Craig Mazerolle

The respondent requested reconsideration of a Licence Appeal Tribunal decision that awarded the applicant an income replacement benefit (IRB) and a vocational assessment treatment plan.

The respondent argued the Tribunal erred in its assessment of medical evidence regarding causation and the post-104 week IRB test.

The Vice-Chair dismissed the IRB grounds, finding the respondent was attempting to re-litigate the evidence.

However, the Vice-Chair found the Tribunal committed a legal error by approving the vocational assessment based on its relevance to the IRB determination rather than its necessity for the applicant's recovery.

The reconsideration was granted in part, and a written re-hearing was ordered solely for the vocational assessment treatment plan.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that granted her a non-earner benefit but denied her request for an award under s. 10 of Reg. 664.

The applicant argued the Tribunal failed to provide adequate reasons for denying the award.

The Vice-Chair agreed, finding the original reasons were conclusory and failed to address the applicant's submissions regarding the insurer's adjusting of the non-earner benefit.

However, upon conducting a fresh review of the award claim, the Vice-Chair concluded the applicant failed to prove the insurer's conduct was unreasonable.

The insurer was entitled to rely on its medical evidence and was not required to conduct updated assessments.

The original decision denying the award was confirmed, but minor typographical errors regarding the non-earner benefit entitlement were corrected pursuant to Rule 17.

The applicant and the respondent insurer, Aviva, both requested reconsideration of a Licence Appeal Tribunal decision regarding statutory accident benefits.

The applicant alleged procedural fairness breaches and errors of law regarding the denial of attendant care benefits and the reliance on an untested expert report.

The Tribunal dismissed the applicant's request, finding no procedural unfairness as the applicant had not properly summonsed the expert, and no error in the adjudicator's requirement for detailed invoices to prove expenses were incurred.

Aviva's request for reconsideration was granted in part to correct a mathematical error in the calculation of a bad faith award, reducing the quantum to $7,263.45.

The applicant's request for costs was denied.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that found he did not sustain a catastrophic impairment.

The applicant argued that the Tribunal breached procedural fairness by preventing his student-at-law representative from fully participating and by temporarily removing the applicant from the virtual hearing room during an objection.

The Vice-Chair agreed, finding that the Law Society of Ontario By-Laws permit a student-at-law to provide legal services under supervision, even in catastrophic impairment claims.

The Vice-Chair also found that removing the applicant during the cross-examination of a key expert witness was a material breach of procedural fairness.

The reconsideration was granted, the original decision was cancelled, and a rehearing before a new adjudicator was ordered.

The applicant requested a reconsideration of a previous Tribunal decision that held him to the Minor Injury Guideline (MIG) and denied his treatment plans.

The Vice-Chair found that the original decision contained a factual error regarding the interpretation of a CT scan report, which did not rule out a concussion as previously concluded.

Upon re-hearing the matter, the Vice-Chair determined that the applicant's consistent neurological symptoms supported a concussion diagnosis, removing him from the MIG.

The applicant was awarded funding for physiotherapy, massage, and occupational therapy (excluding travel time), plus interest.

The claim for a special award was dismissed.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied her claim for income replacement benefits.

The applicant argued that the Tribunal breached procedural fairness by holding a written hearing, made errors of fact and law regarding her non-compliance with document production requests, and failed to consider medical evidence regarding her post-104 week IRB entitlement.

The Vice-Chair dismissed the request, finding that the applicant failed to establish any grounds for reconsideration under Rule 18.2.

The applicant did not show a good reason for requiring a videoconference hearing, attempted to re-litigate findings of fact, and failed to explain why the medical evidence could not have been provided at the original hearing.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied her claims for an attendant care benefit, treatment plans for meal delivery, and a visual skills assessment following a motor vehicle accident.

The Vice-Chair granted the reconsideration in part, finding that the original decision erred by focusing exclusively on the applicant's physical ability to prepare meals while ignoring her documented cognitive and psychological limitations.

The Tribunal varied the decision to award the attendant care benefit of $448.49 per month.

However, while the Tribunal found an error in the original statutory interpretation regarding meal delivery plans, it ultimately confirmed their denial, concluding they were not reasonable and necessary given the approval of the attendant care benefit.

The denial of the visual skills assessment was also confirmed.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that found his accident-related impairments fell within the Minor Injury Guideline (MIG).

The applicant argued the Tribunal erred in its assessment of his pre-existing conditions, psychological impairments, and chronic pain.

The Vice-Chair dismissed the request, finding that the applicant was attempting to re-litigate the original decision and re-weigh the evidence, which is not permitted on reconsideration.

The Tribunal found no material error of law or fact that would have changed the outcome.

The applicant requested a reconsideration of a Tribunal decision that denied payment for an orthopaedic assessment treatment plan.

The applicant argued that the insurer's denial was invalid under s. 38(8) of the Schedule because it relied on an insurer's examination report obtained through a non-compliant notice under s. 44(5).

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

The Tribunal held that the compliance of a denial notice under s. 38(8) is not dependent on compliance with s. 44(5), as the purpose of s. 38(8) is simply to allow the insured person to understand the insurer's reasons for denial.

The appellants requested a reconsideration of a Licence Appeal Tribunal decision that denied their claim for a refund of deposit monies paid towards a condominium townhouse under the Ontario New Home Warranties Plan Act.

The appellants argued the Tribunal breached procedural fairness by relying on an incomplete review by Tarion and made errors of law and fact regarding the builder's alleged fundamental breach.

The Vice-Chair dismissed the request, finding no material breach of procedural fairness and concluding that the appellants were improperly attempting to re-litigate the original findings of fact and law.

The applicant requested a reconsideration of a Tribunal decision denying her entitlement to a post-104 week income replacement benefit (IRB).

The applicant argued the Tribunal erred in law by applying an overly literal interpretation of section 6(2)(b) of the Schedule and made contradictory findings regarding her credibility.

The Tribunal dismissed the request, finding that the original decision-maker conducted the appropriate contextual analysis required by the Court of Appeal in Rumball, and that the applicant was improperly attempting to re-litigate the weighing of evidence.

The applicant requested reconsideration of a Licence Appeal Tribunal decision that denied payment for a chiropractic treatment plan.

The Tribunal originally found the insurer complied with the 10-day notice requirement under s. 38(8) of the Schedule by uploading its denial to the Health Claims for Auto Insurance (HCAI) platform.

On reconsideration, the Vice-Chair found this was an error of law, as uploading a denial to a system inaccessible to the insured person does not constitute 'giving' notice.

The decision was varied to find the treatment plan payable for any services incurred between the 11th business day and the date the applicant actually received the denial.

The appellant requested a reconsideration of a Licence Appeal Tribunal decision that denied compensation for alleged new home warranty breaches regarding an elevator, roof drainage, and doors/windows.

The appellant argued the Tribunal breached procedural fairness, exceeded its jurisdiction, and made errors of fact and law by misapprehending evidence.

The Tribunal dismissed the request, finding the appellant was attempting to re-litigate the original decision and re-weigh the evidence, failing to meet the high threshold for reconsideration under Rule 18.2.

The applicant requested reconsideration of a decision holding him to the Minor Injury Guideline, arguing that a new MRI report showing a full-thickness shoulder tear constituted new evidence under Rule 18.2(c) of the Licence Appeal Tribunal Rules.

The Tribunal dismissed the request, finding that although the MRI report was not before the Tribunal when the decision was rendered and would likely have affected the result, the applicant failed to show that the evidence could not have been obtained previously.

The applicant was aware of the tear months before the decision was released but did not seek permission to introduce it into the hearing record.

The respondent insurer requested a reconsideration of a Tribunal decision that found the applicant entitled to an income replacement benefit.

The applicant, a pedestrian, was struck by a driver whose insurance policy with the respondent had expired.

The respondent argued the Tribunal acted outside its jurisdiction by effectively deciding a priority dispute and erred in finding the applicant was an 'insured person'.

The Tribunal dismissed the reconsideration request, finding no jurisdictional error or error of law.

It affirmed that the original decision correctly applied the 'nexus' test from Kingsway, establishing that the applicant's reliance on information that the driver was insured by the respondent created a sufficient connection to require the respondent to adjust the claim pending any priority dispute.

The applicant requested reconsideration of a Tribunal decision denying her income replacement benefits beyond April 23, 2024.

She argued the Tribunal erred in law by failing to consider contextual factors in the post-104 week test, such as the part-time nature of the reasonably suited employment, and misapprehended expert neurological evidence regarding her migraines.

The Tribunal found that while it erred in law by not applying the holistic analysis mandated by recent appellate jurisprudence, this error would not have changed the outcome given the medical evidence of her significant improvement.

The request for reconsideration was dismissed.

The applicant requested a reconsideration of a Tribunal decision that dismissed his claim for an attendant care benefit following a motor vehicle accident.

The applicant argued the Tribunal ignored evidence of his reliance on his wife, conflated his awareness of medical restrictions with functional ability, and improperly relied on a catastrophic assessment over an attendant care assessment.

The Tribunal dismissed the request, finding that the applicant was attempting to re-weigh the evidence and raise new arguments not presented at the initial hearing.

The Tribunal concluded no error of law or fact was established under Rule 18.2.

The self-represented appellant requested a reconsideration of a Licence Appeal Tribunal decision that ordered the revocation of his real estate salesperson registration.

The appellant argued that the adjudicator who heard the merits of the appeal breached procedural fairness by failing to consider medical and personal evidence he had presented at an earlier adjourned hearing before a different adjudicator.

The Tribunal granted the reconsideration, finding that it had a heightened obligation to ensure the self-represented appellant understood that evidence from the adjourned hearing would only be considered if explicitly raised again.

The original decision was cancelled and a rehearing was ordered.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that dismissed his application for statutory accident benefits.

The original decision found that the income replacement benefit and treatment plans in dispute had already been paid or approved by the respondent.

The applicant argued the Tribunal ignored medical evidence, misunderstood his adjournment request, and failed to consider his written submissions.

The Tribunal dismissed the reconsideration request, finding no error of law or fact and no breach of procedural fairness, noting that the applicant's submissions were primarily focused on an adjournment rather than the substantive issues.

The applicant requested reconsideration of a Licence Appeal Tribunal decision that dismissed his claim for outstanding amounts for psychological services.

The applicant argued the Tribunal erred in finding he had not submitted OCF-18 forms detailing the scope of therapy, which were crucial to determining his treating psychotherapist's entitlement to a higher hourly rate.

The Vice-Chair found that the OCF-18 forms had indeed been submitted with the applicant's reply, and this error of fact likely affected the outcome.

The request for reconsideration was granted, the original decision was cancelled, and the matter was ordered to be reheard by a new adjudicator based on the existing written record.