Licence Appeal Tribunal File Number: 22-010342/AABS
In the matter of an Application pursuant to subsection 280(2) of the Insurance Act, RSO 1990, c I.8, in relation to statutory accident benefits.
Between:
Katarina Macko
Applicant
and
Aviva Insurance Company
Respondent
PRELIMINARY ISSUE HEARING DECISION AND ORDER
ADJUDICATOR:
Tavlin Kaur
APPEARANCES:
For the Applicant:
Shannon Kelly, Counsel
Gus Triantafilopoulos, Counsel
For the Respondent:
Maggie Morgan, Counsel
Heard by way of written submissions
OVERVIEW
1On June 23, 2022, the applicant’s common law spouse was riding an uninsured e-bike and was involved in an accident. As a result of the accident, he unfortunately passed away. The applicant sought benefits for herself pursuant to the Statutory Accident Benefits Schedule – Effective September 1, 2010, O. Reg. 34/10 (the “Schedule”). The applicant was denied certain benefits by the respondent, Aviva General Insurance Company (“Aviva”), and submitted an application to the Licence Appeal Tribunal-Automobile Accident Benefits Services (the “Tribunal”).
PRELIMINARY ISSUE IN DISPUTE
2The preliminary issue to be decided is whether the applicant is an insured person under section 3(1) of the Schedule and therefore eligible for benefits.
3The question that is before the Tribunal is a very narrow one. However, it should be noted that the applicant raised an additional issue in her submissions regarding whether the respondent is required to pay benefits to the applicant pursuant to section 2.1(6) of Ontario Regulation 283/95 in her submissions. In my view, this issue is not properly before the Tribunal. In the Case Conference Report and Order dated June 14, 2023, the Tribunal noted that it does not have the jurisdiction to adjudicate a priority dispute between insurers and declined to add it as a preliminary issue in dispute. As such, the Tribunal will not consider this issue.
RESULT
4I find that the applicant does not meet the definition of an “insured person”.
ANALYSIS
5The Schedule provides that insurers are liable to pay certain benefits to, or on behalf of, insured person who sustain an impairment as a result of an accident involving the use or operation of an automobile