E.J. v. Economical Insurance (20-008287)

The minor claimant was the daughter and sibling of family members involved in a serious accident. The claimant was not herself in the vehicle at the time. The claimant applied for accident benefits, but the insurer denied the application arguing that the claimant was not in an accident. Vice Chair Lake agreed that the claimant was not involved in an accident, but that she was an insured person. The claimant was a dependent of her father. Her father suffered physical injuries as a result of the accident. The claimant suffered psychological injuries as a result of her father’s injuries. The claimant was therefore entitled to accident benefits as an insured person. A treatment plan for psychological treatment was awarded. An claim for lost educational expense was not awarded because it was not incurred prior to the accident.

Ibrahim v. Economical Mutual Insurance Company (20-007384)

The claimant applied to the LAT seeking removal from the MIG, entitlement to chiropractic services, lost educational expenses, and a special award. The insurer sought repayment of $2,800 in IRBs for a period of time the claimant had returned to work and not notified the insurer. Adjudicator Hans concluded that the claimant had chronic pain syndrome, which removed him from the MIG, and entitlement to the chiropractic services. The claim for lost educational expenses was denied. The claimant was required to prove that at the time of the accident he was enrolled in elementary, secondary, post-secondary, or continuing education; and that as a result of the accident, he was unable to continue to the program. The claimant satisfied Adjudicator Hans that he was enrolled in an automotive technological diploma program, but Adjudicator Hans was not convinced that the claimant’s injuries prevented him from continuing in the program. The evidence showed that the claimant attended the day after the accident, and the various days he missed were for reasons other than accident-related injuries. Though the claimant stopped attending the program four months after the accident, there was no evidence proving why the claimant stopped attending. Further, the Disability Certificate stated that the claimant was not disabled from continuing with an educational program. The claim for a special award was dismissed. Adjudicator Hans granted the insurer’s request for repayment of $2,800 in IRBs. The claimant returned to work in November 2017, but only notified the insurer in January 2018. The insurer’s request for repayment was made within 12 months, stated the specific amount of the request, and referred to the correct sections of the SABS.

Hayek v. Unifund Assurance Company (19-008856)

The claimant applied to the LAT claiming lost educational expenses in the amount of $15,153. Adjudicator Paluch awarded the claim in part, finding that the claimant was not entitled to education expenses incurred before the accident, but was entitled to lost education expenses of room and board in the amount of $862.69, which she incurred the month of the accident. In dismissing the majority of the claimant’s claim for lost educational expenses, Adjudicator Paluch held that the claimant failed to itemize and explain how she arrived at the amounts for lost educational expenses. In particular, the claimant failed to explain how the grants that were converted to loans fell under educational expenses. The claimant needed to prove that any requested expenses fell within s. 21(5) and the claimant did not properly explain how her OSAP loan was used to fund tuition, books, equipment or room and board.

C.S. v. Echelon General Insurance Company (19-012146)

The claimant sought $12,763 for lost educational expenses. The insurer had approved $2,596 for lost tuition. The remainder of the claim was for lost grants and loans, which the insurer had denied. The claimant argued that those amounts were intended to help pay for tuition, supplies, and housing. The insurer argued that those claims do not fall within the definition of “lost educational expenses”. Adjudicator Kaur found that the additional amounts did not comply with section 21 of the SABS. Incurring a debt through OSAP because of an accident was not itself enough to qualify for lost educational expenses. With respect to the claims for equipment and books, the claimant failed to provide a breakdown or evidence to corroborate the expenses. With respect to housing costs, the tenancy agreement was signed after the accident and therefore could not be claimed, as the expense had to be incurred prior to the accident to be payable.

A.T. v. TD Insurance Meloche Monnex (19-003627)

The claimant sought lost educational expenses following an accident. At the time of the accident, he was enrolled in a post-secondary computer programming program. He alleged that he was unable to continue in the program and did not qualify for a refund of tuition. Adjudicator Norris dismissed the claim, holding that the claimant failed to prove that the withdrawal was caused by the accident, and due to the claimant’s failure to submit a Disability Certificate (contrary to section 21(3)) despite the insurer’s multiple requests for same.

M.M. v. Aviva Insurance Canada (17-006475)

The claimant sought entitlement to IRBs, various medical benefits, educational expenses, and an accounting report. Adjudicator Boyce found that the claimant was not entitled to payment of IRBs as claimed as she did not demonstrate a substantial inability to perform the essential tasks of her pre-accident employment for the period in dispute. Adjudicator Boyce had noted inconsistencies in the claimant’s IRB claim about her ability to complete her essential pre-accident employment tasks and that the claimant was able to return to work. The surveillance evidence was found to show the claimant doing many routine work tasks that contradicted her claim she was unable to work. She also claimed the cost of the accounting report she completed to calculate her IRB quantum, which was determined to be not payable because it was not an identified issue in dispute. The claimant was found to be entitled to payment for physiotherapy treatment and dental expenses including interest as they were considered to be reasonable and necessary. Further, the claimant was not entitled to the education expenses claimed as there was no evidence to support that she was unable to complete her course as a result of the accident. No special award was granted as there was no indication that Aviva unreasonably withheld or delayed payment of benefits where there was also a genuine dispute over entitlement.