Moira Gracey

The applicant sought a $10,000 death benefit following the death of his daughter in a motor vehicle accident.

The central issue was whether the daughter was principally dependent on the applicant for financial support at the time of the accident.

The Tribunal found that the daughter had recently graduated, was working full-time, and was able to meet her basic financial needs using her own income.

Applying the Miller factors and considering forensic accounting evidence based on LICO and MBM methods, the Tribunal concluded the daughter was not principally dependent on the applicant.

The application for death benefits, interest, and an award was dismissed.

The applicant was injured in a serious motor vehicle accident and sought a determination that he sustained a catastrophic impairment under s. 3.1(1)(7) of the Statutory Accident Benefits Schedule.

The applicant submitted his whole person impairment (WPI) rating was 60%, while the respondent insurer argued it was 34%.

The adjudicator evaluated competing expert medical evidence regarding the applicant's orthopaedic, neurological, and psychological impairments.

After assessing the ratings under the AMA Guides, the adjudicator concluded the applicant's total WPI was 46%.

As this fell below the 55% threshold, the application was dismissed.

The appellant insurer appealed a Licence Appeal Tribunal (LAT) decision ordering it to pay for disputed chiropractic treatment plans once incurred.

The insurer argued the LAT lacked jurisdiction to order payment for expenses not yet incurred prior to the hearing.

The Divisional Court dismissed the appeal, holding that the LAT has broad remedial powers to determine entitlement to benefits, and requiring claimants to self-fund disputed treatments before accessing the LAT would defeat the consumer protection purpose of the Statutory Accident Benefits Schedule.

The applicant was injured in a motor vehicle accident and subsequently sustained a disc herniation while performing deadlifts with a personal trainer to strengthen his back.

The respondent denied income replacement benefits, arguing the disc herniation was a separate injury not caused by the accident.

The Tribunal applied the 'but for' test and found the disc herniation was causally connected to the accident, as the applicant was performing the exercises to rehabilitate his accident-related back injury.

The Tribunal concluded the applicant suffered a substantial inability to perform the essential tasks of his employment for the first 104 weeks, and a complete inability to engage in suitable employment thereafter.

The applicant was awarded ongoing income replacement benefits and the cost of a vocational assessment.

The appellant, who was four years old at the time of a 1996 motor vehicle accident, appealed an arbitrator's decision that section 20.1 of the SABS-1994 precluded him from claiming Loss of Earning Capacity Benefits (LECBs).

The appellant also challenged the constitutionality of section 20.1 under section 15(1) of the Charter, arguing it discriminated based on age.

The Director's Delegate upheld the arbitrator's decision, finding that section 20.1 unambiguously barred the claim because the appellant had not commenced a proceeding regarding educational disability benefits before March 1, 2006.

The Delegate also agreed that section 20.1 did not violate the Charter, as it did not create a distinction based on age but rather on the circumstances existing as of February 28, 2006.

Following an arbitration decision awarding the applicant ongoing income replacement benefits, the parties disputed the applicant's entitlement to interest on the overdue benefits and the expenses of the proceeding.

The arbitrator held that the applicant was entitled to interest on the overdue benefits, distinguishing the case law regarding medical and rehabilitation benefits.

The arbitrator also awarded the applicant her arbitration expenses, including legal fees and disbursements, based on her success in the proceeding and the insurer's conduct.

The insurer appealed an arbitration decision awarding the insured ongoing income replacement benefits beyond the 104-week mark.

The insurer argued the Arbitrator erred in law by qualifying a vocational evaluator as an expert witness and allowing her to opine on the insured's physical and psychological barriers to employment.

The Director's Delegate dismissed the appeal, finding no error in the Arbitrator's application of the Mohan criteria to qualify the vocational evaluator.

The Delegate held that a vocational expert may consider an applicant's symptoms in determining whether they can perform a job, which does not constitute rendering a medical opinion.

The applicant was injured in a motor vehicle accident and received statutory accident benefits until the insurer terminated her income replacement benefits.

The applicant claimed ongoing entitlement due to physical pain and severe psychological impairments, including panic disorder and claustrophobia, which prevented her from using elevators, public transit, or driving.

The arbitrator found the applicant to be a credible witness and accepted the evidence of her treating psychiatrist, family doctor, and a vocational assessor over the insurer's DAC assessors.

The arbitrator concluded that the applicant suffered a substantial inability to perform the essential tasks of her pre-accident employment for the first 104 weeks, and a complete inability to engage in any suitable employment thereafter.

The insurer was ordered to pay ongoing income replacement benefits.