T.S.W. v. The Dominion of Canada General Insurance Company (18-010342)

The claimant sought a determination that his impairments were outside of the MIG and entitlement to NEBs, the cost of prescription medication, and one treatment plan. Adjudicator Driesel found that the claimant was within the MIG and was not entitled to the disputed benefits.

S.K. v. Aviva Insurance Company (18-007679)

The claimant sought entitlement to NEBs. Adjudicator Grieves dismissed the claim. She held that the claimant failed to provide evidence regarding the change in his pre-accident versus post-accident daily activities. The claimant remained independent with personal care, continued to drive, prepare meals, and completed most household chores.

Applicant v. Portage La Prairie Mutual Insurance Company (18-001837)

The claimant sought entitlement to NEBs and a special award. Adjudicator Grieves awarded NEBs from the date of termination onwards. She noted that the claimant suffered ongoing cognitive impairments in multiple domains. Consistent with Heath v. Economical, the claimant was prevented from engaging in the pre-accident activities that were most important to him. Adjudicator Grieves also granted a special award of 40 percent. She found that the insurer failed to consider new information as it became available, and used its IEs to “paper” the denial.

I.D.C. v. Aviva Insurance Canada (17-004536)

The claimant sought entitlement to NEBs, removal from the MIG, and various medical benefits. She alleged that the accident aggravated injuries from an earlier accident. Adjudicator Sharda held that the claimant suffered from pre-existing psychological impairments and chronic pain, which were worsened by the accident, and entitled to her treatment outside of the MIG; further physiotherapy was also awarded. Finally, Adjudicator Sharda awarded NEBs on the basis that the claimant’s pre-accident activities of daily living were restricted. The claimant’s affidavit evidence went unchallenged by the insurer.

D.R. v. Aviva Insurance Canada (18-007848)

The claimant sought entitlement to NEBs. Adjudicator Watt dismissed the claim. He found the claimant’s testimony to conflict with the medical records. He also wrote that the surveillance of the claimant contradicted his reported abilities. The medical reports from the claimant’s experts relied on the claimant’s self-reporting, which was held not to be accurate.

J.G. v. Co-operators General Insurance Company (18-012430)

The claimant sought entitlement to NEBs. The insurer argued that the limitation period barred the dispute. Adjudicator Boyce agreed with the insurer. He concluded that while the denial of NEBs could be considered “pre-emptive” it was still a valid denial, following the Court of Appeal’s decisions in Bonaccorso and Sietzema. The insurer’s post-denial conduct in investigating the claim for NEBs did not vitiate the initial denial. Finally, the adjudicator held that section 7 of the LAT Act should not apply to allow an extension of the limitation period. Prior to the two-year anniversary of the denial, it was clear to the claimant that the insurer was refusing to pay NEBs.

H.M. v. Aviva Insurance Canada (18-004734)

The claimant sought reconsideration of the Tribunal’s decision finding that he was not entitlement to Non-Earner Benefits. Upon receipt of the reconsideration request, the Tribunal invited both parties to submit supplementary submissions. Neither party delivered supplementary submissions. Adjudicator Lake dismissed the claimant’s request for reconsideration. Adjudicator Lake found that the claimant’s request for reconsideration was vague and failed to provide any specific argument as to the alleged errors in the Tribunal’s decision.

M.B. v. TD Insurance Meloche Monnex (18-010696)

The claimant sought entitlement to NEBs. Adjudicator Lake concluded that the claimant did not meet the “complete inability” test. The claimant argued that his pre-existing cerebral palsy combined with the accident related injuries satisfied the test. Adjudicator Lake held that the claimant continued to engage in most of his pre-accident activities, including driving, sledge hockey, choir, volunteering, and searching for work. The evidence suggested there was minimal change or impediment as a result of the accident.

K.T. v. Aviva Insurance Canada (18-003870)

The claimant sought entitlement to NEBs, removal from the MIG, and two medical benefits. Adjudicator Grant concluded that the claimant suffered a predominantly minor injury as a result of the accident, and did not meet the “complete inability” test. The claimant suffered soft tissue injuries in the accident. His post-accident functionality was similar to his pre-accident functionality. Though he suffered from many psychological issues prior to the accident, there was no exacerbation caused by the accident.

T.H. v. Aviva Insurance Company of Canada (17-001125)

The Tribunal dismissed the claim for NEBs and the claimant sought reconsideration arguing that he had been denied natural justice because he was not permitted to call additional witnesses at the hearing, despite agreeing to the procedure in the Case Conference. He also argued that the insurer failed to send an appropriate NEB denial. Member Jovanovic dismissed the reconsideration. He held that the claimant’s legitimate expectations were met because the hearing procedure had been agreed upon during the Case Conference. He also accepted that the insurer had sent an appropriate denial of NEBs. Finally, he held that the Tribunal had applied the correct NEB test.