarding whether the costs should be assessed and paid immediately or after the conclusion of the arbitration.
The Arbitrator clarified the previous order pursuant to Rule 65.6 of the Dispute Resolution Practice Code, substituting the term 'expenses' for 'costs' and ordering that the expenses thrown away are payable by the Applicant regardless of the arbitration's outcome, but are to be assessed and paid after the conclusion of the arbitration hearing.
Adjournment granted on the eve of hearing to obtain critical medical report; costs thrown away ordered.
The Applicant, injured in a 2004 motor vehicle accident, sought an adjournment of his statutory accident benefits arbitration hearing on the eve of the hearing to obtain a medical report from his treating pain specialist.
The Insurer opposed the adjournment, noting it was the Applicant's third request and the Insurer was ready to proceed.
The Arbitrator granted the adjournment, finding that the Applicant had not appreciated the implications of his treatment and had not informed his counsel, and that the evidence was likely critical.
The adjournment was granted peremptory to the Applicant, who was ordered to pay costs thrown away.
