W. Patrick Sloan

The applicant sought statutory accident benefits after slipping and falling on ice while clearing snow from her vehicle.

The respondent insurer denied benefits, arguing the incident did not meet the definition of an 'accident' under the Schedule and questioning the applicant's credibility regarding the sequence of events.

The Tribunal accepted the applicant's version of events and applied the two-part purpose and causation test.

The Tribunal found that clearing snow is an ordinary use of a vehicle and that the ice was a normal risk, not an intervening cause.

The Tribunal concluded the incident was an 'accident' and ordered the matter to proceed to a hearing on the substantive issues.

The applicant sought payment of $2,260.00 for a file review summary proposed in a treatment plan following a motor vehicle accident.

The respondent denied the expense on the basis that it was duplicative, as a file review is included in the cost of each approved assessment.

The Tribunal agreed, finding that a file review is a necessary component of an assessment and not an independently billable task under s. 25(5) of the Schedule.

The Tribunal also found the respondent's denial letter complied with s. 38(8) by providing a clear non-medical reason for the denial.

The application was dismissed.