Rose Bilash

The applicant was injured in a snowmobile accident and sought a determination that he sustained a catastrophic impairment due to a mental or behavioural disorder.

The respondent disputed the catastrophic impairment designation and denied several treatment plans and assessments.

The adjudicator found that the applicant sustained a catastrophic impairment, concluding he had marked impairments in activities of daily living, social functioning, and adaptation, despite the respondent's reliance on social media posts showing the applicant travelling.

The adjudicator awarded the disputed treatment plans at the catastrophic impairment rates and awarded HST on the assessments, but capped the assessment fees at the $2,000 statutory maximum.

Claims for a special award and costs were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit, various treatment plans, and a special award.

The Licence Appeal Tribunal found that the applicant failed to meet the evidentiary burden to establish a complete inability to carry on a normal life, denying the non-earner benefit.

Claims for psychological treatment and a balance for chiropractic documentation were also dismissed for lack of supporting evidence.

However, the Tribunal approved treatment plans for an occupational therapy in-home assessment and further chiropractic treatment, finding them reasonable and necessary given the applicant's documented chronic pain and functional limitations.

The claim for a special award was dismissed as the insurer's denials were based on persuasive medical evidence.

Three appeals were heard together to determine 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 filing appeals set out in s. 56 of the Statutory Accident Benefits Schedule (SABS).

The Divisional Court held that s. 7 does grant the LAT jurisdiction to extend the s. 56 limitation period, as the time limit is fixed 'under an Act' (the Insurance Act).

The Court dismissed the insurers' appeals challenging the LAT's jurisdiction and its exercise of discretion to grant extensions, finding no errors of law.

In the third appeal, where the adjudicator had found no jurisdiction, the Court allowed the appeal and remitted the matter back to the LAT to consider the extension request.

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 applicant was involved in a motor vehicle accident and suffered a cardiac arrest twelve days later, resulting in severe anoxic brain damage.

He sought various accident benefits, arguing the accident caused increased stress that led to the heart attack.

The Tribunal dismissed the application, finding the applicant failed to meet the 'but for' causation test.

Relying on medical evidence of advanced pre-existing coronary artery disease and the lack of documented stress complaints immediately post-accident, the Tribunal concluded the accident was not a necessary cause of the cardiac arrest.

The applicant's physical injuries were deemed soft-tissue in nature and subject to the Minor Injury Guideline.

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

The respondent denied several treatment plans for chiropractic and psychological services on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.

The adjudicator found that the respondent complied with the notice requirements under s. 38(8) of the Schedule.

On the substantive issue, the adjudicator concluded that the applicant's physical injuries were soft tissue in nature and his psychological impairments did not remove him from the MIG.

The adjudicator also found that the applicant did not meet the criteria for chronic pain.

As the applicant's injuries were predominantly minor and the MIG limit was exhausted, the application for further medical benefits was dismissed.

The applicant, who was catastrophically impaired following a motor vehicle accident, sought payment for a psychovocational assessment, winter tires, and a wellness retreat in British Columbia.

The Licence Appeal Tribunal found that the psychovocational assessment was not payable as it was incurred prior to the submission of the treatment plan and was not reasonable and necessary given the volume of existing medical opinions.

The Tribunal also held that winter tires do not constitute a vehicle modification under the Schedule and that the wellness retreat was not reasonable and necessary.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought catastrophic impairment benefits.

The insurer requested a neuropsychological insurer's examination (IE) to assess the claim, which the applicant refused to attend, arguing it was not reasonably necessary.

The insurer raised a preliminary issue that the applicant was statute-barred from proceeding with her Licence Appeal Tribunal application under section 55 of the Statutory Accident Benefits Schedule.

The Tribunal found the neuropsychological IE was reasonably necessary to determine catastrophic impairment and ordered that the applicant is statute-barred from proceeding until she attends the examination.

The insurer appealed an arbitrator's decision finding the insured catastrophically impaired due to a mental or behavioural disorder.

The appeal was dismissed.

The insured sought her legal appeal expenses.

The Director's Delegate awarded the insured $30,000 in expenses, inclusive of disbursements and HST, noting that the insurer's appeal was misguided and the matter was of great importance to the insured.

The insurer appealed an Arbitrator's decision finding that the insured sustained a catastrophic impairment due to a mental or behavioural disorder.

The insurer argued the Arbitrator erred in law by applying a quantitative formula to the definition of marked impairment and misapprehended the evidence.

The Director's Delegate dismissed the appeal, holding that the Arbitrator properly applied a qualitative and contextual assessment of the insured's adaptability domain.

The Delegate further noted that the appeal process is restricted to questions of law, and it is not the Delegate's role to reweigh the evidence or substitute findings of fact.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits, claiming she sustained a catastrophic impairment due to a mental or behavioural disorder.

The sole issue was whether she suffered a marked impairment in the adaptability domain.

The arbitrator preferred the evidence of the applicant's experts, finding that the insurer's psychiatric assessment was based on incomplete facts.

The arbitrator concluded that the applicant's major depression and cognitive difficulties significantly impeded her ability to maintain activities of daily living, continue social relationships, and adapt to stressful circumstances, including parenting and employment.

The applicant was found to be catastrophically impaired within the meaning of the Schedule.

The appellant was injured in a motor vehicle accident and applied for statutory accident benefits.

The insurer paid income replacement benefits but denied non-earner benefits in 2004.

After income replacement benefits were terminated in 2006, the appellant sought non-earner benefits in 2009 and commenced an action in 2012.

The motion judge granted summary judgment dismissing the action as time-barred.

The Court of Appeal upheld the decision, confirming that the two-year limitation period for non-earner benefits began to run when the insurer initially refused them in 2004, even while the appellant was receiving income replacement benefits.

The applicant was injured in a motor vehicle accident while riding as a passenger on a city bus.

She applied for a determination of catastrophic impairment, which the insurer denied.

At arbitration, the arbitrator considered whether the applicant met the criteria under sections 2(1.2)(f) and (g) of the Statutory Accident Benefits Schedule.

The arbitrator found that the applicant's combined physical and psychological impairments resulted in a 42% whole person impairment, falling short of the 55% threshold under section 2(1.2)(f).

However, the arbitrator concluded that the applicant suffers from a pain disorder driven by both physical and psychological factors, resulting in a marked impairment in the realm of adaptation.

Consequently, the applicant was deemed catastrophically impaired under section 2(1.2)(g).

The applicant's request for a special award was denied as there was no dispute regarding the payment of benefits.

Following successful summary judgment in an accident benefits dispute, the defendant sought substantial indemnity costs and alternatively a personal costs order against the plaintiff's lawyer.

The court held that substantial indemnity costs were warranted because the plaintiff unreasonably continued a limitation argument after binding appellate authority and advanced extreme, unfounded allegations of fraud and bad faith against the insurer.

However, the court declined to order costs against counsel personally, finding the conduct did not meet the threshold for abuse of process or comparable misconduct under the governing common law and Rule 57.07 principles.

Costs were fixed at $20,000 all inclusive on a substantial indemnity basis.

The applicant sought a determination that she was catastrophically impaired following a motor vehicle accident, claiming marked or extreme impairment due to a mental or behavioural disorder, or alternatively, a 55% or more whole person impairment (WPI).

The arbitrator found that the applicant did not suffer a marked or extreme mental or behavioural impairment.

After evaluating conflicting medical evidence regarding her physical and cognitive injuries, the arbitrator assessed her combined WPI at 28%, well below the 55% threshold.

The applicant was awarded $6,000 for the costs of catastrophic assessments, but her claims for attendant care benefits were dismissed.

The insurer was awarded its arbitration expenses.

The Applicant was catastrophically injured in a motor vehicle accident and received supplementary attendant care services from her parents and a hospital.

No Form 1 was completed at the time.

Years later, an occupational therapist completed a retroactive Form 1.

The Insurer refused to pay, arguing a Form 1 cannot be retroactive and the expenses were not incurred.

The Arbitrator held that the Schedule does not prohibit a retroactive Form 1 and that the services provided by family and the hospital were 'incurred'.

The Insurer was ordered to pay the attendant care benefits, the cost of the Form 1, interest, and expenses.

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

After his counsel was removed from the record, the applicant failed to provide written submissions or attend the scheduled arbitration hearing.

The arbitrator proceeded in the applicant's absence pursuant to Rule 37 of the Dispute Resolution Practice Code.

As the applicant presented no evidence to support his claims, the arbitration was dismissed.

The insurer was awarded its expenses of the arbitration in the amount of $1,114.67.

The appellant sought the costs of an appeal regarding a claim for home modifications under the Statutory Accident Benefits Schedule.

The insurer sought its legal expenses on the basis that the law was well settled.

The Director's Delegate found that the issue of whether an insured can have multiple 'existing homes' was novel, as it was the first case to apply that principle to a given factual situation.

Accordingly, the parties were ordered to bear their own legal expenses of the appeal.

The appellant, who suffered catastrophic injuries resulting in quadriplegia, appealed an arbitrator's decision denying his claim for $204,130 in home renovations as a rehabilitation benefit.

The insurer had already paid approximately $331,000 towards the purchase of a new home, representing the value of renovations that would have been required for the appellant's existing rented home.

The Director's Delegate upheld the arbitrator's decision, finding that under section 15(8) of the Statutory Accident Benefits Schedule, the maximum benefit available for the purchase of a new home is the value of the renovations to the existing home.

The new home did not become the 'existing home' for the purpose of claiming further renovation costs.

The applicant, who was rendered a quadriplegic in a motor vehicle accident, sought a rehabilitation benefit of $204,130 for renovations to a newly purchased home.

The insurer had already paid $279,980, representing the estimated cost of renovating the applicant's existing rented home, which could not be renovated due to the landlord's refusal.

The applicant argued that the new home was now his 'existing home' and that the statutory limit did not apply because the rented home could not be renovated.

The arbitrator held that the rented home was the 'existing home' and that section 15(8) of the Statutory Accident Benefits Schedule limits the benefit for purchasing a new home to the cost of renovations that would have been required for the existing home.

The claim for the additional amount was dismissed.