Category: Non-Earner Benefits

G.V. v. Northbridge Insurance (16-001689)

The claimant sought entitlement to NEBs and medical benefits. Shortly before the hearing, the insurer removed the claimant from the MIG and agreed to pay for a disputed medical benefits. Adjudicator White held that a special award was payable on the medical benefit due to the late approval by the insurer. She did not award the claimant NEBs, noting that the claimant had not provided any evidence (as opposed to submissions) regarding the claimant’s post-accident life. Furthermore, the medical reports did not support an impairment directly linked to the accident that completely and continuously render the claimant unable to engage in a normal life.

Applicant v. Aviva Insurance (17-002240)

The claimant sought entitlement to non-earner and medical benefits. The insurer denied the benefits and asserted a MIG position. On review of the medical evidence, Adjudicator Avvy Go held the claimant suffered a minor injury with no pre-existing injury and was therefore governed by the MIG. Moreover, the medical evidence did not support the claimant suffering a complete inability to carry on a normal life. Accordingly, the claims were dismissed.

Applicant v. State Farm Insurance Company (16-003195)

The claimant sought entitlement to non-earner benefits. The insurer asserted the claimant did not suffer a complete inability to carry on a normal life. Adjudicator Cezary Paluch, on review of the medical evidence, as well as testimony from the claimant, determined that the claimant met the disability test for non-earner benefits. In doing so, the claimant’s main ADLs were identified and evaluated. Although not specified in the application before the LAT, Adjudicator Paluch awarded interest on the overdue non-earner benefit payment.

L.M. v. Gore Mutual Insurance Company (16-003772)

The claimant sought entitlement to non-earner benefits. The insurer resisted the claim and relied on medical reports as well as a statement from the claimant. Adjudicator Deborah Neilson reviewed the medical evidence and distilled the claimant’s pre- and post-accident activities of daily living. On review, it was held the claimant was completely disabled from performing the identified tasks. Non-earner benefits were awarded. The parties were invited to make submissions regarding interest at a later date.

M.R. v. Aviva Canada (16-001739)

The claimant sought non-earner benefits. Adjudicator Hines concluded that the claimant failed to prove that she suffered a complete inability as a result of the accident. She noted that the claimant had been involved in three earlier accidents in the past few years and had made claims for NEBs in those cases. Adjudicator Hines also had concerns with the claimant’s credibility due to inconsistencies in her testimony as compared to facts confirmed in the documentary record.

M.H. v. Certas Direct Insurance Company (16-003657)

The claimant sought entitlement to non-earner benefits and a lone treatment plan. Adjudicator Rebecca Hines, on review of the medical evidence and surveillance, determined the claimant had not met the burden of proof to establish entitlement to non-earner benefits. The lone treatment plan was deemed payable as evidence did suggest the claimant was still dealing with MVA injuries.

O.D. v. Unifund Assurance Company (16-004399)

The claimant applied for entitlement to non-earner benefits, which was rejected by the insurer. Adjudicator Treksler denied entitlement to non-earner benefits reasoning that the claimant had not submitted sufficient evidence of the activities she could no longer perform, and which activities were important to her prior to the accident. She also noted that the submission of a Disability Certificate was not sufficient on its own to support a claim for non-earner benefits.

R.S. v. Aviva Insurance Canada (16-003141)

The claimant sought entitlement to NEBs. As a preliminary issue, the claimant argued that the insurer’s late surveillance and IE reports should not be considered by the LAT. Adjudicator Sewrattan allowed the materials to be admitted. In terms of the NEB claim, Adjudicator Sewrattan concluded that the claimant had not proven entitlement because he led no evidence about the time he spent on each of his alleged pre-accident activities (he simply listed a series of activities by way of affidavit). Without knowing which activities the claimant spent more time on, Adjudicator Sewrattan was unable to determine what were “substantially all” of the claimant’s pre-accident activities.

H.W. v. Intact Insurance Company (16-000347)

The claimant sought entitlement to non-earner benefits. Adjudicator Theoharis dismissed the claim, reasoning that the claimant failed to demonstrate that the accident had resulted in the claimant being continuously prevented from engaging in substantially all of the activities in which she ordinarily engaged in before the accident. Of particular note was the claimant’s extensive pre-accident medical restrictions and disability benefits (CPP, WSIB, ODSP). Although the claimant did sustain injuries in the accident, she was still able to engage in many of the activities that were important to her prior to the accident.

L.D. v. Aviva Insurance Canada (16-003010)

The claimant sought entitlement to non-earner benefits and 11 treatment plans. On review of the medical evidence, Adjudicator Hines awarded five treatment plans. Additionally, Adjudicator Hines ruled that the mere filing of a disability certificate was insufficient to demonstrate entitlement to non-earner benefits; NEBs were denied.