6 total
Application for accident benefits barred due to unexcused delay in notifying insurer of injuries.
The applicant was involved in a motor vehicle accident and sought statutory accident benefits.
The insurer denied the benefits, arguing the applicant failed to notify them of his intention to apply within the prescribed seven-day period under section 32(1) of the Schedule.
The applicant argued he reported the accident the next day and the insurer failed to provide the necessary forms.
The Tribunal found the applicant did not report any injuries or intention to seek benefits until nearly two years later.
The Tribunal concluded the applicant's explanation for the delay was not credible or worthy of belief, and therefore he was barred from proceeding with his application.
Applicant's injuries fall within Minor Injury Guideline; applicant ordered to pay costs for relitigating settled claims.
The applicant sought statutory accident benefits following a 2016 motor vehicle accident.
The respondent denied the claims, arguing the injuries fell within the Minor Injury Guideline (MIG).
The Tribunal found that the applicant failed to provide compelling evidence of a pre-existing condition that would prevent maximal recovery within the MIG limits.
The Tribunal ordered the respondent to pay the disputed $116.40 treatment plan balance, provided funds remained within the MIG limit, along with applicable interest.
The Tribunal also ordered the applicant to pay $500 in costs for unreasonable conduct, as the applicant's submissions improperly focused on a separate, fully settled 2017 accident.
Insurer awarded $31,661.90 in arbitration expenses after applicant failed to attend preliminary issue hearing.
The insurer sought its expenses following the dismissal of the applicant's arbitration claim for statutory accident benefits.
The applicant had failed to attend the preliminary issue hearing, which was convened to determine if the applicant was involved in a staged accident.
The arbitrator assessed the insurer's expenses, considering the complexity of the matter, which included a Wagg application to obtain Crown evidence from a related homicide investigation.
The arbitrator awarded the insurer $31,661.90 in legal fees, disbursements, and HST, after deducting a portion of the investigative expenses and the filing fee.
Applicant precluded from arbitration for failing to attend insurer's psychiatric examination.
The Applicant was injured in a motor vehicle accident and sought statutory accident benefits.
The Insurer requested that the Applicant attend an independent medical examination (IME) with a psychiatrist to assess his treatment plan, Minor Injury Guideline applicability, and entitlement to non-earner benefits.
The Applicant failed to attend, arguing that the IME should be conducted by a psychologist, not a psychiatrist.
The Arbitrator found that there was a reasonable nexus between the Insurer's choice of a psychiatrist and the Applicant's injuries, given the overlap in specialties and the Applicant's pre- and post-accident psychiatric issues.
The Applicant is precluded from moving to an Arbitration Hearing until he complies with the scheduled IME.
Accident benefits claims dismissed and expenses awarded to insurer after applicant failed to attend arbitration hearing.
The applicant sought statutory accident benefits following a motor vehicle accident.
After his legal representatives removed themselves from the record, the applicant failed to participate in a pre-hearing discussion and did not attend the scheduled arbitration hearing.
The arbitrator proceeded in the applicant's absence and dismissed the claims, as the applicant failed to present evidence to prove his entitlement.
The insurer was awarded $2,500 in expenses due to its complete success and the applicant's apparent abandonment of the proceeding.
Tort insurer cannot add itself as defendant instead of statutory third party.
An automobile insurer sought to intervene in a tort action as an added defendant under Rule 13.01 of the Rules of Civil Procedure in order to allege that the accident was staged and to assert a crossclaim against its insured.
The court held that it was not an appropriate use of Rule 13.01 for a tort insurer to add itself as a party defendant where statutory third party status under s. 258 of the Insurance Act was available.
As a statutory third party, the insurer could still defend the claim on the basis that the accident did not occur or was staged and could obtain discovery of its insured where adversity existed.
Issues between insurer and insured, including indemnity claims, were more properly addressed in separate proceedings.
The request to intervene as a defendant was refused, but the insurer was granted alternate relief to be added as a statutory third party.
