The claimant appealed the Tribunal’s decision that her claim for IRBs was barred by the limitation period. She argued that the insurer’s denials were invalid because the insurer did not provide copies of the IE reports to the practitioners who completed the Disability Certificates. The Court agreed with the Tribunal that the insurer’s failure to provide the IEs was not fatal to the limitation period. The insurer communicated all of the information required to the claimant to enable her to decide whether to dispute her entitlement.
The insurer appealed the LAT’s decision that counsel acting in a priority matter could not also act in the LAT dispute, and the decision excluding the transcript from the priority EUO from the LAT hearing. The Court dismissed the appeal and concluded that the LAT’s decision was reasonable. It held that a conflict could arise if the same counsel acted in the priority dispute and at the LAT. It also reasoned that the protections of section 33 would not be followed if the priority EUO transcript was admitted without leave of the Tribunal.
The claimant sought judicial review of the Tribunal’s decision that it did not have jurisdiction to award interim benefits. Before the hearing, the claimant and the insurer settled the claim on a full and final basis. The claimant argued that the Court should nevertheless make a determination on the matter. The Court dismissed the judicial review on the grounds that it was moot, but wrote that the Tribunal’s earlier decision was not binding on any other adjudicator.
The insurer sought judicial review of the Tribunal’s decision to award various medical benefits. The Court reviewed the Tribunal’s decision on a correctness standard and dismissed the appeal. It agreed with the insurer that a benefit could not be deemed incurred without a specific finding that the insurer unreasonably withheld or delayed payment of a benefit. However, the Court also wrote that the Tribunal’s decision made it clear that the benefit had been incurred because the services were provided and the claimant owed money to the treatment provider.
The insurer sought judicial review of the Tribunal’s decision that the limitation period should be extended based on section 7 of the LAT Act. The Divisional Court dismissed the review on the basis that the LAT proceeding needed to first be completed in its entirety before seeking judicial review.
The claimant judicial review of the dismissal of her claim on two grounds: that she her family physician should be entitled to give opinion evidence, and that the adjudicator did not properly address causation. The Divisional Court agreed with the claimant and remitted the matter for a new hearing. It held that the Tribunal erred in not permitting the family physician to give opinion evidence at the hearing. The Divisional Court also wrote that the Tribunal had not set out the causation test it had applied, and that it was no appropriate for the test to be “implied.”
Aviva sought reconsideration of the Tribunal’s reconsideration that its section 38 denial did not provide sufficient “medical and any other reasons for the examination,” and that the claimant was not required to attend the IE. The Court upheld the reconsideration decision as falling within the range of reasonableness. The Court wrote: “where reasons are required, they must be meaningful in order to permit the insured to decide whether or not to challenge the insurerÂ’s determination. Mere ‘boilerplate’ statements do not provide a principled rationale to which an insured can respond. In essence, such statements constitute no reasons at all.”
The insurer appealed the Tribunal’s decision that the claimant was not barred by the limitation period from seeking IRBs. The Court held that the appeal to Divisional Court was premature, and that the matter should proceed at the Tribunal regarding the claimant’s entitlement to IRBs. If IRBs were awarded, the insurer could then appeal the final decision of the Tribunal. The case was not a rare or exceptional case where the Court should consider an interim or interlocutory decision.
The insurer sought judicial review of the Tribunal’s decision that the claimant was involved in an accident, and also sought judicial review of the Case Conference adjudicator’s framing of the dispute. The claimant had been struck by the door of a vehicle twice, and then physically assaulted by the driver of the vehicle. The insurer had accepted that the door-related injuries qualified as an “accident,” but that the punches to the face did not. The adjudicator concluded that the whole incident was an “accident.” The Court concluded that the Tribunal’s decision was unreasonable and sent the matter back to the Tribunal for a new hearing. The Court explained that the Case Conference adjudicator’s reframing of the issue in dispute denied the insurer procedural fairness. The Court did not address whether the facts of loss qualified as an “accident.”
The claimant sought judicial review of the Tribunal’s decision that she could not pursue specified benefits because she had not completed and returned an election prior to applying to the LAT. The Court dismissed the review. The Court held that the claimant’s failure to submit the election, contrary to section 35 of the SABS, meant that her application was incomplete. The claimant’s submission of an election (for NEBs) after the Case Conference did not retroactively validate her claim. The Court indicated that the claimant could re-apply to the LAT once the insurer had made a decision on the claim for NEBs.