Statutory Accident Benefits Schedule matters (SABS) - ODC

The appellant appealed a decision of the Licence Appeal Tribunal (LAT) dismissing his claims for income replacement benefits on the basis of res judicata.

The appellant argued that the prior LAT decision only addressed the quantum of benefits, not liability, and that the process was procedurally unfair.

The Divisional Court dismissed the appeal, finding that the LAT correctly applied the four preconditions for res judicata and that a party cannot ignore a final LAT decision to recommence the same claims.

The court also found no procedural unfairness in adjudicating the preliminary issue of res judicata.

The appellant, a pedestrian injured in a car accident, appealed the Licence Appeal Tribunal's denial of her request to adjourn a hearing regarding her catastrophic impairment designation.

The adjournment was sought due to a breakdown in her solicitor-client relationship on the eve of the hearing.

The Divisional Court allowed the appeal, finding that the appellant was denied procedural fairness as she demonstrated a complete inability to represent herself at the complex hearing.

The matter was remitted to the LAT for a new hearing on the merits.

The moving party insurer sought an extension of time to commence an application for judicial review of a 2020 Licence Appeal Tribunal (LAT) decision regarding income replacement benefits.

The moving party relied on the recent Supreme Court of Canada decision in Yatar to explain the delay.

The Divisional Court granted the motion on terms, noting that while finality is a central principle, the prejudice to the respondent was diluted by the fact that an appeal regarding the same benefits was still outstanding at the Court of Appeal.

The moving party, who is not a lawyer, brought a motion to be appointed as litigation guardian for the appellant, who allegedly suffers from a mental disability following a motor vehicle accident.

The court dismissed the motion because the moving party failed to file the required affidavit evidence and meet the other mandatory requirements under Rule 7.02(2) of the Rules of Civil Procedure.

The court also stayed the underlying appeal pending evidence of who filed the notice of appeal and under what authority.

The appellant appealed a License Appeal Tribunal (LAT) decision denying his claims for a catastrophic impairment designation, attendant care benefits, and various treatment plans following a motor vehicle accident.

The Divisional Court found no errors of law in the LAT Vice-Chair's application of the 'but for' causation test or her factual findings that the appellant's ongoing impairments were not accident-related.

The court also held that the LAT correctly dismissed the claims for treatment plans and attendant care benefits, as the appellant had no accident-related impairments during the relevant periods.

The appeal was dismissed.

The insurer appealed a Licence Appeal Tribunal (LAT) decision finding that the insured's election of benefits under s. 31(5) of the Statutory Accident Benefits Schedule was invalid due to the insurer's non-compliance with s. 32(2)(b).

The Divisional Court dismissed the appeal, holding that the LAT's factual findings regarding the insurer's non-compliance were not reviewable on a question of law.

The Court agreed that because the initial election was invalid, the insured had not made an election within the meaning of the SABS, and therefore the general prohibition against changing an election did not apply.

The appellant appealed a Licence Appeal Tribunal (LAT) decision denying her entitlement to post-104-week income replacement benefits under the Statutory Accident Benefits Schedule.

The Divisional Court dismissed the appeal, finding no errors of law.

The court affirmed that new binding case law does not constitute new evidence for a reconsideration request, and held that the insurer's denial letter adequately complied with the statutory notice requirements under s. 37(4) of the SABS.

The appellant appealed a Licence Appeal Tribunal decision dismissing her claim for statutory accident benefits due to a two-year delay in notifying her insurer.

The appellant argued the Tribunal erred in law by dismissing the claim under s. 55(1)1 of the Statutory Accident Benefits Schedule, asserting that s. 32(10) provided the insurer's exclusive remedy of extra time to respond.

The Divisional Court dismissed the appeal, holding that s. 32(10) does not preclude the dismissal of a claim under s. 55(1)1 where the claimant fails to provide a reasonable explanation for the delay.

The appellant insurer appealed a Licence Appeal Tribunal (LAT) decision finding the respondent eligible for funding for an attendant care benefit assessment.

The respondent suffered minor injuries in a motor vehicle accident but was removed from the Minor Injury Guideline (MIG) due to a pre-existing medical condition.

The insurer argued that because the injuries were minor, the respondent was excluded from attendant care assessments under the Statutory Accident Benefits Schedule (SABS).

The Divisional Court upheld the LAT's interpretation that once a claimant is removed from the MIG due to a pre-existing condition, they are no longer subject to the limits for minor injuries, and the test for services becomes what is reasonable and necessary.

The appeal was dismissed.

The moving party sought an extension of time to appeal a Licence Appeal Tribunal (LAT) decision that found she was not catastrophically impaired and denied her statutory accident benefits.

Following the LAT decision, the moving party attempted to seek a reconsideration but was denied an extension of time to do so, and subsequently denied a reconsideration of that denial.

The court clarified that only the original merits decision was a final order giving rise to a right of appeal to the Divisional Court.

Applying the test for an extension of time, the court found the moving party had a bona fide intention to appeal, provided an adequate explanation for the delay, and that the respondent suffered no real prejudice.

The court granted the extension of time to appeal the merits decision on specific terms.

The appellant appealed a Licence Appeal Tribunal decision finding he had not suffered a catastrophic impairment following a motor vehicle accident.

The appellant argued the adjudicator erred in her treatment of expert evidence, violated procedural fairness by questioning an expert, misapplied the temporal requirements for assessments under the Statutory Accident Benefits Schedule, and used an overly restrictive causation test.

The Divisional Court dismissed the appeal, finding no errors of law, as the adjudicator properly applied a flexible approach to the timing of assessments and correctly considered impairments caused by the traumatic brain injury.

The applicant sought judicial review of a Licence Appeal Tribunal decision regarding statutory accident benefits.

The Divisional Court declined to exercise its discretion to hear the application, finding that the applicant ought to have pursued a statutory appeal under s. 11(6) of the Licence Appeal Tribunal Act, 1999, which limits appeals to questions of law.

The court held there were no exceptional circumstances to justify bypassing the statutory appeal mechanism and declined to convert the application into an appeal.

The application was dismissed without prejudice to the applicant seeking an extension of time to pursue a statutory appeal.

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

The LAT found that a subsequent fall and seizure was an intervening event not caused by the accident.

On appeal, the appellant argued the LAT breached procedural fairness by allowing the insurer to raise causation late, and erred by applying the 'but for' causation test instead of the 'material contribution' test.

The Divisional Court dismissed the appeal, holding that the procedural fairness issue could not be raised for the first time on appeal, and that the LAT correctly applied the 'but for' test as this was not an exceptional case involving multiple tortfeasors.

The applicants sought judicial review of interlocutory orders staying their proceedings before the License Appeal Tribunal (LAT) regarding catastrophic impairment claims.

The LAT had stayed the proceedings to allow the applicants to attend medical examinations requested by the insurer.

The Divisional Court dismissed the applications as premature, applying the principle that courts should not interfere with ongoing administrative proceedings absent exceptional circumstances.

The court found no such exceptional circumstances, even though the applicants raised a jurisdictional issue regarding the LAT's power to issue the stays.

The appellant insurer appealed a preliminary issue decision of the Licence Appeal Tribunal (LAT) regarding whether the respondent's slip and fall incident constituted an 'accident' under the Statutory Accident Benefits Schedule.

The LAT intervened to raise a preliminary issue regarding the Divisional Court's jurisdiction to hear an appeal from an interlocutory decision.

The Divisional Court dismissed the appeal for want of jurisdiction, confirming that appeals lie only from final decisions of the LAT to prevent fragmentation and delay.

The court also declined the parties' joint request to convert the appeal into an application for judicial review.

The appellant appealed a Licence Appeal Tribunal decision denying his claim for income replacement benefits following a motor vehicle accident.

The appellant argued the Adjudicator breached procedural fairness and erred in law by failing to consider financial documents contained in his voluminous document brief.

The Divisional Court dismissed the appeal, finding no breach of procedural fairness or error of law, as the appellant had failed to enter the documents into evidence despite multiple directions and opportunities from the Adjudicator to do so.

The court also upheld the denial of an award for unreasonably withheld payments.

The appellant, who sustained a catastrophic impairment in a 2000 motor vehicle accident, appealed a Licence Appeal Tribunal decision regarding his claim for enhanced attendant care benefits.

The Divisional Court upheld the LAT's findings that the appellant could not claim retroactive benefits without a valid reason for delay and that the definition of 'incurred' under the New Schedule applied procedurally to his claim.

However, the court allowed the appeal in part, finding that the 2% per month interest rate on overdue benefits under the Old Schedule applied as a substantive benefit, rather than the 1% rate under the New Schedule.

The appellant appealed a Licence Appeal Tribunal (LAT) decision denying her ongoing income replacement and psychological benefits following a motor vehicle accident.

She argued she was denied procedural fairness because the insurer's psychological expert did not produce raw test data until mid-hearing, and that the LAT erred in finding the insurer made 'best efforts' to produce the file.

The Divisional Court dismissed the appeal, finding no denial of procedural fairness as the appellant had sufficient time to review the data during a five-week adjournment and cross-examine the expert.

The Court also found the LAT applied the correct legal test for 'best efforts'.

The appellant appealed a Licence Appeal Tribunal decision dismissing his application for income replacement benefits as an abuse of process.

The Tribunal had dismissed the application after the appellant repeatedly failed to cooperate with an ordered independent psychological examination, including raising consent issues and threatening the psychologist.

The Divisional Court dismissed the appeal, finding no error of law in the Tribunal's conclusion that the appellant's conduct constituted an abuse of process under its rules and the Statutory Powers Procedure Act.

The appellant insurer appealed a Licence Appeal Tribunal reconsideration decision that upheld a finding that the respondent was catastrophically impaired and entitled to non-earner benefits following a motor vehicle accident.

The Divisional Court dismissed the appeal, finding that the appellant failed to identify any extricable error of law in the adjudicator's assessment of the medical evidence and whole person impairment ratings.

The Court also rejected the appellant's argument that the adjudicator lacked jurisdiction to hear the reconsideration request as a single member of the original two-member panel, noting that the Tribunal's rules permit such a procedure.