Statutory Accident Benefits Schedule matters (SABS) - ONSCDC

The appellant appealed and sought judicial review of a Licence Appeal Tribunal (LAT) decision finding she failed to establish catastrophic impairment under Criterion 8 of the Statutory Accident Benefits Schedule.

The appellant argued the LAT adjudicator breached procedural fairness by imposing strict time limits on witness examinations, making unequal evidentiary rulings regarding expert psychiatric testimony, and admitting a late surveillance report.

The Divisional Court dismissed the appeal, holding that the adjudicator's procedural choices were within her discretion to control the tribunal's process and did not result in unfairness.

The court also found no error of law in the LAT's application of the test for catastrophic impairment.

The appellant appealed and sought judicial review of a Licence Appeal Tribunal (LAT) decision finding she was not an 'insured person' under the Statutory Accident Benefits Schedule.

The appellant's uninsured son was in an accident, and they sought benefits under her brother's spouse's policy, requiring proof of dependency.

The Divisional Court dismissed the appeal, finding the LAT did not breach procedural fairness by holding a written hearing and made no error of law in applying both a 'big picture' and mathematical approach to conclude the appellant was not principally dependent on the named insured.

The 92-year-old appellant suffered catastrophic injuries in a motor vehicle accident and sought statutory accident benefits to modify her daughter's home, where she intended to move to receive 24-hour care.

The Licence Appeal Tribunal denied the claim, holding that the appellant first had to prove her existing condominium could not be modified.

On appeal, the Divisional Court found the LAT erred in law by imposing an unlegislated threshold and adopting an unduly narrow interpretation of 'existing home' under section 16 of the SABS.

The appeal was allowed, and the insurer was ordered to pay the claimed benefits immediately.

The appellant was injured in a motor vehicle accident and suffered an intracranial brain contusion.

The insurer placed her in the Minor Injury Guideline (MIG) under the Statutory Accident Benefits Schedule (SABS), limiting her benefits to $3,500.

The Licence Appeal Tribunal upheld this decision, finding that the definition of 'minor injury' includes all contusions, including brain contusions.

On appeal, the Divisional Court found the Tribunal erred in law by focusing on the degree of impairment rather than the nature of the injury.

The court held that an intracranial brain contusion is not a 'minor injury' under the SABS, allowed the appeal, and ordered the appellant removed from the MIG.

The applicant sought judicial review of a Licence Appeal Tribunal decision finding she was not catastrophically impaired under Criterion 7 of the Statutory Accident Benefits Schedule.

The Tribunal had concluded her whole person impairment rating was 49%, falling short of the 55% threshold.

The Divisional Court dismissed the application, finding the Tribunal's assessment of a 0% impairment for the spine and its correction of the upper extremity impairment calculation on reconsideration were reasonable and within its statutory authority to apply the AMA Guides.

The appellant insurer appealed a Licence Appeal Tribunal (LAT) decision granting attendant care benefits to the respondent, who suffered from severe autism and was injured in a minor motor vehicle accident.

The appellant argued there was a reasonable apprehension of bias because the LAT adjudicator had a history of, and continued, public advocacy for autism caregivers after his appointment.

The Divisional Court agreed, finding that the adjudicator's ongoing advocacy efforts following his appointment raised a reasonable apprehension of bias in a case specifically determining attendant care benefits for an autistic claimant.

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

The insureds were seriously injured in a motorcycle accident.

They had standard accident benefits with Economical and optional enhanced benefits with Heartland.

Due to an innocent mistake and incorrect advice, they submitted their initial application for benefits to Economical instead of Heartland.

Heartland denied their subsequent claim for optional benefits, arguing the insureds had elected to claim from Economical.

The Licence Appeal Tribunal initially granted the insureds relief from forfeiture, but this was overturned on reconsideration.

On appeal, the Divisional Court restored the initial LAT decision, holding that the LAT has jurisdiction to grant relief from forfeiture under s. 129 of the Insurance Act, and that the insureds were entitled to withdraw their mistaken application and apply to Heartland.

The appellant sought to quash a Licence Appeal Tribunal (LAT) decision and a reconsideration decision, alleging procedural unfairness.

The Divisional Court dismissed the appeal and application for judicial review, finding that the appellant was given notice of the hearing, did not request an in-person hearing or accommodation, and did not raise procedural unfairness in his reconsideration request.

The court noted that the decisions do not bar the appellant's claims for attendant care benefits or a special award relating to the timing of non-earner benefits payments.

No costs were awarded.

The appellant appealed a Licence Appeal Tribunal (LAT) decision denying his claim for catastrophic impairment benefits.

The LAT had found that the appellant's physician, Dr. Ofokansi, provided only a conclusory opinion on the OCF-19 form without supporting analysis or medical data.

The appellant argued the LAT should have considered the evidence of his psychologist, Dr. Reesor.

The Divisional Court dismissed the appeal, holding that section 45 of the Statutory Accident Benefits Schedule requires a catastrophic impairment assessment to be conducted by a physician.

Since the physician's assessment was entirely conclusory and entitled to no weight, the psychologist's evidence alone was insufficient to establish the claim.

The applicant sought judicial review and appeal of a Licence Appeal Tribunal decision denying his claim for attendant care benefits.

The LAT found that the applicant failed to prove his family members sustained an economic loss in providing care, as required by s. 3(7)(e) of the Statutory Accident Benefits Schedule.

The applicant conceded the LAT correctly interpreted the provision but argued the requirement conflicted with the consumer protection mandate of the legislation and produced an absurd result.

The Divisional Court dismissed the application, holding that there was no ambiguity in the legislation and that rewriting the statute to achieve a perceived equitable result was not a justiciable issue.

The applicant sought judicial review of a Licence Appeal Tribunal (LAT) decision dismissing her claims for statutory accident benefits, including income replacement benefits, catastrophic impairment designation, and attendant care benefits.

The Divisional Court dismissed the application, finding that the LAT's decisions regarding the 104-week deadline for income replacement benefits, the assessment of catastrophic impairment criteria, and the reduction of attendant care benefits were reasonable.

The court also rejected the applicant's claims of procedural fairness violations, concluding that the LAT appropriately controlled its own process.

The applicant appealed and sought judicial review of Licence Appeal Tribunal decisions dismissing her claims for income replacement benefits and medical expenses, and ordering the destruction of internal tribunal documents she submitted as evidence of institutional bias.

The Divisional Court dismissed the appeal and application, finding no error of law in the Tribunal's determination that the insurer's examination notices complied with the Statutory Accident Benefits Schedule.

The Court also upheld the Tribunal's orders striking the applicant's reply evidence and directing the destruction and non-dissemination of internal documents, concluding that the Tribunal reasonably exercised its jurisdiction to control its process and properly applied the doctrines of solicitor-client privilege and deliberative secrecy.

The appellant sought to rescind a 2000 settlement agreement for statutory accident benefits, arguing the insurer failed to comply with disclosure obligations under Regulation 664 by not providing a commuted value for Attendant Care Benefits.

The Licence Appeal Tribunal dismissed the rescission claim, finding the insurer was not required to provide a commuted value for benefits that were never claimed.

On appeal and judicial review, the Divisional Court upheld the Tribunal's decision, concluding it was not an error of law or unreasonable to find the settlement valid where the missing commuted value was for an unclaimed benefit and could not have reasonably affected the decision to settle.

The appellant appealed a Licence Appeal Tribunal (LAT) decision denying his claim for removal from the Minor Injury Guideline (MIG) following a motor vehicle accident.

The appellant argued the LAT erred in law by disregarding his subjective evidence of psychological impairment, providing inadequate reasons, and demonstrating bias against subjective pain complaints.

The Divisional Court dismissed the appeal, finding the LAT adequately explained its weighing of the evidence and that no error of law or procedural fairness violation occurred.

The appellant was injured in a motor vehicle collision and settled his claims for statutory accident benefits with the respondent insurer, providing a full and final release.

He later sought additional benefits for post-traumatic stress disorder, which the insurer denied based on the settlement.

The License Appeal Tribunal dismissed his claim because he had not returned the settlement funds as required by s. 9.1(8) of Regulation 664.

The Divisional Court dismissed the appeal, confirming that repayment of settlement funds is a mandatory precondition to applying to the Tribunal, and there is no exemption for impecuniosity.

The applicant sought judicial review of a Licence Appeal Tribunal (LAT) decision and reconsideration decision which found his motor vehicle accident injuries were subject to the $3,500 Minor Injury Guideline (MIG) limit.

The applicant argued his pre-existing shoulder injury, psychological symptoms, and chronic pain warranted removal from the MIG.

The Divisional Court applied the reasonableness standard of review and found that while the adjudicator made a minor factual error regarding a physiotherapy visit, the overall conclusion was well-supported by medical evidence, including reports from the respondent's assessors.

The application for judicial review was dismissed.

The applicant sought judicial review of an arbitrator's decision, affirmed by the Director's Delegate, awarding costs against him personally in a Financial Services Commission of Ontario (FSCO) arbitration.

The Divisional Court applied a reasonableness standard of review.

The court found no denial of procedural fairness, as the applicant had notice and an opportunity to respond.

The court upheld the arbitrator's finding that the applicant caused expenses to be incurred without reasonable cause, and dismissed the application with costs.

The applicant sought to introduce fresh evidence on an application for judicial review of a decision by the Director's Delegate, which had upheld an Arbitrator's decision.

The Director's Delegate had previously refused to admit the applicant's affidavit because it failed the Palmer test, as the evidence was available during the arbitration.

The Divisional Court agreed, refusing to admit the affidavit for the purposes of the application.

The court allowed certain other documents to be referenced on consent of the parties, but excluded the accompanying affidavit.

The plaintiffs sued their insurer for terminating statutory accident benefits based on reports from health care professionals retained by the insurer under s. 42 of the Statutory Accident Benefits Schedule.

On discovery, the plaintiffs sought to ask questions that amounted to cross-examining these experts.

The motion judge held that the experts were not 'experts' within the meaning of Rule 31.06(3) of the Rules of Civil Procedure, and thus the prohibition against cross-examination did not apply.

The Divisional Court allowed the insurer's appeal, holding that the clear wording of Rule 31.06(3) covers experts engaged by a party for a purpose other than litigation, including s. 42 assessors.

The applicant insurer sought judicial review of decisions by a FSCO arbitrator and Director's delegate finding that the respondent insured suffered a catastrophic impairment under s. 2(1.1)(e)(i) of the Statutory Accident Benefits Schedule.

The insurer argued the arbitrator unreasonably interpreted 'reasonable period of time' for a Glasgow Coma Scale score.

The Divisional Court dismissed the application, holding that the standard of review is patent unreasonableness and the tribunal's decisions were supported by evidence and within its specialized jurisdiction.