1. On May 1, 2015, SM, the applicant, was driving a motorcycle when it travelled across the oncoming traffic lane, struck a curb, went over the grass boulevard and hit an electrical box sending the applicant head first into a tree. Paramedics noted a Glasgow Coma Score (GCS) of 6/15. He was diagnosed with a traumatic brain injury (TBI) and sustained injuries to his lungs, neck and back. He was deemed catastrophic based on his GCS score and remained in the hospital for two weeks.
2. Since the motorcycle did not have insurance he applied for accident benefits to the Motor Vehicle Accident Claims Fund (the “respondent”) under the Statutory Accident Benefits Schedule – Effective September 1, 2010 (the “Schedule”). The respondent provides payment of benefits to injured people who do not have automobile insurance. The respondent denied several benefits and the applicant submitted an application to the Licence Appeal Tribunal – Automobile Accident Benefit Services (the “Tribunal”). The parties were unable to resolve this dispute at a case conference and the matter proceeded to an in-person hearing.
- Is the applicant excluded from making a claim for a non-earner benefit (NEB) because he did not have a valid driver’s licence at the time of the accident pursuant to s.31(1)(a)(ii) of the Schedule;
- If the answer to the first issue is no, is the applicant entitled to receive payment of a NEB in the amount of $185 per week, from November 1, 2015 to date and ongoing;
- Is the applicant entitled to an attendant care benefit (ACB) in the amount of $6,000.00 per month from June 22, 2015 to date and ongoing;
- Is the applicant entitled to a rehabilitation benefit in the amount of $40,140.88 for a treatment plan (“OFC-18”) for rehabilitation support worker (RSW) services recommended by Jean Turgeon, of Prof. Corp. denied by the respondent on March 15, 2017;
- Is the applicant entitled to a rehabilitation benefit in the amount of $401,215.00 for an OCF-18 for home modifications recommended by Jean Turgeon, of Prof. Corp. denied by the respondent of February 15, 2017;
- Is the applicant entitled to interest on the overdue payment of benefits;
- Is the applicant entitled to an award under Ontario Regulation 664, R.R.O. 1990; and
- Is the applicant entitled to costs on the limited issues of ACBs pursuant to Rule 19 of LAT’s Rules of Practice and Procedure (“LAT Rules”)?
Read Full Decision below:
Tribunal File No: 17-001681/AABS