Samia M. Alam

The applicant sought non-earner benefits following a 2013 motor vehicle accident.

The respondent denied the claim and later raised a preliminary issue, arguing the applicant's appeal to the Licence Appeal Tribunal was statute-barred under s. 56 of the Statutory Accident Benefits Schedule because it was filed more than two years after the denial.

The Tribunal found that the applicant had filed for mediation within the two-year period and commenced her appeal within the 90-day extension period following the mediator's report, as permitted by the transition rules.

The Tribunal dismissed the preliminary issue, holding the appeal was not statute-barred, and noted that even if it were, the applicant met the criteria for an extension under s. 7 of the Licence Appeal Tribunal Act.

The applicant sought reconsideration of a Licence Appeal Tribunal decision denying her claim for attendant care benefits following a 2014 motor vehicle accident.

The applicant argued the Tribunal breached procedural fairness by holding a written hearing and erred in its causation analysis by applying the 'but for' test instead of the 'material contribution' test.

The Executive Chair dismissed the request, finding that the applicant had acquiesced to the written hearing format and failed to adduce sufficient evidence to establish causation under either legal test.

The applicant was injured in a motor vehicle accident and received income replacement benefits (IRBs) until the insurer terminated them based on an orthopedic assessment.

A preliminary issue hearing was held to determine whether the application should be dismissed because the applicant failed to provide requested financial information under sections 33 and 34 of the Statutory Accident Benefits Schedule.

The arbitrator found that the insurer's notice of termination was based solely on medical entitlement and did not mention suspension for non-compliance.

Therefore, the applicant was not required to provide further financial information at this stage, and the application for arbitration was allowed to proceed.

The applicants sought accident benefits following an alleged motor vehicle collision.

The insurer denied the claims, alleging the accident was staged and the applicants made material misrepresentations.

At a preliminary issue hearing, the arbitrator heard evidence from the applicants, the occupants of the other vehicle (who confessed to participating in a staged accident scheme), and accident reconstruction experts.

The arbitrator found the applicants' version of events highly improbable, noting inconsistencies between their testimony and the physical damage to the vehicles, the lack of independent witnesses, and the improbable behaviour of the passengers.

The arbitrator concluded the reported accident did not occur and dismissed the claims.

The applicant, a taxi driver, was assaulted by passengers and subsequently fell into a ditch while attempting to close the van's door.

He applied for statutory accident benefits, but the insurer disputed whether the incident constituted an 'accident' under section 3(1) of the Statutory Accident Benefits Schedule.

The arbitrator applied the purpose and causation tests from Greenhalgh, finding that the taxi was being used for its ordinary purpose and that the entire series of events, starting with the use of the automobile, directly caused the impairment.

The arbitrator concluded that the applicant was involved in an accident.

The appellant sought leave to appeal an arbitrator's decision which found that a settlement disclosure and full and final release precluded him from proceeding to arbitration.

The respondent argued the appeal should be rejected for lack of standing, asserting the appellant had not participated and the appeal was brought by a third-party service provider.

The Director's Delegate declined to reject the appeal at the preliminary stage, finding the arbitrator's decision was a final decision of all issues in dispute and that there was insufficient evidence to reject the appeal for lack of standing without a full record.

The appellant sought his legal expenses following a successful appeal regarding interim legal expenses for catastrophic impairment reports.

The respondent agreed the appellant was entitled to expenses but disputed the amount claimed.

The Director's Delegate found that the novelty and importance of the issues justified an increased hourly rate of $150 for the appellant's counsel.

Taking into account the overriding consideration of reasonableness and proportionality, the Delegate fixed the appellant's legal expenses of the appeal at $7,900.42, inclusive of fees, disbursements, and HST.

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

The insurer's assessors concluded he did not meet the threshold, and the applicant sought funding for rebuttal reports.

The insurer denied funding, arguing the new SABS eliminated this right and the applicant failed to meet the timelines under the old SABS.

The arbitrator found the applicant was not entitled to substantive interim benefits for the reports under either SABS.

However, applying the 'whole case approach,' the arbitrator awarded $10,500 as an interim expense to fund the rebuttal reports, citing the applicant's financial distress and the need for procedural fairness to answer the insurer's expert reports.

The appellant was injured in a motor vehicle accident and sought $12,960 in interim expenses to fund a catastrophic impairment rebuttal assessment.

The arbitrator dismissed the motion, finding that while the criteria for interim expenses were met, the $50,000 monetary cap for medical and rehabilitation benefits under section 18 of the 2010 Schedule had been exhausted.

On appeal, the Director's Delegate held that the arbitrator erred in applying the section 18 monetary cap to an award of interim legal expenses under subsection 282(11.1) of the Insurance Act.

The appeal was allowed in part, and the insurer was ordered to pay $6,780 for four expert reports, conditional upon catastrophic impairment being formally added as an issue in the arbitration.

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

The appellant insurer terminated certain benefits, and the respondent applied for mediation and later arbitration.

The insurer appealed a preliminary arbitration decision which found that the respondent's claims were not statute-barred.

On appeal, the Director's Delegate found that the arbitrator erred in law regarding the 'clear and unequivocal refusal' prerequisite and the waiver of the limitation defence.

However, the Delegate upheld the arbitrator's findings that there was evidence supporting the conclusion that the insurer failed to communicate its refusal to pay Income Replacement Benefits, and that the arbitration was validly commenced within the 90-day extension period despite the initial omission of the filing fee.

The appeal was dismissed.

The appellant sought to appeal an arbitrator's preliminary order denying his request for interim legal expenses to fund a rebuttal catastrophic impairment assessment.

The arbitrator had found that while the appellant met the test for interim legal expenses, the $50,000 limit on medical and rehabilitation benefits under section 18 of the 2010 Schedule precluded the award.

The Director's Delegate exercised discretion to accept the appeal, finding that it raised a novel and broadly important issue of whether the statutory benefit maximums apply to interim expense awards under the Insurance Act.

The insurer sought an order requiring the applicant to attend a further psychiatric insurer examination to determine catastrophic impairment, as the psychiatrist who conducted the initial examination had died.

The applicant agreed to attend on the condition that the insurer fund a rebuttal assessment without a $2,000 limit.

The arbitrator found that a further examination was reasonably required in the interest of fairness.

The arbitrator also ordered the insurer to fund a rebuttal assessment without a $2,000 limit, as the applicant's right to a rebuttal assessment crystallized under the Schedule in effect at the time of the 2007 accident.

The appellant insurer sought to appeal an arbitrator's preliminary issue order which dismissed its motion to find the respondent's claims for statutory accident benefits statute-barred.

The Director's Delegate considered whether to accept the appeal before the main arbitration hearing.

Noting that the parties had already adjourned the main hearing pending the potential appeal, the Director's Delegate exercised his discretion to accept the appeal to avoid having the matter sit on hold, and set a timeline for written submissions.

The insured was injured in a motor vehicle accident and applied for a catastrophic impairment determination.

The insurer denied the application based on its medical examinations.

The insured submitted a rebuttal report beyond the 80-day time limit and sought payment for its cost.

The arbitrator found the insured had a reasonable explanation for the delay and ordered the insurer to pay the report's cost.

On appeal, the Director's Delegate upheld the finding of a reasonable explanation but found the arbitrator erred in law by reversing the onus of proof regarding the reasonableness of the report's cost.

The issue of the report's cost was remitted for re-determination.

The insurer appealed an arbitrator's decision ordering it to pay the cost of a late-filed catastrophic impairment rebuttal report plus interest.

The insured sought an extension of time to file a cross-appeal, which the Director's Delegate granted, finding minimal prejudice and that it would produce the most just and quickest resolution.

The insurer also sought a stay of the arbitrator's order pending the appeal.

The Delegate granted a partial stay, staying the interest component of the order but requiring the insurer to pay the principal sum of $16,896.64 for the report, noting the hardship considerations and an undertaking from the assessment clinic to repay the funds if the appeal is successful.

The appellant insurer sought to appeal a preliminary arbitration decision which found that its denial of a catastrophic impairment designation did not trigger the two-year limitation period under the Insurance Act.

The Director's Delegate accepted the appeal, noting it raised a substantive and novel issue of law that could determine the entire arbitration.

However, the request for a stay of the arbitrator's order was denied, as the parties had already consented to adjourn the arbitration hearing, rendering a stay of little practical effect.

The appellants appealed a motion judge's refusal to amend their statement of claim to add a proposed defendant and change the location of a slip and fall accident.

The Court of Appeal upheld the motion judge's finding that the claim against the proposed defendant was statute-barred, as the appellants failed to rebut the presumption of discoverability under s. 5(2) of the Limitations Act, 2002.

The Court also agreed that the doctrine of misnomer did not apply because the intended defendant did not know it was the target of the suit.

However, the Court granted leave to amend the statement of claim to change the location of the accident as against the existing defendant.