Christopher A. Ferguson

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

The insurer denied the claim and raised a preliminary issue that the applicant failed to provide requested information under s. 33 of the Schedule.

The Licence Appeal Tribunal found that the applicant failed to comply with seven requests for information without a reasonable explanation.

Consequently, the insurer is not liable to pay the claimed benefits.

The Tribunal also ordered the applicant to pay $250 in costs for pursuing an unreasonable appeal.

The applicant sought income replacement benefits following a motor vehicle accident.

The insurer brought a preliminary motion to preclude the appeal on the basis that the applicant failed to submit a Disability Certificate (OCF-3) within 104 weeks of the accident, as required by section 36 of the Statutory Accident Benefits Schedule.

The Tribunal found that the applicant failed to meet the strict requirements of section 36 and that the omission was not merely a technical breach.

The Tribunal also denied the applicant's request for relief from forfeiture under section 129 of the Insurance Act, finding the applicant's conduct unreasonable and noting the prejudice to the insurer.

The motion was granted and the appeal was precluded from proceeding.

The applicant sought statutory accident benefits following a 2013 motor vehicle accident.

The insurer denied the claims, and the applicant appealed to the Licence Appeal Tribunal.

The insurer raised a preliminary issue that the claims were barred by res judicata, as the applicant had previously appealed the same claims, resulting in a final decision that her injuries fell within the Minor Injury Guideline and she was not entitled to income replacement benefits.

The Tribunal agreed, finding that the applicant's new medical reports did not constitute fresh, new, and previously unavailable evidence that would impeach the prior decision.

The appeal was dismissed as barred by res judicata, and costs were denied.

The applicant sought reconsideration of a Tribunal decision that found his appeal for statutory accident benefits was statute-barred due to his failure to attend independent medical examinations (IEs).

The applicant also requested the adjudicator's recusal, alleging a reasonable apprehension of bias based on the adjudicator's professional background and alleged errors in the original decision.

The adjudicator dismissed the recusal request, finding no cogent evidence to overcome the presumption of impartiality.

The adjudicator also dismissed the requests for reconsideration, concluding that while some minor factual errors were made in the original decision, they did not amount to significant errors of law or fact that would have altered the outcome regarding the applicant's non-compliance with section 44 of the Schedule.

Both parties' requests for costs were denied.

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

The insurer denied the claims on the basis that the applicant's injuries were predominantly minor and subject to the $3,500 funding limit under the Minor Injury Guideline (MIG).

The applicant argued that she sustained psychological injuries and chronic pain that removed her from the MIG.

The Tribunal found that the applicant's psychological evidence was refuted by the insurer's expert and contemporaneous medical records, and that she did not meet the criteria for chronic pain.

The Tribunal concluded that the applicant's injuries were predominantly minor, and therefore she was not entitled to the claimed medical benefits or interest.

The applicant was injured in a motor vehicle accident and received income replacement benefits (IRBs) until the insurer terminated them, arguing his ongoing back pain was caused by post-accident weight gain rather than the accident.

The Tribunal found that the applicant's rapid weight gain and chronic pain were a result of the accident.

Relying on the applicant's medical experts, the Tribunal concluded the applicant met both the pre-104 week test of substantial inability to perform his pre-accident employment and the post-104 week test of complete inability to engage in suitable employment.

The applicant was awarded ongoing IRBs with interest, and the insurer's claim for repayment of benefits was dismissed.

The applicant sought income replacement benefits, medical benefits, and the cost of examinations following a motor vehicle accident.

The adjudicator found no evidence that the applicant missed work due to the accident, noting she was laid off for unrelated reasons.

Furthermore, the applicant was involved in a second, unrelated motor vehicle accident shortly after the first, and failed to prove that the injuries requiring treatment were caused by the first accident.

The application was dismissed in its entirety.

The applicant, who sustained a catastrophic impairment in a motor vehicle accident, sought payment for case management services (CMS) under the Statutory Accident Benefits Schedule.

The insurer partially denied a 2015 CMS plan based on the Professional Services Guideline limits and fully denied a 2018 CMS plan, arguing the applicant no longer required the services.

The Licence Appeal Tribunal dismissed the appeal, finding the insurer was not liable for amounts exceeding the Guideline limits for the 2015 plan.

For the 2018 plan, the Tribunal preferred the insurer's nursing assessment, which demonstrated the applicant's current capacity to independently manage her treatment and rehabilitation, concluding the CMS was not reasonable and necessary.

The applicant sought income replacement benefits (IRBs) following a motor vehicle accident, claiming she suffered a substantial inability to perform the essential tasks of her pre-accident employment as an early childhood educator due to psychological and physical impairments.

The insurer denied the claim based on multiple insurer's examinations.

The Tribunal found that the applicant failed to meet her burden of proof, noting that her own treating psychiatrist's records indicated her depression and post-concussion syndrome had largely resolved.

The appeal for IRBs and interest was dismissed.

The applicant sought statutory accident benefits for chiropractic treatment and a psychological assessment following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant had reached maximum medical recovery for her physical injuries and that her ongoing complaints were due to pre-existing rheumatoid arthritis.

The Tribunal also denied the psychological assessment, relying on an insurer's examination that found no psychological injury and the applicant's own statements that she did not need psychological treatment.

Claims for an award and interest were consequently dismissed.

The applicant was struck by a taxi as a pedestrian, sustaining severe facial injuries.

She sought statutory accident benefits for septorhinoplasty and scar revision, which the insurer denied.

The insurer raised a preliminary issue that the appeal was statute-barred under s. 56 of the Statutory Accident Benefits Schedule.

The Tribunal found the appeal was not statute-barred because the insurer's subsequent reconsideration and second denial notice rendered the initial denial equivocal, resetting the limitation period.

On the substantive issues, the Tribunal found the proposed treatments were reasonable and necessary, preferring the evidence of the applicant's plastic surgeon over the insurer's expert.

The appeal was allowed and the disputed benefits were ordered payable with interest.

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

The respondent denied the claims on the basis that the applicant's injuries were predominantly minor and the $3,500 limit under the Minor Injury Guideline (MIG) had been exhausted.

The applicant argued that he sustained psychological injuries that removed him from the MIG.

The Tribunal found that the applicant's evidence of psychological impairment was insufficient, noting that he had expressly denied psychological issues to the respondent's assessor and in other documentation.

The Tribunal concluded that the applicant's injuries fell within the MIG, dismissing his claims for medical benefits, interest, and an award.

The applicant was injured in a motor vehicle accident and sought income replacement benefits, which the insurer denied.

The insurer raised a preliminary issue, arguing the applicant's appeal should be barred under section 55(1) of the Statutory Accident Benefits Schedule because he refused to attend further insurer's examinations (IEs).

The Tribunal applied the Al-Shimasawi factors and found the requested IEs were not reasonably necessary, noting they were requested at the '11th hour' before the hearing and without sufficient evidence of new medical information.

The Tribunal held the applicant was entitled to refuse attendance and allowed the appeal to proceed.

The applicant's request for costs was dismissed.

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

The insurer terminated the benefits and subsequently requested neurological and psychological insurer's examinations after receiving new medical information from the appellant.

The appellant deliberately refused to attend the examinations, arguing they were unnecessary and unreasonable.

The Tribunal applied the Al-Shimasawi factors and found the insurer's requests were reasonably necessary.

Consequently, the Tribunal held that the appellant was barred under section 55(1)2 of the Schedule from proceeding with her appeal regarding the income replacement benefits.

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

The insurer denied the claim and raised a preliminary issue that the applicant failed to provide requested information under s. 33(1)1 of the Statutory Accident Benefits Schedule.

The Tribunal found that the applicant failed to comply with seven requests for information and failed to provide a reasonable explanation for the delay.

Consequently, the insurer was not liable to pay the claimed benefits.

The Tribunal also ordered the applicant to pay $250 in costs for bringing an unreasonable appeal.

The applicant sought non-earner benefits following a motor vehicle accident.

The insurer suspended benefits after the applicant refused to provide clinical notes and records, a prior accident benefits file, and a CPP disability file requested under s. 33 of the Statutory Accident Benefits Schedule.

The Tribunal found that the clinical notes and the medical/rehabilitation portions of the prior files were reasonably required to assess causation, given the applicant's pre-existing injuries from a prior accident.

However, because the insurer's initial notices failed to inform the applicant of the saving provision under s. 33(8), the insurer remained liable to pay benefits until a compliant notice was issued on October 19, 2018.

The insurer is not liable to pay benefits after that date until the applicant provides the required information.

The applicant was involved in two motor vehicle accidents and settled his claims with the respondent insurer.

He later sought a determination of catastrophic impairment.

The insurer denied the claim on the basis of the full and final settlement agreements and brought a preliminary motion arguing the applicant must repay the settlement funds before proceeding to the Tribunal.

The Tribunal allowed the motion, finding that under s. 9.1(8) of Regulation 664, an insured person cannot apply to the Tribunal regarding benefits that were the subject of a settlement without first returning the money paid in consideration of that settlement.

The applicant sought statutory accident benefits following a motor vehicle accident, which the insurer denied on the basis that the injuries fell within the Minor Injury Guideline (MIG).

The insurer raised a preliminary issue that the applicant was barred from proceeding because he failed to attend a scheduled insurer's examination (IE).

The Tribunal found that the applicant failed to provide a reasonable explanation for his non-attendance, thereby barring the appeal under s. 55(1)2 of the Schedule.

Although not required to decide the substantive issue, the Tribunal also concluded that the applicant failed to meet the onus of proving his physical and psychological injuries fell outside the MIG, preferring the insurer's expert evidence.

The appeal was dismissed.

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

The insurer denied the claims, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and that the appeal should be barred due to the applicant's failure to attend an insurer's examination.

The Tribunal found the appeal was not barred, as the insurer's request for an examination was made over a year after the denial and on the eve of the hearing.

The Tribunal determined the applicant was removed from the MIG due to a chronic pain condition diagnosed by an uncontroverted medical report.

The Tribunal awarded medical benefits for chiropractic treatment and clinical notes, but denied the cost of a duplicative chronic pain assessment.

The applicant was also awarded non-earner benefits from September 27, 2016, ongoing.

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

The respondent insurer denied the claims, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and were subject to the $3,500 cap.

The applicant argued she should be removed from the MIG due to a pre-existing condition and chronic pain.

The Tribunal found the applicant failed to provide compelling evidence that her pre-existing condition prevented maximal medical recovery within the MIG limit.

Furthermore, the Tribunal preferred the respondent's expert evidence and surveillance footage over the applicant's chronic pain assessment, concluding the applicant did not suffer from chronic pain.

The application was dismissed, and the applicant's injuries were deemed minor.