Chloe Lester

The applicant, an eight-year-old with severe pre-existing disabilities, was struck by a vehicle and sustained a traumatic brain injury.

He applied for a determination of catastrophic impairment under s. 3(2)(d)(ii) of the Statutory Accident Benefits Schedule, arguing that the accident significantly increased his dependency and need for daily support.

The respondent argued that the accident did not exacerbate his pre-existing impairments.

The Tribunal found the applicant's evidence, including his mother's testimony and the Omega Medical Associates assessment, more compelling.

The Tribunal concluded that the applicant's condition worsened significantly after the accident, increasing his dependencies, and deemed him catastrophically impaired.

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

The insurer requested tax documents under section 33 of the Schedule, which the applicant failed to provide.

The insurer subsequently refused to pay the benefits, placing the applicant in non-compliance.

The applicant filed an application for dispute resolution more than two years after the refusal.

The Tribunal held that the refusal to pay stemming from a section 33 non-compliance triggered the two-year limitation period under section 56.

As the applicant failed to provide a reasonable explanation for the delay and filed outside the limitation period, the application was statute-barred and dismissed.

A post-hearing motion for an award and costs was also dismissed.

The respondent filed a motion regarding non-compliance with production orders, and the applicant subsequently filed a motion regarding the respondent's failure to produce clinical notes and records.

The applicant also requested an extension for their opening statement deadline.

To ensure procedural fairness, the adjudicator ordered a new timetable for the exchange of evidence, case law, and opening statements, and directed that any further disputes over production be handled by the hearing adjudicator.

The respondent filed a motion requesting the applicant be ordered to produce unredacted clinical notes and records and an unredacted OHIP Summary.

As there was insufficient time to argue the motion and issue a decision prior to the hearing, the adjudicator directed the parties to argue the motion at the hearing and ordered the applicant to come prepared with the unredacted documents.

The applicant sought costs against the respondent insurer for failing to comply with two Tribunal orders for the production of documents.

The Tribunal found that the respondent acted unreasonably by ignoring the orders and the applicant's follow-up communications, which necessitated a second production order and delayed the proceedings.

The Tribunal ordered the respondent to pay $250.00 in costs to the applicant to discourage such conduct.

The applicant sought costs against the respondent insurer for failing to comply with two Tribunal orders for the production of documents.

The respondent did not produce the required documents until after a second order was issued and the applicant had requested costs.

The Tribunal found the respondent's conduct to be unreasonable, as it disregarded the Tribunal's orders and delayed the proceedings.

The Tribunal awarded costs of $250.00 to the applicant to discourage such conduct in the future.

The applicant, who was catastrophically impaired in a motor vehicle accident, sought rehabilitation benefits for expenses incurred during a family trip to Florida, arguing it facilitated his reintegration into his family.

The insurer denied the expenses.

The Licence Appeal Tribunal held that the travel expenses did not fall within the scope of rehabilitation benefits under section 16 of the Statutory Accident Benefits Schedule, as they were not activities or measures provided by a professional with a treatment goal, nor modifications or devices to accommodate his needs.

The application was dismissed.

The respondent moved to dismiss the application for statutory accident benefits, arguing the issues had already been decided by the Financial Services Commission of Ontario.

At the preliminary motion hearing, the applicant's counsel requested an adjournment due to insufficient notice from the Tribunal.

During the hearing, the applicant discharged her counsel and requested an adjournment to retain new representation.

The adjudicator granted the adjournment, noting the Tribunal's error in communication and finding no prejudice to the respondent, while setting a schedule for potential costs submissions.

The applicant was injured in a motor vehicle accident and sought various statutory accident benefits that were denied by the respondent insurer on the basis that his injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's injuries fell outside the MIG due to overwhelming evidence of a psychological impairment resulting from the accident.

Consequently, the Tribunal approved treatment and assessment plans for a physiatrist assessment, a neurological assessment, a psychological assessment, and psychological counselling sessions.

However, the Tribunal denied claims for attendant care benefits, an attendant care assessment, assistive devices, and further chiropractic treatments, finding that the applicant was largely independent in his activities of daily living and that facility-based physical therapy was no longer reasonable and necessary.

The applicant sought to admit a surreptitious tape recording of an insurer's examination into evidence for an upcoming hearing regarding statutory accident benefits.

The respondent insurer objected to its admission.

The adjudicator found that the recording was not relevant to the issues to be decided, as the applicant had not established its necessity or relevance, and the credibility of the examiner could be assessed through witness testimony at the hearing.

The tape recording was excluded from evidence.