Category: Jurisdiction

M.S. v. Unifund Assurance Company (18-000715)

The claimant applied to the LAT for IRBs. The insurer approved entitlement eight days before the hearing. The claimant sought an order from the Tribunal that she was entitled to ongoing IRBs; the insurer argued that because there was no longer a dispute, the Tribunal did not have jurisdiction. Adjudicator Gosio held that once the insurer agreed to pay IRBs, the Tribunal lost jurisdiction to adjudicate the issue, and that sections 280 and 281 did not permit the Tribunal to make an order once a dispute had been resolved.

T.N. v. TD Insurance Company (19-005638)

The claimant sought entitlement to ACBs in excess of the total approved by the insurer. The insurer raised a preliminary issue that the Tribunal did not have jurisdiction to hear the matter because the claimant had not actually incurrent any attendant care expenses. Adjudicator Lester found that there was a dispute between the parties since the respondent only partially approved the request amount in Form 1, regardless of whether expenses had been incurred. Adjudicator Lester ultimately concluded that the claimant was entitled to ACBs in excess of the amount approved by the insurer, totalling 8 hours per day. With regard to cueing, Adjudicator Lester held that the time should be considered under the specific Form 1 activity, rather than as a supervisory function.

Economical Mutual Insurance Company v. A.S. (19-001820)

The insurer applied to the LAT for repayment of IRBs, and also for a determination on the claimant’s entitlement to further IRBs, the application of a section 33 suspension, and whether the claimant sustained a catastrophic impairment. Adjudicator Boyce held that the insurer could not bring an application related to IRB entitlement, section 33 suspension, or a catastrophic impairment, but could proceed with the request for repayment. He reasoned that the Tribunal only had jurisdiction once there was a dispute between the parties. The insurer’s determination regarding IRBs, section 33, and a catastrophic impairment was not equivalent to a “dispute” or “disagreement.” The claimant could, potentially, agree with the determinations and abide by the decisions. The insurer was permitted to proceed with the request for repayment, but the remainder of the issues were dismissed.

Applicant v. Pafco Insurance Company (18-011583)

The claimant was involved in an accident in 1997. He applied to the LAT to dispute entitlement to IRBs, medical benefits, and a catastrophic impairment. The insurer argued that the claimant never submitted an OCF-1 and did not have a reasonable excuse for the delay. Adjudicator Kepman rejected the claimant’s arguments that he was not provided with the correct forms and that the insurer had not communicated with him around the time of the accident. She dismissed the claim, holding that the Tribunal could not adjudicate a dispute because the claimant never applied for the disputed benefits. She also would have held that the claimant failed to meet the limitation period.

T.K. v. Allstate Insurance (18-007113)

The claimant sought an order for interim benefits pending the LAT hearing. The insurer argued that the LAT did not have jurisdiction to award interim benefits. Adjudicator Letourneau agreed with the insurer and held that he did not have jurisdiction to award interim benefits. When read together, none of the Insurance Act, the Statutory Powers Procedure Act, nor the LAT Act gave the Tribunal the power to make an interim award. Instead, the adjudicator suggested that an expedited hearing be scheduled.

Applicant v. TD Insurance (17-005449)

The insurer brought a motion arguing that the LAT could not adjudicate a catastrophic impairment dispute without some other benefits also being in dispute. Adjudicator Ferguson rejected the insurer’s position and held that the LAT does have jurisdiction to determine whether a claimant is catastrophically impaired regardless of any entitlement to benefits being disputed.

Applicant v. Aviva Insurance Canada (17-004258)

The insurer argued that the LAT did not have jurisdiction to determine if the claimant sustained a catastrophic injury because the claimant had not disputed entitlement to any substantive benefits. Adjudicator Ferguson dismissed the insurer’s motion. Adjudicator Ferguson held that the provisions of the Insurance Act and the SABS did not preclude the LAT from a determination of a catastrophic impairment on a stand-alone basis.

J.T. v. Aviva Canada Inc. (16-003674)

The claimant sought reconsideration of the underlying Tribunal decision, in which the adjudicator concluded that the ATV the claimant was occupying at the time of the accident was not an “automobile,” and that the claimant was therefore not entitled to accident benefits. Executive Chair Lamoureux allowed the reconsideration and remitted the matter to a new adjudicator for a new hearing. She reasoned that the initial adjudicator failed to consider various documentary evidence and failed to analyze that evidence in the context of the OAP1 and the Sale of Goods Act. Executive Chair Lamoureux did uphold the adjudicator’s decision that estoppel did not apply (i.e. that the insurer was not required to continue paying accident benefits simply because it had started paying accident benefits upon receipt of the OCF-1), and re-iterated that the LAT did not have jurisdiction to exercise equitable relief. The LAT’s purpose was to adjudicate the claimant’s entitlement to benefits based on the terms of the SABS.

J.T. v. Aviva Canada Inc. (16-003674)

The claimant sought reconsideration of the underlying Tribunal decision, in which the adjudicator concluded that the ATV the claimant was occupying at the time of the accident was not an “automobile,” and that the claimant was therefore not entitled to accident benefits. Executive Chair Lamoureux allowed the reconsideration and remitted the matter to a new adjudicator for a new hearing. She reasoned that the initial adjudicator failed to consider various documentary evidence and failed to analyze that evidence in the context of the OAP1 and the Sale of Goods Act. Executive Chair Lamoureux did uphold the adjudicator’s decision that estoppel did not apply (i.e. that the insurer was not required to continue paying accident benefits simply because it had started paying accident benefits upon receipt of the OCF-1), and re-iterated that the LAT did not have jurisdiction to exercise equitable relief. The LAT’s purpose was to adjudicate the claimant’s entitlement to benefits based on the terms of the SABS.

Applicant v. State Farm Mutual Automobile Insurance Company (16-000448)

The claimant had an ongoing FSCO arbitration addressing the same benefit in dispute. Adjudicator Watt granted an order on consent dismissing the LAT application.