7 total
Attendant care benefits not deemed incurred as insurer's initial denial of accident was not unreasonable.
The applicant sought attendant care benefits under the "deemed incurred" provision of s. 3(8) of the Schedule, arguing the respondent unreasonably denied her claim by initially taking the position she was not involved in an "accident".
The Tribunal found that the respondent's initial denial was not unreasonable given the nuanced factual and legal issues surrounding the bicycle incident.
Furthermore, the applicant failed to prove that she did not incur the attendant care expenses because of the respondent's denial.
The application for attendant care benefits, interest, and an award was dismissed.
Reconsideration granted to correct typographical and calculation errors in attendant care and occupational therapy awards.
The respondent insurer requested reconsideration of a Tribunal decision awarding attendant care benefits and occupational therapy services to the applicant.
The respondent argued the Tribunal made errors of fact in its calculations and date ranges, and failed to specify that attendant care benefits are subject to proof of incurred expenses.
The Tribunal granted the reconsideration, correcting a typographical error regarding the end date for benefits, clarifying the full quantum of attendant care benefits subject to section 19(1)(a) of the Schedule, and correcting a calculation error regarding the occupational therapy services.
Bicycle crash caused by oil spill on road meets the definition of an automobile accident.
The applicant was injured when her bicycle slipped on an oily substance on the road.
She applied for statutory accident benefits, but the respondent insurer denied the claim on the basis that the incident did not meet the definition of an 'accident' under the Schedule.
The Tribunal found that the substance was likely deposited by an automobile, satisfying the purpose test, and that there was no intervening act breaking the chain of causation.
The Tribunal concluded that the applicant was involved in an accident and is entitled to proceed with her claim for benefits.
Venue transfer granted from Barrie to Toronto as the action had no connection to Barrie.
The defendant brought a motion to transfer a personal injury action arising from a motor vehicle collision from Barrie to Toronto.
The collision occurred in Toronto, and all parties, counsel, and potential witnesses, including medical professionals, were located in or near Toronto.
The plaintiff did not respond to the motion.
The court applied the factors under Rule 13.1.02 of the Rules of Civil Procedure and concluded that Toronto was a substantially better venue, as there was no connection between the action and Barrie.
The motion to transfer was granted.
Insurer did not waive right to deny coverage by requesting a section 42 medical examination.
The applicant brought a motion arguing that the insurer waived its right to deny she was an 'insured person' under a policy of insurance because the insurer requested she attend a section 42 medical examination and provide a disability certificate.
The arbitrator dismissed the motion, finding that an insurer has the right to request a section 42 examination as long as a claim for benefits continues, even if the claim has been denied.
The insurer's compliance with the legislative intent of the Schedule could not be construed as a waiver of its right to maintain its position that the applicant was not involved in an 'accident'.
Application for accident benefits dismissed; applicant failed to prove the alleged bus incident occurred.
The applicant sought statutory accident benefits, alleging she was injured when her arm was caught in the doors of a TTC bus and she was dragged.
The insurer denied the claim on the basis that no such accident occurred.
The arbitrator found the applicant's uncorroborated evidence to be vague, contradictory, and implausible.
The arbitrator concluded that the applicant failed to prove on a balance of probabilities that she was injured as a result of an 'accident' as defined in section 2(1) of the Schedule.
Motion to stay arbitration for a further psychiatric IME dismissed as not reasonably necessary.
The insurer brought a motion to stay the arbitration pending the applicant's attendance at a psychiatric insurer's medical examination (IME).
The applicant had previously attended a psychological IME arranged by the insurer, which concluded she suffered a complete inability to work due to depression but could not isolate the accident as the primary cause.
The insurer sought a further psychiatric IME to address causation.
The arbitrator dismissed the motion, finding the insurer had already been afforded a fair opportunity to evaluate the applicant's condition and failed to establish that the additional psychiatric assessment was reasonably necessary.
The applicant was awarded her legal expenses for the motion.
