<Preliminary Issue Decision in the Tribunal Hearing> -There was a following preliminary issue decision in the Tribunal hearing earlier today:. – Was the Aviva Insurance Company’s Notice of Denial to pay accident benefits containing straightforward and clear language enough to trigger a 2-year limitation under the SABS? – The answer was “No.” The adjudicator was … Read More

Attendant Care Benefits approval

Recently, the Certas Home & Auto Insurance Company requested a new Form 1 for its determining our client’s attendant care benefits under the SABS. The Form 1 was submitted by our occupational therapist recommending a total of $2.5K in assistance. Form-1 included feeding, medication management, and most significantly, 22 hours a day for supervision due … Read More

IRBs after 104-weeks post-accident

-McKay v Travelers 2022 CanLII 6748 The applicant has the onus of proving on a balance of probabilities that he is completely unable to engage in any employment for which he is reasonably suited by education, training, or experience. To be eligible to receive IRBs 104 weeks post-accident, s. 6(2)(b) of the SABS requires that … Read More

The time to apply to the Tribunal is extended.

–18-005114 v Allstate Insurance Company, 2018 CanLII 143515 (ON LAT) –A.F. v. North Blenheim Mutual Insurance Company, 2017 CanLII 87546 (ON LAT) (“Blenheim”) –Manuel v. Registrar, Motor Vehicle Dealers Act, 2002, 2012 ONSC 1492 (Ont. S.C.) -The Tribunal held a case conference on October 16, 2018. At the case conference, Adjudicator Ferguson ordered that the … Read More

The Tribunal erred in calculating the Attendant Care Benefits quantum.

-RECONSIDERATION DECISION –> R.K. v. Aviva Insurance Canada, 2020 CanLII 94744 (ON LAT) -The incurred hours must be paid accordance with the mandatory Guideline rates and Form 1. Thus, for the reasons above, the Adjudicator granted Aviva’s request for reconsideration. <Overview> Aviva seeks reconsideration of the Licence Appeal Tribunal’s (the “Tribunal”) June29, 2018 Order issued … Read More

Slipped and fell at a gas station? What is the two-part test applied by the court for determining whether this incident is an “accident” under s. 3(1) of the SABS?

S.B. v. Aviva Insurance Company of Canada, 2019 CanLII63363 Chisholm v. Liberty Mutual Group, 2002 CanLII 45020 (ONCA) Greenhalgh v. ING Halifax Insurance Co., 2004 CanLII 21045 (ONCA) The first part of the test, the purpose test, requires a determination of whether the incident resulted from an ordinary and well-known activity to which automobiles are … Read More

Two statutory tests for entitlement to the Income Replacement Benefits

16-000082 v Echelon General Insurance Company, 2016 CanLII 82874 The first test is applicable for the period from one week after the date of the accident until the second anniversary. The claimant is entitled to be paid an IRB if he suffered a substantial inability to perform the essential tasks of his pre-accident employment. After … Read More

Applicant’s both NEBs and IRBs can be advanced to the Tribunal.

16-000063 v Dominion of Canada General Insurance Company, 2016 CanLII 67139 Galdamez v. Allstate Insurance Company of Canada, 2012 ONCA 508 Toresho v. Primmum Insurance Company, 2015 ONSC 516 -Under s.35 (1) of the SABS, the Applicant was entitled to notice from the insurer to elect the benefit she wished to receive. -The Application for … Read More