Samia Alam

The applicant sought a determination of catastrophic impairment and entitlement to attendant care benefits and hearing aids following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant was statute-barred from claiming attendant care benefits because she failed to dispute the insurer's denial within the two-year limitation period, and the justice of the case did not warrant an extension.

On the issue of catastrophic impairment, the Tribunal applied the AMA Guides to assess the applicant's physical and psychological impairments, ultimately finding a combined Whole Person Impairment (WPI) of 56%, which exceeds the 55% threshold under Criterion 7.

The Tribunal denied the claim for hearing aids because the applicant incurred the expense without first submitting a treatment plan, contrary to section 38(2) of the Schedule.

The claim for a special award was also dismissed as the insurer did not unreasonably withhold or delay benefits.

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

The Licence Appeal Tribunal found that the applicant's injuries were predominantly minor and subject to the Minor Injury Guideline (MIG) limit, as she failed to establish that pre-existing conditions, chronic pain, or psychological impairments warranted removal.

The Tribunal also dismissed the applicant's claim for an income replacement benefit (IRB), finding she did not prove a substantial inability to perform the essential tasks of her employment during the pre-104-week period.

Claims for a treatment plan, an award, and costs were also dismissed.

The applicant sought statutory accident benefits after allegedly being struck by an e-bike.

The respondent denied benefits on the basis that the incident did not meet the definition of an 'accident' under the Statutory Accident Benefits Schedule.

The Tribunal found that the applicant failed to establish on a balance of probabilities that the e-bike was an 'automobile' in ordinary parlance or under any relevant statute, such as the Highway Traffic Act.

Consequently, the applicant was not involved in an 'accident' and the application for benefits was dismissed.

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

At the time of the accident, the appellant was an on-call agency worker who had not worked for six weeks.

The Divisional Court upheld the Tribunal's finding that the appellant was not 'employed' under s. 5(1)1(i) of the Statutory Accident Benefits Schedule, applying the interpretation from Arab v. Unica Insurance that employment requires the exchange of remuneration for services over a defined period.

The appeal was dismissed.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision denying her entitlement to an income replacement benefit (IRB).

The applicant argued that the adjudicator erred in law by finding that her on-call work arrangement at a pasta factory did not constitute employment at the time of the accident under s. 5(1)(1)(i) of the Statutory Accident Benefits Schedule.

The adjudicator dismissed the request, affirming the application of the Divisional Court's test in Arab, which requires an exchange of remuneration for services over a defined period.

The adjudicator found no error in concluding that being on call, without performing services or receiving remuneration at the time of the accident, did not meet the statutory definition of employment.

The applicant sought statutory accident benefits for physical injuries she sustained while providing full-time attendant care to her husband, who was catastrophically impaired in a motor vehicle accident.

The respondent denied the benefits on the basis that the applicant was not involved in an 'accident'.

The Tribunal applied the two-part test from Caughy and found that the applicant's injuries did not arise out of the use or operation of an automobile, nor were they directly caused by it.

The Tribunal concluded that the injuries resulted from providing care, which broke the chain of causation.

The application was dismissed.

The applicant sought accident benefits following a motor vehicle accident, arguing his injuries warranted removal from the Minor Injury Guideline (MIG) due to a pre-existing torn meniscus, chronic pain, and psychological impairments.

The Licence Appeal Tribunal found the applicant failed to provide compelling medical evidence that his pre-existing knee injury was exacerbated by the accident or prevented his maximal medical recovery within the MIG.

The Tribunal also found insufficient evidence of chronic pain or psychological impairment.

As the MIG limits were exhausted, the claim for an orthopaedic assessment and an award for unreasonable delay were dismissed.

The applicant was injured in a motor vehicle accident while in the course of her employment.

She applied for accident benefits, but the insurer argued she was statute-barred under s. 61 of the Statutory Accident Benefits Schedule because she was entitled to WSIB benefits.

The applicant claimed she had elected to pursue a tort action, which would allow her to claim accident benefits under the s. 61(2) exception.

The Tribunal found that the applicant's election to sue in tort was not made in good faith, noting significant delays in pursuing the tort action, failure to notify the WSIB promptly, and ongoing appeals for WSIB benefits.

The Tribunal concluded the tort election was made solely for the purpose of claiming accident benefits, rendering her statute-barred.

The application was dismissed.

The applicant sought an income replacement benefit (IRB) following a motor vehicle accident.

Prior to the accident, the applicant worked on an on-call basis but had not worked for over six weeks before the collision.

The Licence Appeal Tribunal found that the applicant was not employed at the time of the accident within the meaning of section 5(1)(1)(i) of the Schedule, as she was not receiving remuneration for services during that period.

The application for an IRB and interest was dismissed.

The appellant, a taxi driver, was assaulted by a passenger after exiting his vehicle to collect a fare.

He applied for statutory accident benefits, which were denied on the basis that the incident was not an 'accident' under s. 3(1) of the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal upheld the denial, finding the purpose and causation tests were not met.

The Divisional Court dismissed the appeal, holding that the issues raised were questions of mixed fact and law, not extricable errors of law, and the Tribunal made no error in its application of the legal tests.

The appellant appealed a Licence Appeal Tribunal decision finding she was not catastrophically impaired under s. 3.1(1) 2. iii of the Statutory Accident Benefits Schedule.

The appellant suffered a severe and permanent alteration of the structure of her leg, but her functional mobility impairment (measured by the SCIM) was only temporary.

The Divisional Court upheld the adjudicator's interpretation that the SABS requires both the structural and functional alterations to be permanent to meet the catastrophic impairment threshold.

The appeal was dismissed.

The respondent insurer requested reconsideration of a preliminary issue decision which found that it had requested Insurer's Examinations more often than reasonably necessary, meaning the applicant was not barred from proceeding with his income replacement benefit claim under s. 55 of the Schedule.

The Tribunal denied the reconsideration request, finding that the preliminary issue decision did not finally dispose of the appeal and therefore fell outside the scope of Rule 18.1.

Furthermore, the Tribunal found no procedural unfairness or error of law, as the insurer's requests for examinations were duplicative and unreasonable, and the applicant had no duty to explain his non-attendance at improperly requested examinations.

The appellant insurer appealed a Licence Appeal Tribunal (LAT) decision requiring it to fund the respondent's catastrophic impairment (CAT) assessment under s. 25(1)5 of the Statutory Accident Benefits Schedule.

The insurer argued it was only required to pay for an assessment completed before the insured submitted their application.

The Divisional Court upheld the LAT's decision, finding that the preparation of an application does not cease once the formal document is submitted, and the insurer must fund any assessment necessary for determining whether the impairment is catastrophic.

The applicant was injured in a 2015 motor vehicle accident and sought statutory accident benefits.

The insurer denied medical benefits, placing her in the Minor Injury Guideline (MIG), and denied a non-earner benefit.

The Tribunal found that the accident exacerbated the applicant's pre-existing conditions and caused chronic pain, removing her from the MIG.

The Tribunal ordered the insurer to pay for a psychological assessment with interest, finding it reasonable and necessary.

However, the claims for an in-home attendant care assessment and a non-earner benefit were dismissed, as the applicant failed to prove a complete inability to carry on a normal life.

The applicant was injured in a 2015 motor vehicle accident and sought accident benefits, which the respondent insurer denied on the basis that her injuries fell within the Minor Injury Guideline (MIG).

The applicant had significant pre-existing injuries from prior accidents.

The Tribunal found that the subject accident exacerbated her pre-existing conditions and caused chronic pain, removing her from the MIG.

The Tribunal ordered the respondent to pay for a psychological assessment, finding it reasonable and necessary, along with interest.

However, the Tribunal dismissed the claims for an In-Home Attendant Care assessment and a non-earner benefit, as the applicant failed to prove a complete inability to carry on a normal life.

The insurer requested a reconsideration of a decision awarding the insured funding for catastrophic impairment assessments.

The insurer argued the adjudicator erred in law by finding the assessments were not true rebuttal reports and were prepared for the purpose of a catastrophic application under s. 45 of the Schedule.

The adjudicator dismissed the reconsideration request, finding no errors of law that would materially affect the outcome.

The adjudicator maintained that the insured's right to be assessed for catastrophic impairment was not exhausted and that the timing of the application did not invalidate the funding request.

The insured's request for costs was also denied.

The applicant sought payment for the cost of an accounting report obtained to calculate his Income Replacement Benefit (IRB) following a motor vehicle accident.

The insurer denied the expense.

The Tribunal found that the accounting report was not reasonable and necessary because it was commissioned prematurely before any dispute over the IRB quantum existed, and the applicant's IRB calculation was straightforward, based on only two income sources.

The claim for the cost of the report and interest was dismissed.

The insurer sought its expenses of $24,213.20 following an arbitration hearing where it successfully argued the applicant was not catastrophically impaired.

The arbitrator found there was divided success, as the applicant was only 1% away from the catastrophic impairment threshold and was successful on some treatment plans.

The insurer's offers to settle were not compliant with the Code as they were on a full and final basis.

Considering the criteria in the Code, the arbitrator ordered that each side bear its own expenses.

The insurer brought an application to the Licence Appeal Tribunal seeking a determination that the insured was not catastrophically impaired and was not entitled to income replacement benefits, as well as seeking repayment of overpaid benefits.

The insured raised a preliminary issue arguing the Tribunal lacked jurisdiction because the insured had not disputed the insurer's determinations.

The Tribunal held that an insurer cannot bring an application to determine entitlement to benefits or catastrophic impairment where the insured has not disputed the insurer's denial, as no 'dispute' exists under s. 280 of the Insurance Act.

However, the Tribunal allowed the insurer's application for repayment of overpaid income replacement benefits to proceed.

The applicant was injured in a 2005 motor vehicle accident and sought a catastrophic impairment determination in 2015.

The insurer denied the designation based on its own assessments.

The applicant sought funding for his own catastrophic assessments, which the insurer denied on the basis that the 2010 amendments to the Schedule eliminated funding for rebuttal reports.

The Tribunal held that while the 2010 amendments apply prospectively and eliminated rebuttal report funding, the applicant's requested assessments were actually his first assessments, not true rebuttals.

Denying funding would rob the applicant of his substantive right to be assessed.

The Tribunal found the assessments partially reasonable and necessary, awarding $10,500.00.