Category: Reconsideration

F.C. v. Intact Insurance Company (18-005079)

The claimant had applied to the Tribunal for accident benefits, and commenced an action for property damage in the Superior Court. The insurer alleged that the claimant had committed material misrepresentations, and sought a stay of the LAT proceedings until the Superior Court decision was rendered or a preliminary hearing addressing the material misrepresentations. The Tribunal rejected both requests; the insurer sought reconsideration. Adjudicator Lester held that the Tribunal did not act outside its jurisdiction or violate the rules of natural justice or procedural fairness, and noted that the claimant would be prejudiced by a stay of the LAT application.

J.M. v. Aviva General Insurance (17-007215)

The insurer sought reconsideration of the Tribunal’s decision that catastrophic impairment assessments are payable outside of the medical benefits limits. Vice Chair Flude held that the Tribunal’s decision did not contain a significant error of law, and was correct. He concluded that earlier FSCO decisions addressing the same issue were correct, and that catastrophic impairment assessment costs are not to be deducted from the medical benefits limits.

S.M. v. Aviva General Insurance Company (17-008818)

Vice-Chair Helt dismissed the insurer’s request for reconsideration. The insurer alleged that the LAT violated the rules of natural justice and procedural fairness and made significant errors of law. The parties had agreed upon a document exchange deadline. The claimant brought a motion following the deadline, requesting an opportunity to file an affidavit. The LAT allowed the claimant to file the affidavit, but limited the scope of the affidavit to an orthopaedic assessment. The insurer was not permitted to cross-examine the claimant on her affidavit. Vice-Chair Helt held that any prejudice resulting to the insurer was remedied with the opportunity to respond to the affidavit. The Vice-Chair also held that there are instances where additional evidence may be allowed to be filed after deadlines if it is in the interest of ensuring there is a complete record before the adjudicator. In this matter, the LAT allowed the additional affidavit evidence, but limited it in scope and provided the insurer an opportunity to respond.

T.T. v. Aviva Insurance Company (17-002535)

The insurer sought reconsideration of the Tribunal’s award of $300 in costs related to the failure to comply with production of documents. Vice Chair Kershaw granted the reconsideration. She held that the Case Conference Order did not provide a disclosure deadline for the production of documents, so the insurer was not in breach by delivering a surveillance report shortly before the hearing. Further, the Tribunal’s decision to exclude the late surveillance was a sufficient remedy; costs were not additionally warranted.

A.F. v. North Blenheim Mutual Insurance Company (16-002336)

The claimant sought reconsideration of the Tribunal’s decision that he was barred from seeking entitlement to certain benefits due to the limitation period. In particular, he argued that section 7 of the LAT Act applied in extending the time by which he had to apply to the LAT. Vice Chair Kershaw granted the reconsideration and allowed the claimant’s application to proceed. She held the Tribunal made an error in law by: failing to consider that the claimant continuously demonstrated his intention to dispute entitlement to denied benefits; including the time delay caused by the backlog at FSCO; concluding that there was prejudice to the insurer by the delay, since the claimant had applied for mediation at FSCO within the designated time frame; and concluding that the claimant had not spoken to a LAT representative by telephone and was advised that the 90 day post-mediation extension applied to LAT applications.

G.S. v. Aviva General Insurance Company (17-004847)

The insurer sought reconsideration of the Tribunal’s decision that the claimant’s injuries fell outside of the MIG due to chronic pain. Vice Chair Mather dismissed the reconsideration and held that the Tribunal had not made a significant error in law and had not violated the rules of natural justice. The Tribunal had considered the medical evidence, which supported the legal conclusions. The Tribunal’s reasons addressed the parties’ arguments, and made clear why the claimant was removed from the MIG.

A.F. v. North Blenheim Mutual Insurance Company (16-002336)

The claimant sought reconsideration of the Tribunal’s decision that he was barred from seeking entitlement to certain benefits due to the limitation period. In particular, he argued that section 7 of the LAT Act applied in extending the time by which he had to apply to the LAT. Vice Chair Kershaw granted the reconsideration and allowed the claimant’s application to proceed. She held the Tribunal made an error in law by: failing to consider that the claimant continuously demonstrated his intention to dispute entitlement to denied benefits; including the time delay caused by the backlog at FSCO; concluding that there was prejudice to the insurer by the delay, since the claimant had applied for mediation at FSCO within the designated time frame; and concluding that the claimant had not spoken to a LAT representative by telephone and was advised that the 90 day post-mediation extension applied to LAT applications.

A.F. v. North Blenheim Mutual Insurance Company (16-002336)

The claimant sought reconsideration of the Tribunal’s decision that he was barred from seeking entitlement to certain benefits due to the limitation period. In particular, he argued that section 7 of the LAT Act applied in extending the time by which he had to apply to the LAT. Vice Chair Kershaw granted the reconsideration and allowed the claimant’s application to proceed. She held the Tribunal made an error in law by: failing to consider that the claimant continuously demonstrated his intention to dispute entitlement to denied benefits; including the time delay caused by the backlog at FSCO; concluding that there was prejudice to the insurer by the delay, since the claimant had applied for mediation at FSCO within the designated time frame; and concluding that the claimant had not spoken to a LAT representative by telephone and was advised that the 90 day post-mediation extension applied to LAT applications.

A.F. v. North Blenheim Mutual Insurance Company (16-002336)

The claimant sought reconsideration of the Tribunal’s decision that he was barred from seeking entitlement to certain benefits due to the limitation period. In particular, he argued that section 7 of the LAT Act applied in extending the time by which he had to apply to the LAT. Vice Chair Kershaw granted the reconsideration and allowed the claimant’s application to proceed. She held the Tribunal made an error in law by: failing to consider that the claimant continuously demonstrated his intention to dispute entitlement to denied benefits; including the time delay caused by the backlog at FSCO; concluding that there was prejudice to the insurer by the delay, since the claimant had applied for mediation at FSCO within the designated time frame; and concluding that the claimant had not spoken to a LAT representative by telephone and was advised that the 90 day post-mediation extension applied to LAT applications.

N.F. v. North Blenheim Mutual Insurance Company (16-002606)

The claimant sought reconsideration of the Tribunal’s decision that he was barred from seeking entitlement to certain benefits due to the limitation period. In particular, he argued that section 7 of the LAT Act applied in extending the time by which he had to apply to the LAT. Vice Chair Kershaw granted the reconsideration and allowed the claimant’s application to proceed. She held the Tribunal made an error in law by: failing to consider that the claimant continuously demonstrated his intention to dispute entitlement to denied benefits; including the time delay caused by the backlog at FSCO; concluding that there was prejudice to the insurer by the delay, since the claimant had applied for mediation at FSCO within the designated time frame; and concluding that the claimant had not spoken to a LAT representative by telephone and was advised that the 90 day post-mediation extension applied to LAT applications.