Rebecca Brown Greer

Zurich appealed a Superior Court decision that held Zurich and Chubb equally responsible for paying statutory accident benefits to a claimant injured in a rental vehicle.

The claimant initially applied to Chubb, who denied the claim and failed to notify Zurich within 90 days as required by O. Reg. 283/95.

The second arbitrator found Chubb solely responsible for the benefits due to its breaches of sections 2 and 3 of the Regulation.

The appeal judge overturned this, finding the insurers should share responsibility.

The Court of Appeal allowed Zurich's appeal and reinstated the arbitrator's award, holding that the appeal judge erred in treating the insurers as having equal priority under section 268 of the Insurance Act.

The arbitrator reasonably exercised his discretion in requiring Chubb to pay the benefits permanently as a consequence of its breaches.

The applicant sought statutory accident benefits following an alleged motor vehicle accident.

The respondent denied the claim, arguing the applicant was not a passenger in the vehicle and that the collision was staged.

The Tribunal found discrepancies in the applicant's evidence, noting he was not listed in the police report and the driver's examination under oath did not clearly identify him.

Relying on a forensic engineering report, the Tribunal also concluded the collision was staged.

Applying the Caughy test, the Tribunal held the incident did not meet the definition of an 'accident' under section 3(1) of the Schedule and dismissed the application.

The applicant sought statutory accident benefits following a 2014 motor vehicle accident.

The insurer denied the claims and the applicant applied to the Licence Appeal Tribunal.

The Tribunal found the applicant was barred from claiming a non-earner benefit because she failed to submit a disability certificate within 104 weeks of the accident.

The Tribunal also found the applicant was barred from claiming various treatment plans because she failed to dispute the insurer's valid denials within the two-year limitation period.

The Tribunal declined to extend the limitation period under section 7 of the Licence Appeal Tribunal Act, noting the applicant provided no evidence of an intention to appeal or explanation for the delay.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident.

The matter proceeded to a written hearing.

The applicant's representative withdrew, and the applicant failed to file any submissions or evidence despite receiving notice.

The Tribunal proceeded with the hearing in the applicant's absence.

The Tribunal found that the applicant failed to meet her onus to demonstrate entitlement to removal from the Minor Injury Guideline (MIG) or the disputed medical benefits.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits (IRBs), treatment plans for physiotherapy and psychological assessments, catastrophic assessment costs, and visitor expenses.

The Licence Appeal Tribunal dismissed the application in its entirety.

The adjudicator found that the applicant failed to meet her burden of proof for all claims, as she did not provide sufficient medical or documentary evidence to establish that she suffered a substantial or complete inability to work, or that the disputed treatment plans and expenses were reasonable and necessary as a result of the accident.

The applicant sought non-earner benefits following a motor vehicle accident.

The respondent denied the benefits and raised a preliminary issue that the applicant was barred from proceeding because she failed to dispute the denial within the two-year limitation period under s. 56 of the Schedule.

The applicant argued the limitation period had not started because the respondent failed to provide a valid notice of denial or request an election of benefits.

The Tribunal found the respondent's denial notices were clear, unequivocal, and compliant with the Schedule.

The Tribunal declined to extend the limitation period under s. 7 of the LAT Act, finding no bona fide intention to appeal within the time limit, a substantial delay, and prejudice to the respondent.

The application was dismissed.

The applicant was involved in a motor vehicle accident and sought a non-earner benefit (NEB) under the Statutory Accident Benefits Schedule.

The respondent insurer argued the application was statute-barred because the applicant failed to submit the OCF-1 form within the required timeframe.

The Tribunal found the applicant was not statute-barred, as the respondent failed to prove it sent the blank OCF-1 form to the applicant's correct address, meaning the 30-day time limit was never triggered.

However, on the substantive issue, the Tribunal dismissed the claim for a NEB.

The applicant failed to provide sufficient medical evidence comparing his pre- and post-accident functioning to establish a complete inability to carry on a normal life within 104 weeks of the accident.

Claims for interest and an award were consequently dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident.

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found the applicant failed to provide sufficient medical evidence to prove a psychological impairment that would warrant removal from the MIG.

The Tribunal also dismissed the claim for non-earner benefits, as the applicant did not demonstrate a complete inability to carry on a normal life.

Claims for a psychological assessment, an award, and interest were also dismissed.

The applicant sought various statutory accident benefits following a motor vehicle accident, including multiple treatment plans for physiotherapy and psychological services, attendant care benefits, and the cost of an accounting report for income replacement benefits.

The Tribunal dismissed the application in its entirety.

The Tribunal found the applicant failed to prove the treatment plans were reasonable and necessary, noting inconsistencies in self-reported improvement and accepting medical evidence that the applicant required a multi-disciplinary chronic pain program rather than further facility-based physical therapy.

The Tribunal also denied the cost of the accounting report, finding the applicant's income calculation was straightforward and did not require an accountant's expertise.

Claims for attendant care benefits, interest, and a special award were similarly dismissed.

The applicant sought statutory accident benefits, alleging he struck his head and fell while being transported in an ambulance.

The respondent denied the claim on the basis that the applicant was not involved in an 'accident' under section 3(1) of the Statutory Accident Benefits Schedule.

The Tribunal found that the contemporaneous medical and ambulance records did not support the applicant's assertion that he sustained a head injury during the ambulance ride, noting instead that the records described an older, scabbed wound.

The application was dismissed as the applicant failed to prove on a balance of probabilities that the use or operation of an automobile directly caused his impairment.

The applicant sought statutory accident benefits following a motor vehicle accident and applied for a catastrophic impairment designation.

The insurer denied the designation and later argued that the applicant's application to the Tribunal was barred by the two-year limitation period under section 56 of the Schedule.

The Tribunal held that a denial of a catastrophic impairment designation is a threshold determination, not a refusal to pay a specific benefit, and therefore does not trigger the limitation period.

The applicant was permitted to proceed to a hearing.

The Licence Appeal Tribunal initiated a reconsideration of a previous decision after discovering the former adjudicator had accepted an offer of employment with the respondent's parent company, Aviva, prior to hearing the matter.

The Associate Chair found that the former adjudicator's failure to disclose this conflict and recuse herself created a reasonable apprehension of bias, violating the rules of procedural fairness.

The original decision was cancelled, and a new oral hearing with a different adjudicator was ordered.

The respondent insurer requested a reconsideration of a Tribunal decision that found it liable to pay income replacement and medical benefits due to insufficient medical reasons in its Notices of Examination (NOEs).

The insurer argued the Tribunal erred in law by imposing an enhanced standard of specificity for NOEs, by awarding substantive benefits based solely on defective notice, and by allowing the insured to challenge the NOEs after attending the insurer examinations.

The Tribunal dismissed the reconsideration request, finding that the insurer was attempting to relitigate issues already decided and had failed to establish any error of law or breach of procedural fairness under Rule 18.2.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming funding for psychological services and a catastrophic impairment assessment.

The respondent denied the claims on the basis that they were not reasonable and necessary.

The Tribunal found that the respondent provided sufficient medical reasons for its denials and complied with the notice requirements under the Schedule.

The Tribunal concluded that the applicant failed to meet his evidentiary burden to prove the treatments and assessments were reasonable and necessary, particularly given the lack of response to prior psychological treatment and the absence of evidence supporting a neurological impairment.

The application was dismissed.

The applicant sought a special award under section 10 of Regulation 664, alleging the respondent unreasonably withheld or delayed payment of income replacement benefits and a medical benefit for psychological treatment.

The adjudicator found that the applicant was responsible for delays by failing to provide medical documents in a timely manner and refusing to attend a functional abilities evaluation.

The respondent acted reasonably in scheduling independent examinations to assess the new medical information provided.

The claims for a special award and interest were dismissed.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits.

He failed to submit his application within the 30-day time limit prescribed by the Schedule, submitting it nearly two years later.

The Licence Appeal Tribunal found that the applicant did not have a reasonable explanation for the delay, rejecting his claim that a difficult property damage settlement prevented him from applying.

The application was dismissed as statute-barred.