Christopher Evans

The applicant was injured in a snowmobile accident and sought a determination that he sustained a catastrophic impairment due to a mental or behavioural disorder.

The respondent disputed the catastrophic impairment designation and denied several treatment plans and assessments.

The adjudicator found that the applicant sustained a catastrophic impairment, concluding he had marked impairments in activities of daily living, social functioning, and adaptation, despite the respondent's reliance on social media posts showing the applicant travelling.

The adjudicator awarded the disputed treatment plans at the catastrophic impairment rates and awarded HST on the assessments, but capped the assessment fees at the $2,000 statutory maximum.

Claims for a special award and costs were dismissed.

The applicant, who sustained a catastrophic brain injury in a 1997 motor vehicle accident, applied for retroactive attendant care benefits (ACBs) in 2021.

The respondent insurer denied the retroactive claim.

The Tribunal found that the applicant was entitled to retroactive ACBs for the period after his discharge from the hospital, as well as for two weekends spent at home during his hospital stay, because the services were reasonably necessary and quantifiable.

The Tribunal also held that interest on the overdue benefits began to accrue 10 business days after the 2021 application was submitted.

Finally, the Tribunal granted a special award of $42,000 under s. 10 of Regulation 664, finding that the respondent unreasonably withheld benefits by failing to adequately inform the applicant of his potential entitlement to ACBs shortly after the accident.

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

The respondent insurer denied benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and later moved to bar the application under s. 55(1)2 of the Schedule for failure to attend insurer's examinations.

The Tribunal found the application was not barred because the insurer's notice lacked adequate reasons.

On the merits, the Tribunal concluded the applicant's psychological issues, including severe depression, pre-dated the accident and that the accident itself was a suicide attempt.

Consequently, the applicant failed to prove he sustained a psychological impairment caused by the accident or that a pre-existing condition prevented his recovery under the MIG.

The application for psychological benefits, an award, and interest was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's determination that her injuries fell within the Minor Injury Guideline (MIG).

The applicant claimed her tennis elbow, neck and shoulder strains, and ongoing pain constituted non-minor injuries.

The Tribunal found that the tennis elbow predated the accident and that the applicant failed to prove her pain caused functional impairment or disability.

As the applicant did not establish a non-minor injury, she was subject to the $3,500 MIG limit, which was essentially exhausted.

The claim for $4,115.00 in chiropractic services was dismissed.

The respondent's request for costs was also denied.

The applicant requested a reconsideration of a previous Licence Appeal Tribunal decision that awarded her attendant care benefits for a three-month period.

She argued the Tribunal erred by not awarding benefits for a broader sixteen-month period, despite conceding that only the three-month period was formally in dispute at the hearing.

The adjudicator dismissed the request, finding no error of law or fact in the original decision.

The adjudicator held that the Tribunal lacks jurisdiction on reconsideration to decide a new dispute regarding entitlement periods that were not before it in the original hearing.

The applicant sought statutory accident benefits following a motor vehicle accident, including attendant care, medical and rehabilitation benefits, and a functional abilities evaluation.

The respondent insurer denied the benefits, arguing the applicant's impairments were not caused by the accident and that she was independent in her activities of daily living.

The Tribunal found that the accident was a necessary cause of the applicant's impairments, satisfying the 'but for' test, and that her injuries were not minor.

Relying on the in-person observations of the respondent's occupational therapist over the virtual assessment of the applicant's expert, the Tribunal concluded that some attendant care was reasonable and necessary.

The applicant was awarded partial attendant care benefits of $2,820.16 with interest, but her claims for medical and rehabilitation benefits and the functional abilities evaluation were dismissed for lack of evidence.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision which found he had not proved he sustained a non-minor injury and denied certain statutory accident benefits.

The applicant argued the adjudicator failed to consider evidence of chronic pain and psychological impairment, and breached procedural fairness.

The adjudicator dismissed the request, finding no errors of fact or law were made and no breach of procedural fairness occurred, noting the applicant was improperly attempting to reargue his case.

The applicant sought statutory accident benefits following a motor vehicle accident, including an income replacement benefit (IRB) and a psychological assessment.

The respondent argued the IRB claim was barred by res judicata due to a prior Tribunal decision.

The Tribunal found the IRB claim was barred from February 4, 2020 onward, but not for the preceding period.

The Tribunal awarded an IRB from November 1 to December 2, 2019, because the respondent failed to provide a timely denial notice under s. 36(5)(b) of the Schedule.

The claim for the unapproved portion of a psychological assessment was dismissed as the applicant failed to prove it was reasonable and necessary.

An award under s. 10 of Regulation 664 was denied, but interest was granted on the overdue IRB.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the insurer's determination that her injuries fell within the Minor Injury Guideline (MIG) and its denial of income replacement benefits (IRB) and a chiropractic treatment plan.

The Tribunal found that the applicant's injuries were predominantly minor, as she failed to prove ongoing functional impairment due to pain, and that she did not meet the test for an IRB because she did not demonstrate a substantial inability to perform the essential tasks of her pre-accident employment.

The Tribunal relied on surveillance evidence showing the applicant performing physical tasks and accepted the respondent's independent medical assessment.

The application was dismissed in its entirety.

The applicant sought $2,028.20 for osteopathy, kinesiology, and physiotherapy services incurred without first submitting a treatment plan, arguing the exception under s. 38(2)(d) of the Statutory Accident Benefits Schedule applied.

The Licence Appeal Tribunal found that the insurer did not explicitly or implicitly agree that the previously-incurred expenses were essential for the applicant's treatment or rehabilitation.

The application was dismissed, and the applicant was denied the expenses, interest, an award, and costs.

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

A written hearing was scheduled, but the applicant failed to file submissions.

The applicant's counsel advised of a breakdown in the solicitor-client relationship and requested to be removed from the record.

The applicant subsequently advised the Tribunal that he did not want to be contacted again.

The Tribunal dismissed the application as the applicant failed to meet his onus to prove entitlement to the benefits, and ordered the removal of his counsel from the record.

The respondent brought a motion to quash a summons issued to the Director of Clinical Services & Operations at an independent medical examination facility.

The applicant sought to examine the witness regarding the facility's quality assurance process and alleged inappropriate changes to draft reports.

The Tribunal granted the motion and quashed the summons, finding that the applicant failed to establish the witness had relevant first-hand knowledge.

The Tribunal also found the summons was an abuse of process because it breached a prior Case Conference Report and Order and required the production of an excessively broad array of documents.

The self-represented applicant requested a reconsideration of a Licence Appeal Tribunal decision regarding a lump sum indemnity for non-pecuniary damage.

The applicant alleged that the adjudicator demonstrated a reasonable apprehension of bias during the hearing and erred in denying a motion to add three new issues.

The adjudicator dismissed the reconsideration request, finding no evidence to overcome the strong presumption of adjudicative impartiality.

Furthermore, the adjudicator held there was no error of fact or law in denying the motion to add issues, as the applicant had failed to provide the respondent with adequate notice, which would have breached procedural fairness.

The applicant requested a reconsideration of a decision finding she did not sustain a catastrophic impairment.

She alleged breaches of procedural fairness, including the adjudicator's refusal to order late productions, exclusion of witnesses, and refusal to recuse himself for alleged bias.

She also alleged errors of fact and law in the assessment of her whole person impairment and social functioning under the AMA Guides.

The Tribunal dismissed the request, finding no breach of procedural fairness as the procedural rulings were justified and did not demonstrate bias.

Furthermore, the Tribunal found no errors of fact or law in the interpretation or application of the AMA Guides to the applicant's impairments.

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

The adjudicator found that the applicant's injuries were predominantly minor, as he failed to establish a psychological impairment or chronic pain syndrome that would remove him from the Minor Injury Guideline.

Consequently, his medical and rehabilitation benefits were capped at $3,500, and his claims for further treatment were dismissed.

The adjudicator partially allowed the claim for an income replacement benefit, granting it for a limited period during which the applicant was substantially unable to perform the heavy physical tasks of his construction business.

The claim for HST on an income replacement report was denied, as the Schedule does not mandate HST payments beyond the statutory cap for such reports.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including an income replacement benefit (IRB) and funding for assessments.

The insurer denied the benefits, arguing the applicant suffered predominantly minor injuries.

The Licence Appeal Tribunal found that the applicant suffered from chronic pain causing functional impairment, removing her from the Minor Injury Guideline and entitling her to $65,000 in medical and rehabilitation benefits.

The Tribunal awarded the IRB and the cost of a chronic pain assessment, but denied funding for a psychological assessment and a special award for unreasonable delay.

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

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

The Tribunal found that the applicant suffers from chronic pain syndrome, removing him from the MIG and entitling him to $65,000 in medical and rehabilitation benefits.

However, the Tribunal dismissed the claim for a non-earner benefit, finding the applicant did not suffer a complete inability to carry on a normal life.

The Tribunal also denied the proposed chiropractic and massage therapy services but granted the cost of a chronic pain assessment.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including a non-earner benefit, medical benefits, and assessment costs.

The insurer initially denied the claims on the basis of the Minor Injury Guideline but later conceded the injuries were non-minor.

The Tribunal found the applicant was not entitled to a non-earner benefit because she continued to engage in substantially all of her pre-accident activities, despite some limitations.

However, the Tribunal ordered the insurer to pay for occupational therapy, physiotherapy, and the costs of psychological, occupational therapy, and chronic pain assessments, finding them reasonable and necessary.

Claims for a special award and costs were dismissed.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision denying her entitlement to an income replacement benefit (IRB).

The applicant argued that the adjudicator erred in law by finding that her on-call work arrangement at a pasta factory did not constitute employment at the time of the accident under s. 5(1)(1)(i) of the Statutory Accident Benefits Schedule.

The adjudicator dismissed the request, affirming the application of the Divisional Court's test in Arab, which requires an exchange of remuneration for services over a defined period.

The adjudicator found no error in concluding that being on call, without performing services or receiving remuneration at the time of the accident, did not meet the statutory definition of employment.

The applicant, an Ontario resident, was injured in a motor vehicle accident in Quebec and elected to receive statutory accident benefits under Quebec law.

The parties agreed the applicant was entitled to a lump sum indemnity for non-pecuniary damage but disputed the amount.

The adjudicator accepted the opinions of both the applicant's and respondent's orthopaedic experts, finding that the applicant's cervical spine impairment met the criteria for a category two severity rating (4%) under the Quebec Regulation.

Combined with a category two lumbar spine impairment (4%), the overall impairment rating was 8%.

The adjudicator awarded the applicant a further $5,127.66 plus interest, based on the indexed maximum amount of $256,383.00.