Sandi Smith

The applicant sought statutory accident benefits following a 2007 motor vehicle accident.

The insurer denied ongoing attendant care and housekeeping benefits in September 2018.

The applicant applied to the Tribunal in March 2022, beyond the two-year limitation period (even accounting for the O. Reg. 73/20 suspension).

The Tribunal found the 2018 denial was clear and unequivocal, meaning the application was filed late.

However, applying the Manuel factors, the Tribunal exercised its discretion under section 7 of the LAT Act to extend the limitation period, noting the appeal had merit due to the applicant's catastrophic impairment and the insurer suffered no prejudice as it had continued to conduct assessments during the delay.

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

The insurer raised a preliminary issue that the claim was statute-barred because the applicant failed to submit a Disability Certificate (OCF-3) within 104 weeks of the accident and failed to dispute the denial within the two-year limitation period.

The Tribunal found that the applicant did not submit a qualifying OCF-3 until over four years after the accident and failed to appeal the denial within two years.

The Tribunal declined to extend the limitation period under s. 7 of the LAT Act, finding the delay unreasonable and prejudicial to the insurer.

The claim for non-earner benefits was dismissed as statute-barred.

The applicant filed a request for reconsideration of an adjudicator's decision that found the applicant was limitation-barred from obtaining Income Replacement Benefits.

The Associate Chair dismissed the request for reconsideration, noting that under the amended Rule 18.1 of the Common Rules of Practice and Procedure, requests for reconsideration are only accepted for decisions that finally dispose of an appeal.

Because the issue of catastrophic determination remained scheduled for a future hearing, the underlying decision did not finally dispose of the appeal.

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

Both parties brought motions for the production of documents.

The insurer sought an order compelling a non-party, the Ministry of Community and Social Services, to produce the applicant's Ontario Disability Support Program (ODSP) file.

The applicant did not oppose this motion, and the arbitrator granted it, finding the file relevant to the applicant's ongoing health and disability status.

The applicant sought an order compelling the insurer to produce its adjuster's log notes relating to catastrophic impairment from 2006 to 2016.

The arbitrator granted the motion in part, ordering production of the notes for a reasonable period of one year prior to the receipt of the first catastrophic impairment assessments, rather than back to the date of the accident.

The insured was injured in a motor vehicle accident and received income replacement benefits until the insurer terminated them following insurer examinations.

The insurer sent multiple Explanations of Benefits (OCF-9s) advising of the termination and the dispute resolution process.

The insured applied for arbitration after the 90-day limitation period following mediation had expired, arguing the refusals were not clear and unequivocal.

The Director's Delegate allowed the insurer's appeal, finding that the OCF-9s, both individually and in totality, met the requirements for a valid refusal by clearly denying benefits and explaining the dispute resolution process.

The insured's application for arbitration was dismissed as statute-barred.

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

After failing to participate in the arbitration process and losing contact with his counsel, who was subsequently removed from the record, the insurer brought a motion to dismiss the application.

The arbitrator found that the applicant had abandoned his claim, rendering it frivolous and vexatious under section 68 of the Dispute Resolution Practice Code.

The application for arbitration was dismissed without costs.

The insurer brought a preliminary issue motion arguing that the applicant's claims for attendant care and medical benefits were time-barred.

The applicant had requested the addition of these issues to an existing arbitration by letter within 90 days of the mediator's report.

The arbitrator held that the longstanding practice of adding issues by letter, rather than requiring a new formal application, was permitted under the Dispute Resolution Practice Code and created a legitimate expectation.

With the exception of one medical benefit claim that was not mediated within two years of denial, the claims were found to be timely and were added to the arbitration.

The Applicant sought arbitration for weekly income benefits following a 1993 motor vehicle accident.

The Insurer raised a limitation defence, arguing the Applicant failed to commence mediation within two years of the 1996 termination of benefits.

At a pre-hearing conference, the Arbitrator ordered that the limitation issue be severed and heard as a preliminary issue, as it could dispose of the entire arbitration.

The Arbitrator also dismissed the Insurer's request to order the Applicant to obtain and produce various third-party files at this stage, finding it premature and contrary to the judicial economy of a bifurcated hearing.

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

The insurer denied the claim for treatment expenses.

The applicant applied for mediation and subsequently arbitration.

The insurer raised a preliminary issue that the application for arbitration was filed beyond the two-year limitation period under section 281(5) of the Insurance Act.

The arbitrator found that a letter from the applicant's paralegal representative constituted an admission of actual notice of the insurer's refusal to pay benefits.

As the applicant failed to commence mediation within two years of this refusal, the application for arbitration was time-barred.

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

During an arbitration hearing on entitlement to income replacement benefits, the hearing arbitrator adjourned the matter and purportedly severed the issue of quantum to be heard by a different arbitrator.

At the subsequent hearing on quantum, the new arbitrator raised the issue of jurisdiction.

The arbitrator held that the issue of quantum was a necessary sub-issue of entitlement and could not be severed without statutory authority.

As the original hearing arbitrator remained seised of the issue, the separate hearing on quantum was declared a nullity.