Category: Income Replacement Benefits

G.W. v. Coachman Insurance Company (16-003306)

Post author By tgp-admin
Post date November 15, 2019
No Comments on G.W. v. Coachman Insurance Company (16-003306)

The insurer sought reconsideration of the adjudicator’s decision regarding entitlement to ACBs, interest, and a special award. The claimant sought reconsideration of the adjudicator’s finding of an end date for IRBs and ACBs, and the formula used to calculate the quantum of the special award. Vice-Chair Marzinotto partially granted both the insurer’s and the claimant’s requests. She held that the amount payable for ACBs based on a finding of unreasonably withholding benefits under s. 3(8) of the SABS was limited to the economic loss incurred by the claimant’s wife, which was less than the Form 1 amount. Vice-Chair Marzinotto found that the arbitrator did not err in finding an end date for IRBs and ACBs at the 104-week mark as the hearing took place in the pre-104 week period and there was no evidence submitted on post-104-week entitlement. Vice-Chair Marzinotto held that the formula for calculating the maximum amount available for a Special Award is: 50 percent x (benefits that were unreasonably withheld or delayed + SABS interest on these benefits calculated under the Schedule + compound interest calculated according to s.10 O. Reg.664).

O.M. v. Aviva Insurance Canada (16-003552)

Post author By tgp-admin
Post date November 6, 2019
No Comments on O.M. v. Aviva Insurance Canada (16-003552)

The claimant sought entitlement to IRBs. The claimant failed to attend the scheduled hearing and did not submit any evidence in support of the claim. Vice Chair Shapiro dismissed the claim.

O.I. v. RBC General Insurance Company (18-005774)

Post author By tgp-admin
Post date November 5, 2019
No Comments on O.I. v. RBC General Insurance Company (18-005774)

The claimant sought entitlement to IRBs for a six months period. Adjudicator Maedel dismissed the claim. He found that the claimant did not suffer job-limiting chronic pain; rather, the claimant suffered some pain in his right shoulder and lower back, but maintained normal range of motion. These impairments did not render him substantially unable to complete his essential work tasks.

M.R. v. Allstate Insurance Company (17-008969)

Post author By tgp-admin
Post date November 1, 2019
No Comments on M.R. v. Allstate Insurance Company (17-008969)

The claimant sought reconsideration of the Tribunal’s denial of ACBs and order barring the claim for medical benefits based on IE Non-Attendance; the Tribunal had awarded IRBs. Adjudicator Mazerolle held that the Tribunal denials did not meet the criteria in Rule 18 for reconsideration. However, Adjudicator Mazerolle found that the award of IRBs beyond the 104-week mark was an error and that the claimant had not led evidence to support IRBs on the “complete inability” test.

P.M. v. Aviva Insurance Canada (17-005419)

Post author By tgp-admin
Post date October 29, 2019
No Comments on P.M. v. Aviva Insurance Canada (17-005419)

The claimant sought entitlement to IRBs and medical benefits. She also sought entitlement to an accounting report. Adjudicator Watt denied the claim for IRBs, as the claimant had been paid IRBs up to the date she returned to work on a modified basis. He found the treatment plans not reasonable and necessary. Finally, he held that the cost of the accounting report was not payable because it was the claimant’s behaviour which resulted in difficulties calculating the IRB. She withheld information regarding disability benefits and her return to work. Furthermore, she was not a self-employed person.

Fordjour v. Royal and Sun Alliance Insurance Company of Canada (2019 ONSC 6268)

Post author By tgp-admin
Post date October 28, 2019
No Comments on Fordjour v. Royal and Sun Alliance Insurance Company of Canada (2019 ONSC 6268)

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.”

P.G. v. Intact Insurance Company (18-005386)

Post author By tgp-admin
Post date October 23, 2019
No Comments on P.G. v. Intact Insurance Company (18-005386)

The claimant sought entitlement to ongoing IRBs and over $20,000 in assessments related to the IRB claim. Adjudicator Parish held that the claimant was entitled to IRBs up to the 104-week mark, but that the claimant’s functionality did not meet the “complete inability” test. She also awarded the cost of an occupational therapy situational assessment, orthopaedic assessment, and vocational assessment because they were relevant to the claimant’s injuries and claim for IRBs. The proposed psychological assessment, neurological assessment, executive summary, and transportation were not awarded because the claimant had not sought or been referred for psychological or neurological treatment; the executive summary was duplicative of the awarded assessments; and there was no evidence that transportation to the assessments was required.

M.C. v. Wawanesa Mutual Insurance Company (18-002854)

Post author By tgp-admin
Post date October 22, 2019
No Comments on M.C. v. Wawanesa Mutual Insurance Company (18-002854)

The insurer sought reconsideration of the Tribunal’s decision to award IRBs. Adjudicators Parish and Maleki-Yazdi rejected the reconsideration. They held that the award of IRBs “to date and ongoing” was not outside of the jurisdiction of the LAT, and that the claimant was entitled to IRBs as long as she met the appropriate disability test. Second, they rejected the argument that classifying the claimant’s job duties as “light” was an error of mixed fact and law. The Tribunal had provided sufficient reasons for its classification of the claimant’s pre-accident job, and that reconsideration was not an opportunity to re-litigate the matter.

P.W. v. Economical Insurance (18-008457)

Post author By tgp-admin
Post date October 22, 2019
No Comments on P.W. v. Economical Insurance (18-008457)

The claimant sought entitlement to IRBs. Adjudicator Boyce held that the claimant failed to prove his claim because he had not made any written submissions or evidence regarding the claim. Adjudicator Boyce also noted that the claimant was not employed at the time of the accident, had not worked for 26 of the previous 52 weeks, and was not receiving benefits from EI. He was therefore not entitled to IRBs under section 5 of the SABS.

D.T. v. Wawanesa Mutual Insurance Company (18-005613)

Post author By tgp-admin
Post date October 2, 2019
No Comments on D.T. v. Wawanesa Mutual Insurance Company (18-005613)

The claimant sought entitlement to IRBs, the MIG, and various medical benefits. The insurer argued that the claimant’s entitlement to IRBs had already been decided and was res judicata. The Tribunal had already adjudicated an application for IRBs (among other things), which was upheld on reconsideration and at the Divisional Court. There was no new evidence to support that the claimant had additional injuries or conditions. The new medicolegal reports the claimant obtained could have been obtained prior to the first hearing.

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