Samia M. Alam

The appellant appealed a Licence Appeal Tribunal decision denying her income replacement benefits following a motor vehicle accident.

At the time of the accident, the appellant was an on-call agency worker who had not worked for six weeks.

The Divisional Court upheld the Tribunal's finding that the appellant was not 'employed' under s. 5(1)1(i) of the Statutory Accident Benefits Schedule, applying the interpretation from Arab v. Unica Insurance that employment requires the exchange of remuneration for services over a defined period.

The appeal was dismissed.

The applicant sought accident benefits following a motor vehicle accident, arguing his injuries warranted removal from the Minor Injury Guideline (MIG) due to a pre-existing torn meniscus, chronic pain, and psychological impairments.

The Licence Appeal Tribunal found the applicant failed to provide compelling medical evidence that his pre-existing knee injury was exacerbated by the accident or prevented his maximal medical recovery within the MIG.

The Tribunal also found insufficient evidence of chronic pain or psychological impairment.

As the MIG limits were exhausted, the claim for an orthopaedic assessment and an award for unreasonable delay were dismissed.

The respondent insurer requested reconsideration of a preliminary issue decision which found that it had requested Insurer's Examinations more often than reasonably necessary, meaning the applicant was not barred from proceeding with his income replacement benefit claim under s. 55 of the Schedule.

The Tribunal denied the reconsideration request, finding that the preliminary issue decision did not finally dispose of the appeal and therefore fell outside the scope of Rule 18.1.

Furthermore, the Tribunal found no procedural unfairness or error of law, as the insurer's requests for examinations were duplicative and unreasonable, and the applicant had no duty to explain his non-attendance at improperly requested examinations.

The appellant insurer appealed a Licence Appeal Tribunal (LAT) decision requiring it to fund the respondent's catastrophic impairment (CAT) assessment under s. 25(1)5 of the Statutory Accident Benefits Schedule.

The insurer argued it was only required to pay for an assessment completed before the insured submitted their application.

The Divisional Court upheld the LAT's decision, finding that the preparation of an application does not cease once the formal document is submitted, and the insurer must fund any assessment necessary for determining whether the impairment is catastrophic.

The applicant was injured in a 2015 motor vehicle accident and sought statutory accident benefits.

The insurer denied medical benefits, placing her in the Minor Injury Guideline (MIG), and denied a non-earner benefit.

The Tribunal found that the accident exacerbated the applicant's pre-existing conditions and caused chronic pain, removing her from the MIG.

The Tribunal ordered the insurer to pay for a psychological assessment with interest, finding it reasonable and necessary.

However, the claims for an in-home attendant care assessment and a non-earner benefit were dismissed, as the applicant failed to prove a complete inability to carry on a normal life.

The applicant was injured in a 2015 motor vehicle accident and sought accident benefits, which the respondent insurer denied on the basis that her injuries fell within the Minor Injury Guideline (MIG).

The applicant had significant pre-existing injuries from prior accidents.

The Tribunal found that the subject accident exacerbated her pre-existing conditions and caused chronic pain, removing her from the MIG.

The Tribunal ordered the respondent to pay for a psychological assessment, finding it reasonable and necessary, along with interest.

However, the Tribunal dismissed the claims for an In-Home Attendant Care assessment and a non-earner benefit, as the applicant failed to prove a complete inability to carry on a normal life.

The insurer requested a reconsideration of a decision awarding the insured funding for catastrophic impairment assessments.

The insurer argued the adjudicator erred in law by finding the assessments were not true rebuttal reports and were prepared for the purpose of a catastrophic application under s. 45 of the Schedule.

The adjudicator dismissed the reconsideration request, finding no errors of law that would materially affect the outcome.

The adjudicator maintained that the insured's right to be assessed for catastrophic impairment was not exhausted and that the timing of the application did not invalidate the funding request.

The insured's request for costs was also denied.

The applicant sought payment for the cost of an accounting report obtained to calculate his Income Replacement Benefit (IRB) following a motor vehicle accident.

The insurer denied the expense.

The Tribunal found that the accounting report was not reasonable and necessary because it was commissioned prematurely before any dispute over the IRB quantum existed, and the applicant's IRB calculation was straightforward, based on only two income sources.

The claim for the cost of the report and interest was dismissed.

The insurer brought an application to the Licence Appeal Tribunal seeking a determination that the insured was not catastrophically impaired and was not entitled to income replacement benefits, as well as seeking repayment of overpaid benefits.

The insured raised a preliminary issue arguing the Tribunal lacked jurisdiction because the insured had not disputed the insurer's determinations.

The Tribunal held that an insurer cannot bring an application to determine entitlement to benefits or catastrophic impairment where the insured has not disputed the insurer's denial, as no 'dispute' exists under s. 280 of the Insurance Act.

However, the Tribunal allowed the insurer's application for repayment of overpaid income replacement benefits to proceed.

The applicant was injured in a 2005 motor vehicle accident and sought a catastrophic impairment determination in 2015.

The insurer denied the designation based on its own assessments.

The applicant sought funding for his own catastrophic assessments, which the insurer denied on the basis that the 2010 amendments to the Schedule eliminated funding for rebuttal reports.

The Tribunal held that while the 2010 amendments apply prospectively and eliminated rebuttal report funding, the applicant's requested assessments were actually his first assessments, not true rebuttals.

Denying funding would rob the applicant of his substantive right to be assessed.

The Tribunal found the assessments partially reasonable and necessary, awarding $10,500.00.

The applicant, who was deemed catastrophically impaired following a 1999 motor vehicle accident, sought attendant care benefits and the cost of a home modification assessment.

The Tribunal found that the applicant did not have to 'incur' past attendant care benefits for them to be payable, as the 1996 Schedule applied.

The Tribunal awarded attendant care benefits for the period of October 2016 to July 2017 but dismissed the claims for other periods, finding the applicant did not require 24-7 supervision.

The Tribunal also dismissed the claim for the home modification assessment, finding the $2,000 cap under the 2010 Schedule applied.

The applicant sought a non-earner benefit following a motor vehicle accident.

The respondent denied the benefit, arguing the applicant's injuries were caused by a pre-existing psychiatric condition.

The Tribunal found that the applicant failed to prove on a balance of probabilities that the accident was a necessary cause of his impairments.

Furthermore, the applicant failed to meet the test for a non-earner benefit, as he did not demonstrate a complete inability to carry on a normal life as a result of and within 104 weeks of the accident.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought the cost of an accounting report prepared to calculate her Income Replacement Benefit (IRB).

The respondent denied the cost, arguing the calculation was straightforward and did not require a forensic accountant.

The Tribunal agreed with the respondent, finding that the applicant had only one source of income and the calculation merely required deducting short-term disability payments from the gross weekly income.

The Tribunal dismissed the claim, concluding the accounting report was not reasonable and necessary.

The applicant sought reconsideration of a decision dismissing his appeal for a non-earner benefit as being outside the two-year limitation period.

The applicant argued the adjudicator breached natural justice, committed errors of law, and failed to consider extending the time under s. 7 of the LAT Act.

The Vice-Chair dismissed the reconsideration request, finding no breach of natural justice or error of law.

Applying the four-factor test from Manuel, the Vice-Chair declined to exercise discretion to extend the limitation period, noting the applicant's failure to explain a five-month delay and lack of evidence regarding prejudice to the respondent.

The applicant was injured in a motor vehicle accident and sought accident benefits.

The respondent insurer raised preliminary issues arguing the applicant was statute-barred from proceeding with claims for non-earner, medical, and attendant care benefits due to a failure to notify the insurer of the circumstances giving rise to the claim within seven days, and a failure to submit an application for attendant care within 104 weeks.

The Tribunal found the applicant had a reasonable explanation for the delay in providing notice and allowed the claims for non-earner and medical benefits to proceed.

However, the Tribunal found the applicant was barred from proceeding with the attendant care claim because she failed to submit a Form-1 within the 104-week period.

The applicant, a pedestrian struck by a vehicle, sought statutory accident benefits including income replacement benefits (IRBs), physical rehabilitation therapy, and a physiatry assessment.

The Licence Appeal Tribunal found that the applicant failed to prove a substantial inability to perform the essential tasks of his pre-accident employment, noting he returned to work with increased hours shortly after the accident.

The Tribunal dismissed the claims for IRBs and physical therapy, but granted the cost of a physiatry assessment to determine if a herniated disc was accident-related.

Claims for interest, a special award, and adding a new issue were dismissed.

The respondent requested a reconsideration of an adjudicator's order directing that the issue of payment for an economic loss report proceed by way of a written hearing rather than a hybrid hearing.

The respondent argued that an oral hearing was necessary to cross-examine the applicant's employer, who was also the applicant's lawyer, regarding the decision to submit an accounting report instead of an OCF-2.

The Associate Chair dismissed the reconsideration request, finding that the adjudicator appropriately applied the Tribunal's rules promoting efficient and proportional resolution and did not violate the rules of procedural fairness.

The applicant brought a motion to exclude transcripts from a criminal proceeding from being admitted as evidence at an upcoming hearing for statutory accident benefits.

The applicant argued the prejudicial effect outweighed the probative value.

The adjudicator dismissed the motion as premature, holding that the admissibility of evidence should be determined by the hearing adjudicator who will have a full appreciation of the facts.

A second motion to extend the production deadline was granted on consent.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits.

During her in-person hearing, she suffered an anxiety attack and was unable to complete her cross-examination.

The respondent sought to complete the cross-examination, while the applicant argued her affidavit should be accepted without further questioning.

The Tribunal ordered the applicant to complete a limited, two-hour cross-examination via teleconference, with mandatory breaks, to balance the respondent's right to a fair hearing with the applicant's medical needs.

The applicant, a tow truck driver, was injured when a glass pane broke while he was helping an auto body shop owner open a garage bay door after delivering a broken-down taxi.

He applied for an income replacement benefit, which the insurer denied on the basis that the incident was not an 'accident' under the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal initially agreed.

On reconsideration, the Associate Chair upheld the decision, finding that while the purpose test was met, the causation test failed because the shop owner's request for help was an intervening act that broke the chain of causation between the use of the tow truck and the injury.