Marinus Lamers

The applicant sought attendant care and housekeeping benefits following a 2009 motor vehicle accident.

The respondent denied the benefits in October 2011.

The applicant later sought the benefits at a higher tier after being determined catastrophically impaired, arguing the limitation period did not apply or was negated by subsequent payments.

The Tribunal found the 2011 denial letter was clear and unequivocal, triggering the two-year limitation period under the Insurance Act.

The Tribunal held that discoverability does not apply to the statutory accident benefits scheme and that a subsequent catastrophic impairment determination does not trigger a new limitation period.

The application was dismissed as statute-barred.

The applicant requested that a motion to exclude the respondent's reply submissions in a preliminary issue hearing be heard by telephone conference instead of in writing.

The Tribunal dismissed the request, finding that the motion involved legal rather than factual disputes, which are efficiently handled in writing.

The Tribunal also found that holding the motion separately by telephone would be less efficient and that the applicant would not suffer prejudice from a written hearing.

The applicant brought a motion seeking production of all documentation relating to the stoppage, acceptance, payment, and subsequent denial of attendant care, housekeeping, and home maintenance benefits, and an order that the preliminary issue hearing be conducted orally rather than in writing.

The adjudicator dismissed the motion, finding that an oral hearing was not required as the evidence was documentary and the legal arguments were best presented in writing.

The adjudicator also declined to reconsider a previous order denying the broad production request, noting that equitable remedies like estoppel and waiver are beyond the Tribunal's jurisdiction and discoverability does not apply to statutory accident benefits.

The applicant sought to withdraw her application for arbitration of accident benefits to combine it with a related court action.

The insurer consented to the withdrawal but sought reimbursement of its $2,000 filing fee, arguing the arbitration was an abuse of process since the applicant knew earlier that a court action was necessary.

The arbitrator found the applicant's conduct was not an abuse of process but was unwise and wasteful, amounting to frivolous or vexatious conduct under section 282(11.2) of the Insurance Act.

The applicant was permitted to withdraw but ordered to reimburse the insurer's $2,000 filing fee within 30 days of resolving the court action.