Avril A. Farlam

The applicant sought post-104 week income replacement benefits (IRB) following a motor vehicle accident, claiming a complete inability to engage in any employment due to physical, psychological, and cognitive injuries.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to meet his burden of proof.

The adjudicator preferred the evidence of the respondent's medical assessors, noting that the applicant had engaged in undisclosed post-accident employment, including selling insurance and acting as a director for several corporations.

The applicant's failure to disclose these activities to his own treatment providers undermined their opinions.

Claims for interest and a special award were also dismissed.

The applicant requested a reconsideration of a previous decision that dismissed her application for caregiver and non-earner benefits on the grounds of res judicata and being statute-barred.

The applicant argued that the Tribunal erred in fact and law and violated procedural fairness, specifically regarding the start date of the limitation period and the deemed receipt of the denial letter.

The Vice Chair found no errors of fact or law, noting that the applicant failed to provide evidence at the original hearing that the denial letter was mailed rather than given on its date.

The request for reconsideration was dismissed as the applicant was attempting to re-argue her case.

The applicant sought statutory accident benefits after slipping and falling on an icy driveway while walking around her parked vehicle to help her child exit.

The respondent denied benefits on the basis that the incident was not an 'accident' under s. 3(1) of the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal found that while the incident met the purpose test, it failed the causation test.

The use or operation of the automobile was not the direct cause of the applicant's injuries; rather, the ice on the driveway was an intervening act and the dominant feature that caused the slip and fall.

The application was dismissed.

The respondent brought a motion to dismiss the applicant's application for post-104 week income replacement benefits as statute-barred.

The respondent had denied the benefits in a letter dated March 9, 2018, and the applicant did not file her application until September 11, 2020, beyond the two-year limitation period under s. 56 of the Statutory Accident Benefits Schedule.

The applicant argued she was out of the country and did not discover the denial until August 2020.

The Tribunal found the denial was discoverable upon delivery to her lawyer, who acted as her agent.

The Tribunal also declined to extend the limitation period under s. 7 of the Licence Appeal Tribunal Act, finding no bona fide intention to appeal within the time limit, excessive delay, prejudice to the respondent, and lack of merit in the claim.

The application was dismissed.

The appellants brought a motion to extend the deadline for their productions and to adjourn the peremptory hearing dates, citing the COVID-19 pandemic and their inability to retain legal counsel.

The Licence Appeal Tribunal denied the motion, applying the Conway factors for adjourning a peremptory hearing.

The Tribunal found that the appellants had consented to the peremptory dates, failed to provide compelling reasons or evidence of efforts to retain counsel, and had a pattern of delay.

The Tribunal concluded that granting the adjournment would prejudice the respondent and be contrary to the public interest and the Tribunal's mandate for timely resolution.

The appellant brought a motion to extend the time to appeal an Office of the Fire Marshal decision regarding a fire safety inspection order.

The appellant missed the 15-day appeal deadline and the 30-day deadline to request an extension under the Fire Protection and Prevention Act, 1997, citing delays caused by the COVID-19 pandemic and contractor issues.

The Fire Safety Commission dismissed the motion, finding it had no statutory authority to grant an extension because the application was made more than five months after the 30-day time limit expired.

The applicant requested a reconsideration of a decision denying her non-earner benefits due to her failure to submit a completed OCF-3 disability certificate.

She argued the Tribunal violated procedural fairness and made errors of law and fact in interpreting section 36 of the Schedule and weighing evidence.

The Tribunal dismissed the request, finding no errors of law, fact, or procedural fairness, and noted that dissatisfaction with the result or a desire to re-argue the case are not valid grounds for reconsideration.

The respondent requested a reconsideration of a decision finding he was not involved in an 'accident' as defined in s. 3(1) of the Statutory Accident Benefits Schedule relating to the vehicle insured by the applicant.

The respondent argued the Tribunal exceeded its jurisdiction and made an error of law by narrowly framing the issue to a specific vehicle.

The Tribunal dismissed the request, finding the issue was properly framed by prior consent orders and the Tribunal did not exceed its jurisdiction or make an error of law.

The appellant appealed the 90-day impoundment of her vehicle under the Highway Traffic Act, arguing exceptional hardship due to job loss and financial difficulties.

The Licence Appeal Tribunal found that the exceptional hardship ground was not available to the appellant because she had previously had a vehicle impounded under section 55.1 of the Act.

The impoundment was confirmed.

The applicant requested a reconsideration of a decision finding he sustained minor injuries subject to the $3,500 funding limit.

The applicant sought to introduce new medical reports and MRI results under Rule 18.2(d) of the Common Rules of Practice and Procedure.

The Tribunal dismissed the request, finding that the evidence existed and could have been obtained prior to the original decision.

Furthermore, the Tribunal held that even if the evidence had been admitted, it was vague, lacked a causal connection to the accident, and would not have affected the outcome given the applicant's lack of functional limitations and return to work.

The applicant sought statutory accident benefits following a motor vehicle accident, including non-earner benefits and various treatment plans.

The respondent denied the claims.

The Tribunal found that the applicant failed to prove she suffered a complete inability to carry on a normal life, noting inconsistencies in her self-reporting and preferring the evidence of the respondent's assessors.

The Tribunal also found the disputed treatment plans were not reasonable and necessary.

The application was dismissed, and no award or costs were granted.

The applicant requested a reconsideration of a decision denying him income replacement benefits and a treatment plan.

He argued the adjudicator misapprehended expert evidence, breached procedural fairness, and made errors of fact and law regarding causation and expert qualifications.

The Vice Chair dismissed the request, finding no errors of law or fact and no breach of procedural fairness, noting the applicant was attempting to re-litigate the case.

The respondent's request for costs was also dismissed, as the applicant's conduct did not rise to the level of being unreasonable, frivolous, or vexatious.

The applicant sought statutory accident benefits following a motor vehicle accident.

The respondent determined the applicant's injuries fell within the Minor Injury Guideline (MIG) and denied further treatment plans and income replacement benefits (IRB) after the $3,500 limit was exhausted.

The Tribunal found that the applicant failed to prove on a balance of probabilities that he suffered from chronic pain or psychological injuries caused by the accident that would remove him from the MIG, noting he withheld information about a subsequent shooting incident from his assessors.

The Tribunal also found the applicant did not suffer a substantial inability to perform the essential tasks of his employment.

The application was dismissed.

The appellant appealed the 45-day impoundment of its company truck under the Highway Traffic Act, arguing that the impoundment would result in exceptional hardship to its business.

The vehicle was impounded after being driven by an employee with a suspended licence.

The Licence Appeal Tribunal dismissed the appeal, finding that the appellant failed to demonstrate that there was no alternative to the impounded vehicle, a prerequisite for establishing exceptional hardship under O. Reg. 631/98.

The Tribunal noted that the appellant had other vehicles available and had not adequately considered renting a replacement.

The applicant requested a reconsideration of a decision denying her entitlement to $26,919.25 for a catastrophic determination assessment.

The applicant argued that the adjudicator applied the incorrect test and failed to consider the Divisional Court's decision in Aviva Insurance Company v. J.A., which clarified the law on when an insurer must pay for a CAT assessment and what constitutes a rebuttal assessment.

The adjudicator found that an error of law or fact was made in the original decision by characterizing the assessment as a rebuttal assessment.

The request for reconsideration was granted, and the matter was ordered to be reheard in writing by a different adjudicator.

The applicant sought statutory accident benefits following a 2003 motor vehicle accident.

The respondent requested a preliminary issues hearing to dismiss the application on grounds of res judicata, expiry of the limitation period, and failure to attend insurer's examinations.

The Tribunal found that the claims for caregiver and non-earner benefits had already been denied in a 2013 FSCO decision and were res judicata.

Furthermore, the Tribunal held that the application was statute-barred as it was filed more than two years after the respondent's clear and unequivocal denial in 2018.

The Tribunal declined to extend the limitation period, finding no bona fide intention to appeal, excessive delay, and incurable prejudice to the respondent.

The application was dismissed.

The applicant sought income replacement benefits (IRB) and medical/rehabilitation benefits following a motor vehicle accident.

The respondent denied the benefits and sought repayment of IRB previously paid, alleging the applicant had returned to work and wilfully misrepresented his employment status.

The Tribunal found that the applicant had returned to his pre-accident employment shortly after the accident and failed to prove a substantial inability to perform the essential tasks of his employment.

The Tribunal ordered the applicant to repay $1,619.99 in overpaid IRB due to his wilful misrepresentation.

The claims for psychological services and various medical assessments were dismissed as not reasonable and necessary.

The applicant sought statutory accident benefits following a motor vehicle accident, including an income replacement benefit (IRB) and funding for chiropractic and psychological treatment plans.

The respondent insurer denied the benefits.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to establish a substantial inability to perform the essential tasks of his pre-accident employment as a meat processor, noting he had returned to work for four months post-accident.

The Tribunal also found the proposed treatment plans were not reasonable and necessary, preferring the evidence of the respondent's medical assessors over the applicant's treating practitioners.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits.

The insurer denied several treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's fractured finger was not a minor injury, removing her from the MIG.

The Tribunal approved four chiropractic treatment plans as reasonable and necessary, but denied a psychological assessment and a second disability certificate.

The applicant's claim for a special award was also dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident.

The respondent denied non-earner benefits (NEB) and determined the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's claim for NEB was statute-barred because she failed to dispute the clear and unequivocal denial within the two-year limitation period, and she did not establish grounds for an extension under s. 7 of the LAT Act.

Furthermore, the Tribunal concluded that the applicant's injuries were predominantly minor and subject to the MIG, as she failed to provide compelling medical evidence of chronic pain or a pre-existing condition that would warrant removal from the MIG.

Since the $3,500 MIG limit had already been exhausted, the disputed treatment plans were not payable.