A.W. v. Cooperators General Insurance Company (16-000283)

The claimant sought entitlement to non-earner benefits as well as a number of treatment plans. The insurer took a MIG position and also noted that the initial OCF-3 did not support an NEB claim. Although a subsequent disability certificate was submitted supporting NEBs, no further medical evidence was provided. On review, Adjudicator Pay concluded that the claimant was not entitled to NEBs or the disputed treatment plans.

Applicant v. Unifund Assurance Company (16-000879)

The claimant sought an order for NEBs, and medical benefits. As a preliminary issue, the insurer sought the exclusion of documents not produced in accordance with the Case Conference Order. Adjudicator Truong held that the Tribunal could set deadlines that were more stringent than those in the LAT Rules. The documents were excluded and the claims for NEBs and medical benefits were dismissed.

M.N.K.A. v. State Farm Mutual Automobile Insurance (16-001592)

The claimant sought entitlement to NEBs and two medical benefits. Adjudicator Bass denied all claims as not meeting the requisite test for entitlement.

Applicant v. Co-operators General Insurance Company (16-000714)

The claimant sought NEBs, medical benefits, and removal from the MIG. The adjudicator found that the claimant did not satisfy the burden of being removed from the MIG. There was a causation issue as the claimant was involved in two separate accidents and the alleged injuries from each accident were similar. NEBs were denied on credibility issues and the failure to provide sufficient evidence of the details of the claimant’s pre-accident lifestyle.

A.B. v. Aviva Insurance Company of Canada (16-000342)

The claimant sought entitlement to NEBs and transportation costs. The insurer relied upon surveillance as part of its defence. Adjudicator Richards concluded that the claimant did not meet the complete inability test, and was not entitled to transportation costs. The adjudicator allowed the surveillance to be admitted despite non-compliance with the timelines in the LAT Rules.

D.S. v. Certas Home and Auto Insurance Company (16-000279)

A completed OCF-3 was submitted; the claimant was said to have not met the test for NEBs. An OCF-10 was submitted whereby the claimant elected NEBs. The insurer sought a preliminary hearing to have the claimant’s claim for NEBs dismissed without a hearing. Adjudicator Pay concluded that the claimant was still entitled to pursue a claim for NEBs despite the original OCF-3 not supporting NEBs.