Michael Smitiuch

The respondent insurer requested a reconsideration of a Tribunal decision that barred the applicant from proceeding with his application due to his failure to attend a properly scheduled s. 44 insurer's examination.

The respondent argued the Tribunal erred by failing to also address whether the applicant was barred for failing to dispute the denial of benefits within the two-year limitation period.

The Tribunal dismissed the request, finding that because the application was already barred under s. 55, the limitation period issue was moot and there was no error in declining to rule on it.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that found him statute-barred from pursuing a claim for occupational and physical therapy treatment plans and denied 10 other treatment plans.

The applicant argued the adjudicator made several errors of fact and law, including misinterpreting section 44 of the Schedule and failing to consider the severity of his concussion.

The adjudicator granted the reconsideration in part, correcting a factual error regarding the applicant's attendance at an insurer's examination and awarding a $200 form completion fee.

However, the adjudicator found no errors of law or fact that would change the outcome of the remaining dismissed claims.

The applicant sought medical and rehabilitation benefits following a motor vehicle accident.

The respondent denied the benefits on the basis that the applicant failed to attend scheduled insurer examinations (IEs) and that the treatment plans were not reasonable and necessary.

The Tribunal found that the applicant was statute-barred from proceeding with claims related to two issues because he failed to attend the required IEs without a reasonable explanation.

For the remaining treatment plans, the Tribunal concluded that the applicant failed to meet his evidentiary burden to establish that the proposed treatments were reasonable and necessary.

The application was dismissed, and claims for interest, costs, and an award were denied.

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

The insurer terminated her income replacement benefits on February 4, 1998.

The applicant applied for mediation on June 16, 1999, but the application was returned by FSCO due to deficiencies.

The applicant did not correct the deficiencies until August 15, 2000, well after the two-year limitation period had expired on February 4, 2000.

The arbitrator found that the applicant failed to commence a valid mediation within the prescribed time limit and could not retroactively cure the defect to revive the original application.

The arbitration was dismissed as time-barred.

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

The insurer made an offer of Loss of Earning Capacity Benefits (LECBs).

The applicant disputed the residual earning capacity (REC) component but did not expressly dispute the pre-accident earning capacity (PEC) component within 45 days.

The insurer brought a preliminary motion arguing the applicant was time-barred from arbitrating the PEC issue under s. 281(5) of the Insurance Act and s. 72(1) of the Schedule.

The arbitrator dismissed the motion, finding that under the Schedule, silence is deemed a rejection of both the REC and PEC components of the offer, and the limitation period had not expired.

The applicant was injured in a motor vehicle accident while driving an uninsured vehicle.

He applied for statutory accident benefits, including income replacement benefits, from the third-party insurer.

The insurer denied the claim under paragraph 30(1)(a) of the 1996 Statutory Accident Benefits Schedule, arguing the applicant knew or ought reasonably to have known the vehicle was uninsured.

The arbitrator found that the applicant could not reasonably have expected that either his bankrupt mother or her trustee in bankruptcy were paying for the insurance.

The arbitrator concluded that an ordinary, rational person in the applicant's situation ought reasonably to have known the vehicle was uninsured.

The claim for income replacement benefits and a special award was dismissed.