Marc E. Smith

The applicant sought catastrophic impairment benefits following a motor vehicle accident.

The insurer requested that the applicant attend several in-person section 44 insurer examinations to determine catastrophic impairment and ongoing income replacement benefit entitlement.

The applicant refused to attend, citing privacy concerns and arguing the notices were deficient.

The Tribunal found that the insurer's notices complied with the Schedule and that the requested examinations were reasonably necessary.

Consequently, the Tribunal held that the applicant was statute-barred under section 55 of the Schedule from proceeding with the application.

The applicant, who sustained a catastrophic impairment in a motor vehicle accident, sought weekly caregiver benefits for his two children.

The insurer denied the claim on the basis that the applicant was not the primary caregiver at the time of the accident.

The Tribunal applied a qualitative and quantitative analysis and found that the applicant's wife was the primary caregiver, as she performed more caregiving tasks and took on the more significant responsibilities regarding the children's medical and behavioural needs.

The application for caregiver benefits and associated interest was dismissed.

The respondent insurance company requested a reconsideration of the Tribunal's decision to proceed with a hybrid/teleconference hearing rather than an in-person hearing.

The Executive Chair dismissed the request, finding that the adjudicator acted within his jurisdiction and did not violate the rules of natural justice or procedural fairness in determining the hearing format.