5 total
Insurer's failure to provide compliant denial notices results in payment of non-earner benefits.
The applicant sought non-earner benefits and an award under Regulation 664 following a motor vehicle accident.
The Tribunal found that the respondent insurer failed to provide compliant notices under section 36(4) of the Statutory Accident Benefits Schedule, as its denial letters either failed to make a determination on entitlement or failed to provide medical reasons.
Consequently, under section 36(6), the applicant was entitled to non-earner benefits from the date the disability certificate was submitted until the 104-week mark, plus interest.
The claim for a special award was dismissed as the applicant did not establish substantive entitlement or unreasonable delay.
Application for accident benefits dismissed as statute-barred due to unexplained five-month delay in notifying insurer.
The applicant was involved in a motor vehicle accident and sought statutory accident benefits.
She failed to notify the insurer of her intention to claim benefits within the required seven-day period, waiting over five months to submit an application.
The Licence Appeal Tribunal found that the applicant failed to provide a reasonable explanation for the delay, rejecting her arguments that she was unaware she could claim benefits and that her health conditions prevented timely notification.
Consequently, the applicant was found to be statute-barred from proceeding with her application.
Reconsideration dismissed; no error of law or fact in finding slip and fall was not an accident.
The respondent requested a reconsideration of a preliminary issue decision which found she was not involved in an 'accident' when she slipped and fell on ice after exiting a vehicle.
She alleged errors of law and fact, including the Tribunal's failure to consider section 32 of the Schedule, its reliance on binding Divisional Court case law over non-binding Tribunal decisions, and a perceived conflict of interest based on an allegation that the adjudicator and her counsel attended the same law school.
The Tribunal dismissed the request, finding no errors of law or fact, and noting that the bias allegation was factually inaccurate and insufficient to overcome the presumption of impartiality.
Slip and fall on ice after exiting vehicle is not an accident under the Schedule.
The respondent sought statutory accident benefits after slipping and falling on ice while exiting a vehicle.
The insurer denied benefits and brought a preliminary issue motion to determine if the incident met the definition of an 'accident' under s. 3(1) of the Schedule.
The Tribunal applied the purpose and causation tests, finding that while exiting a vehicle met the purpose test, the presence of ice was an intervening act that broke the chain of causation.
The Tribunal concluded the incident was not an accident and dismissed the application.
Motion by applicant's counsel to withdraw from the record granted due to breakdown in solicitor-client relationship.
The applicant was injured in a motor vehicle accident and applied for statutory accident benefits.
Her legal representatives brought a motion to be removed from the record due to a breakdown in the solicitor-client relationship, citing the applicant's failure to respond to communications and attend a pre-hearing.
The arbitrator granted the motion, finding that the representatives had complied with the Dispute Resolution Practice Code and that the breakdown in the relationship made it impossible to obtain the applicant's consent.
