Category: Reconsideration

C.W. v. Unifund Assurance Company (16-003336)

The insurer sought reconsideration of the Tribunal’s decision that the claimant’s injuries were non-minor due to a partial shoulder tear and pre-existing back pain. Executive Chair Lamoureux dismissed the reconsideration. She held that the Tribunal’s decision was based on the evidence before it and that the Tribunal was entitled to weight the contradicting evidence as it saw fit. Executive Chair Lamoureux was not satisfied that there was a significant error of fact or law.

C.W. v. Unifund Assurance Company (16-003336)

The insurer sought reconsideration of the Tribunal’s decision that the claimant’s injuries were non-minor due to a partial shoulder tear and pre-existing back pain. Executive Chair Lamoureux dismissed the reconsideration. She held that the Tribunal’s decision was based on the evidence before it and that the Tribunal was entitled to weight the contradicting evidence as it saw fit. Executive Chair Lamoureux was not satisfied that there was a significant error of fact or law.

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

The Tribunal initially held that the claimant had failed to apply to the LAT within two years. The claimant’s application occurred during the transition between FSCO and the LAT. Executive Chair Lamoureux held that it was an error for the Tribunal not to consider whether the limitation period should be extended. She noted that section 7 of the Licence Appeal Tribunal Act granted the Tribunal the power to extend any limitation period under any other Act. She remitted the matter to an adjudicator to determine whether a extension should be granted. The Executive Chair looked to earlier LAT case law and wrote that the factors to consider in granting an extension are: (1) the existence of a bona fide intention to appeal within the appeal period; (2) the length of the delay; (3) prejudice to the other party; and (4) the merits of the appeal. The four factors are not strict factors that each must be met. Rather, they are a guide to assist in determining the justice of each case.

Y.D. v. Aviva Insurance Canada (16-001810)

The Tribunal ruled against the claimant’s application for further attendant care benefits on the basis that no expenses had been incurred, and that the Tribunal did not have equitable jurisdiction to order the ongoing payment of attendant care benefits based solely upon earlier payments of the benefit. Executive Chair Lamoureux upheld the earlier decision and noted that even if the Tribunal did have equitable jurisdiction to decide the matter, the pre-requisites for estoppel to apply were not present in this case.

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

The Tribunal initially held that the claimant had failed to apply to the LAT within two years. The claimant’s application occurred during the transition between FSCO and the LAT. Executive Chair Lamoureux held that it was an error for the Tribunal not to consider whether the limitation period should be extended. She noted that section 7 of the Licence Appeal Tribunal Act granted the Tribunal the power to extend any limitation period under any other Act. She remitted the matter to an adjudicator to determine whether a extension should be granted. The Executive Chair looked to earlier LAT case law and wrote that the factors to consider in granting an extension are: (1) the existence of a bona fide intention to appeal within the appeal period; (2) the length of the delay; (3) prejudice to the other party; and (4) the merits of the appeal. The four factors are not strict factors that each must be met. Rather, they are a guide to assist in determining the justice of each case.

M.B. v. Aviva Insurance Canada (16-002325)

The Tribunal initially held that the claimant failed to attend IEs related to post-104 week IRBs. The claimant applied for reconsideration and was successful. Executive Chair Lamoureux held that the IE notice sent to the claimant did not provide sufficient reasons, in particular because the insurer had simply restated its reasons from IEs related to initial entitlement to IRBs that “the impairments identified do not appear clearly or directly caused by the accident.” The Executive Chair reasoned that this notice would not have informed an unsophisticated person why a further IE was required for a benefit that had been granted and was being paid. The Executive Chair also held that the claimant need not raise the issue of the IE notice contents at the time of the IE, and that the issue could be raised for the first time during litigation.

M.B. v. Aviva Insurance Canada (16-002325)

The Tribunal initially held that the claimant failed to attend IEs related to post-104 week IRBs. The claimant applied for reconsideration and was successful. Executive Chair Lamoureux held that the IE notice sent to the claimant did not provide sufficient reasons, in particular because the insurer had simply restated its reasons from IEs related to initial entitlement to IRBs that “the impairments identified do not appear clearly or directly caused by the accident.” The Executive Chair reasoned that this notice would not have informed an unsophisticated person why a further IE was required for a benefit that had been granted and was being paid. The Executive Chair also held that the claimant need not raise the issue of the IE notice contents at the time of the IE, and that the issue could be raised for the first time during litigation.

Aviva Canada Inc. v. R.R. (16-004445)

The insurer appealed the dismissal of its repayment claim, which had been denied because there was no proof that the claimant was given the notice of repayment. Executive Chair Lamoureux held that there had been a breach of procedural fairness because the issue of whether a notice was provided to the claimant was not addressed in the written materials, and the insurer had failed to include the repayment notice in its materials due to “administrative oversight.” The matter was remitted for rehearing.

G.K. v. Security National Insurance Company (16-001904)

The insurer sought reconsideration of the Tribunal’s decision that the claimant was a resident of Ontario at the time of the accident, and therefore an “insured person.” Executive Chair Lamoureux rejected the reconsideration. She held that the Tribunal was asked to make a determination that largely turned on the facts of the case, and that the Tribunal had not erred in finding that the claimant resided in Ontario. She also held that section 3 of the SABS was the pertinent section to consider, and that section 59 was only relevant to determining whether an insured could elect benefits in another jurisdiction. Finally, Executive Chair Lamoureux noted that the insurer was essentially asking for reconsideration on the Tribunal’s findings of fact, which was not an appropriate request.

G.T. v. Unifund Assurance Company (16-001283)

The insurer appealed a ruling in which the claimant was awarded an orthopaedic assessment. The insurer argued that the assessment was available through OHIP, and therefore not payable under the SABS. Executive Chair Lamoureux rejected the reconsideration. She held that the obligation was on the insurer to advance evidence establishing that a benefit at issue was available through a collateral source (such as OHIP), and could not rely upon bare assertions. No evidence was presented about what benefits OHIP covered or the speed at which the claimant could obtain such an assessment through OHIP.