Statutory Accident Benefits Schedule matters (SABS) - ODC

The appellant appealed a Licence Appeal Tribunal (LAT) decision denying certain statutory accident benefits.

The Divisional Court found that the LAT adjudicator denied the appellant procedural fairness by unilaterally separating her hearing from her mother's, drastically reducing the scheduled hearing time without adequate notice, and refusing to allow cross-examination of the respondent's occupational therapist whose report had been materially altered by an assessment company.

The appeal was allowed, and the matter was remitted for a new hearing before a different adjudicator.

The appellant appealed a Licence Appeal Tribunal (LAT) decision dismissing her application for catastrophic impairment benefits because she failed to attend an insurer's psychiatric examination.

The appellant argued the LAT erred in law by barring her entire application and breached procedural fairness.

The Divisional Court dismissed the appeal, finding no error of law as the appellant's counsel had confirmed to the LAT that non-CAT benefits were exhausted, making the CAT designation a prerequisite.

The Court also found no breach of procedural fairness, as the appellant had ample opportunity to make submissions and attend rescheduled examinations.

The appellant appealed a Licence Appeal Tribunal decision that dismissed her application for statutory accident benefits due to her failure to provide a reasonable explanation for notifying the insurer outside the prescribed timelines.

The Divisional Court found that the Tribunal erred in law by failing to consider the appellant's argument that section 32(10) of the Statutory Accident Benefits Schedule provides the only consequence for late delivery of an application without a reasonable excuse, and by incorrectly concluding this was a new issue on reconsideration.

The appeal was allowed and the matter remitted to the Tribunal for a new hearing.

The appellant appealed a Licence Appeal Tribunal decision denying his claim for income replacement benefits on the basis that it was barred by the two-year limitation period.

The appellant had returned to work immediately after the accident but stopped working 16 months later, at which point he applied for benefits.

The Divisional Court allowed the appeal, finding that the adjudicator erred in law by failing to apply the doctrine of discoverability.

Following Tomec, the court held that the limitation period could not begin to run before the appellant became eligible for the benefits.

The appellant appealed a decision of the Licence Appeal Tribunal denying her claims for various statutory accident benefits following a motor vehicle accident.

The appellant argued the insurer failed to properly manage her request for a catastrophic impairment designation.

The Divisional Court dismissed the appeal, finding the adjudicator correctly concluded that the issue of catastrophic impairment was not properly before the tribunal because the appellant had not initiated a claim or provided an evidentiary basis for it.

The court found no errors of law in the adjudicator's decision.

The appellant was denied income replacement benefits after her insurer discovered she misrepresented her address to obtain a lower premium.

The insurer subsequently charged her a retroactive premium increase.

The Licence Appeal Tribunal upheld the denial and refused to apply section 131 of the Insurance Act, which excuses non-compliance based on an insurer's conduct, finding it lacked equitable jurisdiction.

On appeal, the Divisional Court held the LAT erred in law by conflating equitable remedies with statutory relief under section 131, which the LAT has jurisdiction to apply.

The appeal was allowed and the matter remitted for a new hearing.

The appellant insurer appealed a Licence Appeal Tribunal decision regarding the calculation of Income Replacement Benefits (IRBs) for a self-employed lawyer injured in a motor vehicle accident.

The Divisional Court found that the LAT adjudicator erred in law by applying section 4(2)3 of the Statutory Accident Benefits Schedule, which applies to employed persons, rather than section 4(3), which applies to self-employed persons.

The appeal was granted, the LAT decision was set aside, and the matter was remitted for a fresh hearing.

The insurer appealed a Licence Appeal Tribunal decision finding that the insured's claim for income replacement benefits was not statute-barred, as the termination letter was not clear and unequivocal.

The insured cross-appealed the dismissal of her claim for post-104 week income replacement benefits, arguing the adjudicator failed to consider whether alternative employment was comparable in status and reward.

The Divisional Court dismissed both appeals, holding that the limitation issue was a question of mixed fact and law not subject to appeal, and that the post-104 test under the Schedule does not require alternative employment to be comparable in status and reward.

The appellant appealed a Licence Appeal Tribunal decision denying his request for a catastrophic impairment designation, income replacement benefits, and physiotherapy following a motor vehicle accident.

The appellant argued the Vice-Chair erred by failing to include a contingency for future surgery in his whole person impairment rating and by ignoring expert evidence.

The Divisional Court dismissed the appeal, confirming that whole person impairment is assessed based on the claimant's condition at the time of the hearing without contingencies for future deterioration or surgery.

The appellant appealed two decisions regarding her claims for statutory accident benefits following a 2007 motor vehicle accident.

The first appeal challenged a Licence Appeal Tribunal decision denying certain attendant care benefits and setting the interest accrual date, which the Divisional Court dismissed as raising questions of fact rather than law.

The second appeal challenged a Financial Services Commission of Ontario decision finding it lacked jurisdiction to adjudicate a claim for housekeeping benefits due to a 2011 consent order settling the issue.

The Divisional Court dismissed both appeals, finding no errors of law and upholding the lower tribunals' decisions.

The appellant appealed a Licence Appeal Tribunal reconsideration decision that barred her application for statutory accident benefits due to late notice.

The appellant argued the Tribunal erred in law in interpreting the notice requirements under the Statutory Accident Benefits Schedule.

The Divisional Court dismissed the appeal, finding that the issues raised regarding the limitation period and the reasonableness of the delayed notice were questions of mixed fact and law, which fall outside the court's statutory jurisdiction to hear appeals on questions of law only.

The court also noted the appellant improperly raised new arguments not advanced before the Tribunal.

The appellant insurer appealed an arbitrator's decision dismissing its motion to dismiss the respondent insurer's application for loss transfer indemnity under s. 275 of the Insurance Act.

The dispute arose after a pedestrian was struck by a vehicle insured by the appellant and claimed Statutory Accident Benefits under a motorcycle policy issued by the respondent to the pedestrian's father.

The Divisional Court upheld the arbitrator's findings that the priority scheme in s. 268 of the Insurance Act ranks insurers, not policies, and that the respondent was entitled to indemnification.

The appeal was dismissed.

The appellant appealed a Licence Appeal Tribunal (LAT) decision regarding his entitlement to an Income Replacement Benefit (IRB) and a special award following a motor vehicle accident.

The appellant argued the LAT erred in calculating his IRB by deducting post-accident income, failing to quantify ongoing benefits, and denying a special award for unreasonable delay.

The Divisional Court dismissed the appeal, finding the LAT correctly applied the Statutory Accident Benefits Schedule to calculate the IRB, reasonably exercised its discretion in finding the ongoing quantum issue moot, and applied the correct legal test in denying the special award.

The appellant insurer appealed a License Appeal Tribunal reconsideration decision that ordered it to pay for a psychological assessment treatment plan because it failed to provide a timely denial notice under s. 38(8) of the Statutory Accident Benefits Schedule.

The Divisional Court allowed the appeal, holding that s. 38(11)2 only requires an insurer to pay for goods and services that are actually incurred during the period before a proper notice is given.

The court found that requiring payment for non-incurred expenses would result in a consumer windfall contrary to the purpose of the legislation.

The reconsideration decision was set aside and the decision of first instance was reinstated.

The appellant appealed a Licence Appeal Tribunal (LAT) decision and a reconsideration decision that denied his claim for ongoing income replacement benefits following a motor vehicle accident.

The appellant argued the LAT erred in law by admitting the insurer's expert reports without the required expert forms, misinterpreting the Statutory Accident Benefits Schedule (SABS), and denying procedural fairness.

The Divisional Court dismissed the appeal, finding the adjudicator properly exercised her discretion to admit the reports and weigh the evidence, correctly applied the SABS disability tests, and afforded the appellant procedural fairness.

The appellant appealed a Licence Appeal Tribunal decision refusing to extend the limitation period for her non-earner benefits claim.

The application was filed five days after the two-year limitation period expired.

The Divisional Court found the Tribunal made three errors of law: it incorrectly measured the length of delay and prejudice from the date of the insurer's denial rather than the expiry of the limitation period, and it failed to consider new evidence regarding the appellant's bona fide intention to appeal.

The appeal was allowed and the matter remitted for a new hearing.

The appellant appealed decisions of the Licence Appeal Tribunal denying his motion to add new issues to his hearing and dismissing his claim for chiropractic treatment benefits.

The Divisional Court dismissed the appeal, finding no error of law or denial of procedural fairness in the Tribunal's refusal to add late issues.

The Court also upheld the Tribunal's finding that the appellant was not entitled to reimbursement for chiropractic treatments because he failed to submit the required treatment plans in advance, as mandated by section 38(2) of the Statutory Accident Benefits Schedule.

The appellant was struck by a car while riding his bicycle and applied for a determination of catastrophic impairment based on a Glasgow Coma Scale score of 8.

The Licence Appeal Tribunal denied the application.

On appeal, the Divisional Court found that the Tribunal breached procedural fairness by refusing to admit a video of the accident, permitting the respondent's expert to testify beyond the scope of his report, and refusing to allow the appellant to call reply evidence.

The appeal was granted and the matter remitted to the Tribunal for a new hearing before a different adjudicator.

The applicant insurer sought leave to appeal a motion judge's decision refusing to strike portions of the respondent's statement of claim.

The respondent, a child passenger in a vehicle driven by her mother, sued the mother's statutory accident benefits insurer for damages arising from the insurer's denial of the mother's claim, alleging breach of contract, bad faith, and negligence resulting in the loss of her mother's care and guidance.

The Divisional Court granted leave to appeal, finding good reason to doubt the correctness of the motion judge's conclusions that the respondent could claim mental distress damages for breach of a peace of mind contract, that the insurer owed the respondent a duty of good faith regarding her mother's claim, and that the alleged harm was foreseeable in tort.

The applicant insurer sought judicial review of a decision by the Director's Delegate of the Financial Services Commission of Ontario, which upheld two arbitrators' refusals to order independent medical examinations of the respondent claimant.

The arbitrators had denied the insurer's requests primarily due to the insurer's delay in seeking the examinations until the eve of or during the arbitration hearings.

The Divisional Court applied the reasonableness standard of review and dismissed the application, finding that the Director's Delegate reasonably concluded the arbitrators had properly exercised their discretion to refuse the examinations in the interests of fairness and preventing delay.