Siona Sullivan

The applicant sought entitlement to statutory accident benefits for a rehabilitation assistant, physiotherapy, massage, and a gym membership following a motor vehicle accident.

The Tribunal found that the applicant failed to prove the treatment plans were reasonable and necessary.

Medical evidence demonstrated that the applicant's rotator cuff tear pre-dated the accident and that she had reached maximal medical improvement with full range of motion.

The application was dismissed.

The applicants, two brothers, suffered serious burn injuries from an explosion and fire while replacing the fuel pump of an inoperable vehicle in a residential garage.

They applied for statutory accident benefits, which their insurers denied on the basis that the incident was not an 'accident' under the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal held a preliminary issue hearing to determine if the incident met the definition of an accident.

Applying the purpose and causation tests, the Tribunal found that repairing an inoperable vehicle hoisted on jacks is not an ordinary and well-known activity to which automobiles are put by motorists.

The Tribunal concluded the applicants were not using the vehicle for a motoring purpose, and therefore the incident was not an accident within the meaning of the Schedule.

The applications for benefits were dismissed.

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs) at a rate of $400.00 per week.

The insurer paid IRBs at a rate of $308.74 per week, based on the applicant's declared self-employment income to the Canada Revenue Agency.

The arbitrator held that under section 4(5) of the Statutory Accident Benefits Schedule, the applicant is bound by the income declared for tax purposes, precluding him from claiming a higher income for IRB purposes.

The applicant's IRB entitlement was fixed at $308.74 per week, subject to future adjustment if his tax returns are reassessed.

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

Her occupational therapist submitted a treatment and assessment plan (OCF-18) that included a new diagnosis of a foot fracture.

The insurer denied the plan and required the applicant to attend an insurer examination with an orthopaedic surgeon to investigate the new diagnosis.

The applicant failed to attend the examination, arguing the insurer's notice lacked sufficient medical reasons.

The arbitrator found that investigating a new diagnosis constituted a valid medical reason, making the notice compliant with section 44 of the Schedule.

Consequently, the applicant was precluded from proceeding to mediation under section 55(2) of the Schedule.

The appellant, a five-year-old child, was injured when she fell down the interior stairs of a parked fire truck while attending a birthday party.

The respondent insurer denied her claim for statutory accident benefits on the basis that the incident was not an 'accident' under the Schedule.

The arbitrator agreed, finding that the fire truck was being used as a display rather than a motor vehicle.

On appeal, the Director's Delegate reversed the decision, holding that the arbitrator erred in law by reading the purpose test too narrowly.

Exiting a parked vehicle, even one used for education and entertainment, is a normal and well-known use of a motor vehicle.

The incident was declared an accident.

The applicant, a five-year-old child, was injured when she fell out of a parked fire truck while attending a birthday party.

She sought statutory accident benefits from the insurer, who denied the claim on the basis that the incident was not an 'accident' under s. 3(1) of the Schedule.

The arbitrator found that the fire truck was being used as a display for entertainment and educational purposes, not as a motor vehicle.

Therefore, the incident did not meet the purpose test for the normal use or operation of an automobile.

The application for accident benefits was dismissed.