Chloe Lester

The applicant, a firefighter who responded to the Toronto van attack, sought reconsideration of a decision finding that his psychological impairments were not caused by an 'accident' under the Statutory Accident Benefits Schedule.

The applicant argued that the adjudicator erred in applying the purpose and causation tests to both the Ryder van used in the attack and the fire truck he drove to the scene.

The Vice-Chair dismissed the request for reconsideration, finding no significant legal or evidentiary errors in the adjudicator's conclusion that the applicant's impairments were directly caused by exposure to the horrific scene rather than the use or operation of a vehicle.

The applicant sought a determination of catastrophic impairment and entitlement to various medical and rehabilitation benefits following a motor vehicle accident.

The Tribunal found that the applicant was not catastrophically impaired, as he only demonstrated a moderate impairment in adaptation and a 37% whole person impairment, falling short of the required thresholds.

The Tribunal approved three treatment plans for chiropractic and massage therapy up to the non-catastrophic policy limits, but dismissed the remaining claims as the limits were exhausted.

The applicant's claim for an award under Regulation 664 was dismissed, as the insurer's reliance on its assessors did not constitute unreasonable conduct.

However, the Tribunal awarded $500 in costs against the respondent because its counsel unreasonably interfered with a summonsed witness, which delayed the hearing.

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

The respondent placed the applicant in the Minor Injury Guideline (MIG) and denied treatment plans beyond the $3,500 limit.

The Tribunal found the applicant was not subject to the MIG because a pre-existing gunshot wound to his shoulder would prevent maximal recovery from his soft tissue injuries.

The Tribunal ordered the respondent to pay for two physical therapy treatment plans.

A psychological assessment was also deemed payable because the respondent failed to provide notice of its refusal within the required 10 business days under s. 38(8) of the Schedule.

Claims for a special award and costs were dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits from her insurer, Wawanesa.

The Licence Appeal Tribunal found that the applicant sustained a catastrophic impairment due to marked impairments in adaptation and concentration, persistence, and pace, stemming from somatic symptom disorder and major depressive disorder.

The Tribunal also found the applicant entitled to both pre-104 and post-104 income replacement benefits, as her physical and psychological impairments prevented her from working as a personal support worker or in any suitable employment.

Several treatment plans were deemed payable because Wawanesa failed to provide proper medical and other reasons for denial in its notices, violating s. 38(8) of the Schedule.

Finally, the Tribunal ordered a 30% special award under Regulation 664, finding that Wawanesa unreasonably withheld benefits by blindly following its assessors' reports without considering the totality of the medical evidence or continuously adjusting the file.

The applicant was injured in a motor vehicle accident and received income replacement benefits (IRBs) for approximately 13 years before the respondent insurer terminated them.

The applicant sought post-104 week IRBs, arguing that his chronic pain, reliance on opioids, and resulting cognitive issues prevented him from working.

The respondent relied on independent medical examinations and video surveillance to argue the applicant could perform light duties.

The Tribunal found that the applicant's pain and medication use severely limited his functionality, rendering him unable to sustain competitive employment.

The Tribunal held that the applicant met the test for post-104 week IRBs and awarded the benefits with interest.

The respondent's request for costs was denied.

The applicant brought a motion to adjourn the hearing on the basis that he was having difficulties securing two witnesses and obtaining records from a treating clinic.

The respondent opposed the motion, arguing the applicant had ample opportunity to summons the witnesses and obtain the documents since the application was filed in 2020.

The Tribunal denied the motion, finding that the applicant failed to demonstrate exceptional circumstances and that granting adjournments for failure to accommodate witness schedules or obtain documents would inhibit efficient and timely resolution of proceedings.

Following the oral decision denying the adjournment, the applicant withdrew the application.

The applicant sought a determination that she was catastrophically impaired due to a traumatic brain injury sustained in a motor vehicle accident.

The central issue was whether she met the threshold under the Glasgow Outcome Scale Extended (GOSE) structured interview.

The tribunal found that the applicant's assessors took an overly specific view of the GOSE questionnaire, while the respondent's assessors correctly applied a more generalized approach.

The tribunal also held that under section 45(2) of the Schedule, an occupational therapist cannot complete the GOSE questionnaire for catastrophic determination.

The tribunal concluded that the applicant did not meet the required criteria and dismissed the application.

The self-represented applicant sought entitlement to a post-104 income replacement benefit, medical benefits, an award, and interest following a motor vehicle accident.

The applicant's previous counsel removed himself from the record prior to the hearing, and the applicant proceeded without submitting any documentary evidence.

The Licence Appeal Tribunal dismissed the application, finding that while the applicant's oral testimony regarding the accident's impact was sympathetic, she failed to provide any objective medical evidence to discharge her onus of proving entitlement to the disputed benefits.

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

The respondent denied funding for physical therapies and assessments, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's diagnoses of chronic pain syndrome and adjustment disorder, supported by expert assessments, warranted removal from the MIG.

The Tribunal rejected the respondent's argument that the expert assessments should be given less weight merely because the applicant had not complained of these issues to his treating practitioners.

The applicant was awarded all disputed treatment plans and interest.

The applicant brought a motion seeking an order from the Tribunal to state a case to the Divisional Court for a contempt hearing, alleging that the respondent's counsel interfered with a summonsed witness and violated the Rules of Professional Conduct.

The Tribunal found that the respondent's counsel's conduct, while uncooperative, did not establish a prima facie case for contempt of court.

The motion was dismissed.

The applicant sought statutory accident benefits beyond the $3,500 Minor Injury Guideline (MIG) limit following a motor vehicle accident, arguing that pre-existing back and neck issues, ocular migraines, and accident-related chronic pain and psychological injuries warranted removal from the MIG.

The Tribunal found that the applicant's pre-accident medical records did not establish an ongoing condition that would prevent maximal recovery within the MIG limit.

Furthermore, the Tribunal preferred the respondent's independent medical examination report over the applicant's physiotherapist and occupational therapist records, as the latter were not physicians capable of diagnosing chronic pain or psychological impairments.

The applicant was found to be subject to the MIG and entitled only to the remaining $38.51 of the limit, with claims for an award and costs dismissed.

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

The respondent initially placed the applicant in the Minor Injury Guideline (MIG) but later removed him due to psychological injuries.

The respondent denied four physical treatment plans.

The Tribunal found that the respondent failed to provide proper medical and other reasons for denying three of the treatment plans after the applicant was removed from the MIG, making them payable.

The fourth treatment plan was denied as the applicant's accident-related injuries had resolved and ongoing pain was likely due to pre-existing diabetes.

The applicant was also awarded interest on overdue payments.

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

The respondent denied a chiropractic treatment plan and a mental health assessment on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant suffered from psychological impairments caused by the accident, removing her from the MIG.

The Tribunal preferred the evidence of the applicant's treating family physician over the respondent's assessors.

The Tribunal ordered the respondent to pay for the chiropractic treatment plan, the mental health assessment, and applicable interest.

The applicant in a statutory accident benefits dispute sought to summons the respondent's insurance adjuster to testify regarding the handling of the claim, specifically concerning a potential award for unreasonable delay.

The respondent opposed the summons, arguing the adjuster should not have to testify, or alternatively, should only be subject to examination-in-chief after the applicant's case.

The Tribunal held that the adjuster's testimony was relevant and could be summonsed.

However, because the applicant called the adjuster, the questioning must begin as an examination-in-chief, subject to a potential request to cross-examine if the witness proves hostile.

The Tribunal also found the summons invalid because it was served via email rather than personally as required by the Statutory Powers Procedure Act, and declined to order substituted service without evidence of failed attempts at personal service.

The respondent was ordered to provide the adjuster's address to facilitate personal service.

The applicant sought reconsideration of a decision dismissing her application for lack of jurisdiction.

The original decision held that the Tribunal did not have jurisdiction to determine whether the applicant's injuries fell outside the Minor Injury Guideline (MIG) as a standalone issue, because the MIG is a classification of injuries and not a benefit itself.

The Vice-Chair dismissed the request for reconsideration, finding no significant legal or evidentiary mistake.

The Tribunal affirmed that determining the MIG classification without a corresponding claim for specified benefits does not entitle an insured to any benefits, and thus falls outside the Tribunal's jurisdiction.

The applicant requested a reconsideration of a decision dismissing her application for accident benefits without a hearing due to abandonment.

The applicant argued that the Tribunal violated procedural fairness by failing to serve her personally with notices of the case conferences and the notice of intent to dismiss.

The Tribunal dismissed the reconsideration request, finding that the notices were properly served on the applicant's legal representative by email.

The Tribunal held that by providing a law firm email address, counsel undertook the responsibility to communicate with the applicant, and service on the representative constituted proper notice under the Tribunal's rules and the Hearings in Tribunal Proceedings (Temporary Measures) Act, 2020.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming his pre-existing conditions and injuries warranted treatment beyond the $3,500 Minor Injury Guideline (MIG) limit.

The respondent denied the benefits, arguing the injuries were predominantly minor.

The Licence Appeal Tribunal found that the applicant suffered soft tissue injuries and did not have a pre-existing condition that would prevent maximal recovery within the MIG.

As the MIG limits were exhausted, the applicant was not entitled to the disputed chiropractic treatment plan, nor to an award or interest.

The application was dismissed.

The applicant requested a reconsideration of a decision dismissing her application for abandonment after she failed to attend two scheduled case conferences.

The applicant argued that the Tribunal violated procedural fairness by serving the notices of the case conferences and the notice of intent to dismiss on her legal representative rather than on her personally.

The Tribunal dismissed the request for reconsideration, finding that email service on the applicant's legal representative was valid under Rule 6.1(e) of the Tribunal's Rules of Practice and Procedure, and that the representative bore the responsibility of communicating with the client.

The respondent brought a motion to dismiss the application without a hearing, arguing the Tribunal lacked jurisdiction because the only issue in dispute was whether the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued that the MIG classification could be decided as a standalone issue.

The Tribunal held that it does not have jurisdiction under s. 280(1) of the Insurance Act to determine MIG classification unless it is tied to a specific benefit dispute, as the MIG itself is not a statutory accident benefit but a framework establishing monetary limits.

The respondent's motion was granted and the application was dismissed.

The applicant sought statutory accident benefits following a 2016 motor vehicle accident.

The respondent determined the applicant's injuries fell within the Minor Injury Guideline (MIG) and denied claims for a non-earner benefit, chiropractic treatment beyond the MIG limit, and prescription medications.

The Tribunal found that the applicant failed to provide compelling evidence that pre-existing conditions prevented maximal recovery within the MIG, thus capping treatment at $3,500.

The Tribunal approved the disputed chiropractic treatment plan up to the remaining MIG limit, finding it reasonable and necessary for pain reduction.

The claim for a non-earner benefit was dismissed as the applicant did not suffer a complete inability to carry on a normal life, having resumed personal care and university studies shortly after the accident.

Claims for prescription medication reimbursement and a special award were also dismissed, though interest was awarded on the approved treatment plan.