Statutory Accident Benefits Schedule matters (SABS) - ODC

The appellant appealed a Licence Appeal Tribunal decision finding she was not catastrophically impaired under s. 3.1(1) 2. iii of the Statutory Accident Benefits Schedule.

The appellant suffered a severe and permanent alteration of the structure of her leg, but her functional mobility impairment (measured by the SCIM) was only temporary.

The Divisional Court upheld the adjudicator's interpretation that the SABS requires both the structural and functional alterations to be permanent to meet the catastrophic impairment threshold.

The appeal was dismissed.

The moving party sought an extension of time to file an application for judicial review of decisions made by the Licence Appeal Tribunal.

At the case conference, the moving party advised she would proceed by appeal if the respondents did not oppose an extension of time and if the judicial review application could be held in abeyance pending the outcome of her appeal and the Court of Appeal's decision in Yatar.

The respondents did not oppose the extension.

The court granted the extension of time to file the notice of appeal and ordered the judicial review application to be held in abeyance.

The appellant was injured in a motor vehicle accident and received income replacement benefits (IRBs) from the respondent insurer.

The insurer stopped the IRBs when the appellant returned to work, providing a notice that did not include medical reasons.

When the appellant later had to stop working and sought to resume IRBs, the insurer denied the claim, and the Licence Appeal Tribunal found the appeal time-barred.

On appeal, the Divisional Court held that section 37(4) of the Statutory Accident Benefits Schedule requires insurers to provide medical reasons for discontinuing IRBs.

Because the insurer's notice lacked medical reasons, it was not a valid refusal and did not trigger the limitation period.

The appeal was allowed and the matter remitted to the Tribunal.

The appellant, an environmental clean-up worker, suffered impairments from toxic exposure while cleaning up a chemical spill caused by a fatal collision between two trucks.

He applied for statutory accident benefits, which were denied on the basis that the incident was not an 'accident' under s. 3(1) of the SABS.

The Licence Appeal Tribunal upheld the denial, finding that while the use of the vac-truck met the purpose test, it did not meet the causation test as the toxic substances, not the vehicle, directly caused the injuries.

The Divisional Court dismissed the appeal, holding that the LAT made no errors of law in its articulation or application of the purpose and modified causation tests.

The appellant appealed a Licence Appeal Tribunal decision finding her application for Income Replacement Benefits was statute-barred.

The appellant argued the Tribunal erred in law by finding the insurer's denial letter was valid and by refusing to extend the limitation period.

The Divisional Court dismissed the appeal, holding that the Tribunal applied the correct legal tests and that the appellant's challenges to the Tribunal's factual findings and exercise of discretion did not raise extricable questions of law.

The appellant, an Uber driver, sought accident benefits after an altercation with passengers resulted in him swerving his vehicle and injuring his knee.

The Licence Appeal Tribunal denied the claim, finding the incident did not meet the definition of an 'accident' under the Statutory Accident Benefits Schedule as it failed both the purpose and causation tests.

The Divisional Court dismissed the appeal, holding that the Tribunal applied the correct legal tests from Chisolm and that the appellant's challenges were impermissible appeals of factual findings.

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 sought judicial review of a Licence Appeal Tribunal decision barring him from proceeding with an appeal for catastrophic injury benefits due to his failure to attend an insurer's medical examination and provide documents.

The Divisional Court dismissed the application, finding that the applicant had an adequate alternative remedy through a statutory right of appeal under the Licence Appeal Tribunal Act.

The court held that no exceptional circumstances existed to justify bypassing the statutory appeal process in favour of judicial review.

Three appeals were scheduled to be heard regarding whether the Licence Appeal Tribunal (LAT) has jurisdiction under s. 7 of the Licence Appeal Tribunal Act to extend the two-year limitation period for statutory accident benefits applications.

The LAT had previously made conflicting decisions on this issue and indicated it did not intend to appear.

The Divisional Court adjourned the appeals and ordered the LAT to intervene and file materials to assist the court in determining the jurisdictional issue.

The appellant was injured in a motor vehicle accident and received income replacement benefits until the insurer refused further benefits.

The appellant applied to the Licence Appeal Tribunal to dispute the refusal, but the adjudicator dismissed the application as being outside the two-year limitation period.

On appeal, the appellant argued the refusal was invalid because the insurer failed to provide copies of independent assessment reports to her treating practitioner, as required by section 37(5) of the Statutory Accident Benefits Schedule.

The Divisional Court dismissed the appeal, holding that while the insurer breached section 37(5), this omission did not invalidate the clear and unequivocal refusal of benefits, and the limitation period had expired.

The appellant appealed a decision of the Licence Appeal Tribunal regarding statutory accident benefits.

At the hearing, the appellant advised the court she was not actually seeking to appeal the Tribunal's decision, but rather sought to add unresolved claims to an existing Superior Court action.

The Divisional Court dismissed the appeal, noting that the appellant had not appealed the prior Superior Court decision that barred her from adding those claims, and the time to do so had expired.

The applicant was injured in a motor vehicle accident and sought a psychological assessment, which the insurer denied on the basis that the Minor Injury Guideline (MIG) applied.

At arbitration, the Arbitrator found the MIG unconstitutional under s. 15 of the Charter without making any factual findings about the applicant's condition or whether the MIG actually precluded his benefits.

The Director's Delegate overturned this decision, holding that constitutional issues cannot be decided in a factual vacuum.

The Divisional Court dismissed the applicant's judicial review, affirming that the Arbitrator erred by deciding the Charter issue without a proper factual foundation.

The self-represented appellant brought a motion to review an order refusing to extend the time to review a registrar's dismissal of his appeal for delay.

The underlying appeal related to an arbitrator's denial of attendant care and housekeeping benefits.

The court found the motion had no chance of success, as previous judges had already determined the appeal lacked legal merit.

The court dismissed the motion as frivolous, vexatious, and an abuse of process under Rule 2.1 of the Rules of Civil Procedure.

The court also ordered that the appellant may not bring any further motions in the appeal proceeding without prior leave.

The appellant appealed the dismissal of her claim for statutory accident benefits by the Licence Appeal Tribunal.

The Divisional Court allowed the appeal, finding that the adjudicator erred by excluding opinion evidence from the appellant's treating family physician and by failing to properly assess the issue of causation.

The court held that the adjudicator's erroneous evidentiary ruling infected the fact-finding process and that the failure to state the proper test for causation rendered the reasons insufficient.

The decisions below were set aside and the matter was remitted to the LAT for a new hearing before a different adjudicator.

The appellant appealed a decision of the Licensing Appeal Tribunal.

Prior to the hearing, the parties reached a settlement.

The Divisional Court endorsed the settlement, explicitly noting that its endorsement should not be taken as approval of the Tribunal's reasoning in the case.

The plaintiff appealed a trial judge's decision to deduct Income Replacement Benefits (IRBs) from a jury award for past income loss, which reduced the award to zero, and the subsequent costs order against him.

The Divisional Court upheld the IRB deduction, finding no evidence the jury had already accounted for it.

However, the court allowed the appeal regarding costs, finding the trial judge breached natural justice by deciding the defendants' entitlement to costs without hearing submissions from the plaintiff.

The costs issue was remitted to the trial judge.

The applicant insurer sought judicial review of a decision by the Director's Delegate of the Financial Services Commission of Ontario, which allowed the insured to rescind a settlement agreement.

The Director's Delegate found that the Settlement Disclosure Notice did not properly describe the benefits available to the self-employed insured and was improperly signed by the insurer's counsel rather than hand-signed by the insurer.

The Divisional Court held that the Director's Delegate's decision regarding the inadequate description of benefits was reasonable, as the notice failed to account for the insured's self-employment losses.

Although the court found the Director's Delegate's reasoning regarding the signature requirement to be unreasonable, the application for judicial review was dismissed based on the inadequate benefits description.

The applicant insurer sought judicial review of a Ministry of Health decision ordering it to pay the long-term care fees of its insured, who was severely injured in a motor vehicle accident.

The insured had applied for a reduction in nursing home co-payments under the Nursing Homes Act, but the Director refused, finding the insurer liable.

The insurer argued it was exempt under s. 75(13) of the Statutory Accident Benefits Schedule because the reduction was a benefit 'reasonably available' to the insured.

The Divisional Court dismissed the application, holding that the Director's decision was reasonable and that social assistance benefits based on financial need do not fall within the ambit of s. 75(13).

Following the death of their daughter in a motor vehicle accident, both parents applied for death benefits from the insurer.

The insurer paid the father but denied the mother's claim, arguing the Statutory Accident Benefits Schedule only contemplated a single payment.

The motions judge agreed and dismissed the mother's action.

On appeal, the Divisional Court held that the wording of s. 25(2)5.i. of the Schedule, which provides for payment to 'a person' rather than 'the person', requires the insurer to make separate payments to each person upon whom the deceased was dependent.

The appeal was allowed.

The plaintiff sued the defendant insurer for statutory accident benefits.

The plaintiff's counsel offered to settle the claim, which the defendant accepted.

The plaintiff subsequently rescinded the settlement, arguing the defendant failed to comply with the disclosure requirements of s. 9.1 of Regulation 664.

The defendant successfully brought a motion for judgment on the settlement.

On appeal, the Divisional Court set aside the judgment, holding that the insurer's duty to comply with s. 9.1 does not end once the insured retains a solicitor and commences litigation.