Craig Mazerolle

The Tribunal initiated a review of an initial decision and a reconsideration decision under Rule 18.5 of the Licence Appeal Tribunal Rules.

The Vice-Chair found that the adjudicator in the initial hearing committed a material breach of procedural fairness by admitting the respondent's expert medical reports without requiring the expert to attend for cross-examination.

Because the adjudicator relied heavily on these reports to deny several treatment plans, the breach was material.

Both the initial and reconsideration decisions were cancelled, and the matter was sent for a rehearing.

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

The Tribunal found that the applicant was barred from proceeding with claims for an income replacement benefit and several treatment plans because he failed to dispute their denials within the two-year limitation period, and declined to extend the time under section 7 of the LAT Act due to lengthy, prejudicial delays.

The Tribunal also dismissed the remaining claims for attendant care benefits and other treatment plans, finding the applicant failed to meet his evidentiary burden to show the expenses were reasonable and necessary.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied his claims for attendant care benefits and various treatment plans following a motor vehicle accident.

The Vice-Chair found that the original adjudicator committed a material breach of procedural fairness by striking pages of the applicant's submissions without analyzing the prejudicial impact.

The decision was cancelled and reheard.

On rehearing, the Vice-Chair granted the applicant's claim for attendant care benefits at $2,257.09 per month, preferring the evidence of the applicant's occupational therapist.

However, the claims for the disputed treatment plans were dismissed as the applicant failed to draw specific connections to the medical evidence to show they were reasonable and necessary.

The applicant requested a reconsideration of a Tribunal decision that denied his entitlement to a post-104 week Income Replacement Benefit (IRB) and found that the quantum for his pre-104 week IRB could not be determined.

The Vice-Chair dismissed the request to admit new tax documents to determine the IRB quantum, finding the applicant failed to show the evidence could not have been obtained previously.

However, the Vice-Chair found the original adjudicator committed an error of law by failing to explicitly engage with the expert evidence regarding the post-104 week IRB test.

Upon reviewing the evidence, the Vice-Chair concluded the applicant suffers from a complete inability to engage in reasonably suited employment due to chronic pain and cognitive struggles.

The decision was varied to find entitlement to the post-104 week IRB, though no benefit is currently payable as the quantum remains undetermined.

The Tribunal initiated a review of a previous reconsideration decision under Rule 18.5 because the applicant's properly filed submissions were not before the adjudicator.

The Vice-Chair found this omission constituted a material breach of procedural fairness, cancelled the previous reconsideration decision, and reheard the applicant's request for reconsideration.

On the merits of the request, the Vice-Chair found the applicant failed to establish any errors of fact or law, or any breach of procedural fairness in the initial decision regarding her removal from the Minor Injury Guideline.

The request for reconsideration was dismissed.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied her claims for a non-earner benefit and nine treatment plans.

The applicant argued the adjudicator erred in law and fact regarding the limitation period for the non-earner benefit, the validity of the insurer's examination notice, and the assessment of medical evidence for the treatment plans.

The Vice-Chair found no errors of law or fact that would have changed the outcome, noting the applicant was attempting to re-litigate issues already decided.

The request for reconsideration was dismissed.

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

The applicant argued the adjudicator erred in interpreting medical evidence and failed to address his argument that the insurer's denials of two treatment plans did not comply with s. 38(8) of the Statutory Accident Benefits Schedule.

The Vice-Chair found no error in the adjudicator's assessment of the medical evidence.

However, the Vice-Chair found the adjudicator erred in law by failing to address the s. 38(8) argument.

Upon conducting the s. 38(8) analysis, the Vice-Chair concluded the insurer's denial letters provided sufficient medical and other reasons to comply with the Schedule.

The request for reconsideration was granted in part to address the error, but the original decision was confirmed.

The respondent insurer requested a reconsideration of a Tribunal decision which found that the applicant had a reasonable explanation for the late submission of his Application for Accident Benefits (OCF-1).

The insurer argued that the adjudicators erred in their assessment of the applicant's credibility and the reasonableness of his explanation, specifically regarding when he retained counsel and his post-accident medical complications.

The Tribunal dismissed the request for reconsideration, finding that the insurer was attempting to re-litigate findings of fact and had failed to establish any error of law or fact that would warrant varying the decision.

The applicant sought income replacement benefits (IRBs) beyond the 104-week post-accident mark, requiring him to prove a complete inability to engage in any reasonably suited employment.

The respondent insurer denied the benefits, relying on surveillance evidence and expert reports suggesting the applicant had some capacity for work.

The Tribunal found the applicant's testimony, corroborated by his spouse and medical evidence, established that his chronic pain and severe psychological impairments prevented him from sustaining employment.

The Tribunal placed significant weight on the applicant's experts and found the surveillance evidence did not contradict his reported limitations.

The applicant was awarded ongoing IRBs and interest on overdue payments.

The appellant requested a reconsideration of a Licence Appeal Tribunal decision that confirmed the suspension of his driver's licence due to an alcohol use disorder.

The appellant argued that the adjudicators erred and breached procedural fairness by relying on a Medical Condition Report that was missing a mandatory street address, while disregarding another report that lacked a signature.

The Vice-Chair dismissed the request, finding that the adjudicators had properly weighed the evidence and that the appellant was improperly attempting to re-litigate the case and reweigh the evidence.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision which found she was not catastrophically impaired and denied a treatment plan for a catastrophic assessment.

The applicant argued the adjudicator erred in weighing the medical evidence, particularly regarding a pre-existing 2019 accident, and placed undue weight on surveillance evidence showing her speeding.

The Vice-Chair dismissed the request, finding the applicant was improperly attempting to re-weigh the evidence rather than identifying an error of law or fact.

The Tribunal also upheld the denial of the treatment plan balance, noting the applicant failed to explain why an amount greater than the statutory cap was reasonably required.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that dismissed her application without a hearing.

The applicant had sought damages for torts, including intimidation, against the insurer and other named respondents.

The Vice-Chair dismissed the reconsideration request, finding no error of law or fact in the initial determination that the Tribunal lacks jurisdiction to award common law damages or punitive damages.

The Tribunal reaffirmed that its remedial powers are limited to those granted by statute, such as deeming benefits incurred or making special awards, and do not extend to tort damages.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that found he had not established removal from the Minor Injury Guideline (MIG) for an alleged psychological impairment.

The applicant relied on Rule 18.2(c) of the Licence Appeal Tribunal Rules, 2023, arguing that new medical evidence justified removal from the MIG.

The Tribunal dismissed the request, finding that the applicant was attempting to re-litigate the case and failed to demonstrate that the updated medical records could not have been obtained previously or would likely have affected the result.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that found he remained within the Minor Injury Guideline (MIG) and was not entitled to disputed treatment plans.

The applicant argued the adjudicator erred in applying s. 18(2) of the Statutory Accident Benefits Schedule and in assessing his claim of chronic pain.

The Tribunal dismissed the reconsideration request, finding that the applicant failed to demonstrate an error of law or fact.

The Tribunal held that the applicant was attempting to re-litigate the weighing of medical evidence, which is not a valid ground for reconsideration under Rule 18.2.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied her non-earner benefits for a specific period due to her failure to submit a completed disability certificate (OCF-3) under s. 36(3) of the Schedule.

The applicant argued that the Tribunal erred in its strict interpretation of s. 36(3), asserting that the provision should not apply to an incapable applicant, and that the Tribunal failed to properly consider the Human Rights Code and the Charter.

The Vice-Chair dismissed the reconsideration request, finding that the applicant was attempting to re-litigate arguments made at the initial hearing and had failed to establish any error of law or fact under Rule 18.2(b).

The applicant sought a non-earner benefit (NEB) and an award following a 2014 motor vehicle accident.

On a rehearing ordered by a reconsideration decision, the Tribunal found the applicant established entitlement to the NEB.

The Tribunal applied the Heath test and concluded that the applicant's accident-related physical and psychological impairments continuously prevented her from engaging in substantially all of her pre-accident activities, which included daily exercise, chores, and socializing.

The Tribunal placed limited weight on the respondent's expert reports, finding they either lacked a comprehensive analysis of the applicant's activities or contradicted their own findings.

The applicant's request for an award under s. 10 of O. Reg. 664 was dismissed, as she failed to establish that the respondent unreasonably withheld or delayed payment of the NEB.

The applicant requested a reconsideration of the Tribunal's decision not to process her application.

The application sought damages from an insurer and several non-insurer respondents for alleged breaches of the duty of good faith and civil conspiracy.

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

The Tribunal held that its jurisdiction under section 280 of the Insurance Act is limited to disputes over statutory accident benefits and amounts, and it does not have the authority to award punitive or other damages against insurers or non-insurers.

The respondent insurer requested a reconsideration of a Licence Appeal Tribunal decision that had approved a $2,460 orthopaedic assessment treatment plan.

The Vice-Chair granted the reconsideration, finding that the initial adjudicator committed a material breach of procedural fairness by failing to provide adequate reasons for why the treatment plan was reasonable and necessary, focusing instead on the Minor Injury Guideline.

Upon rehearing the matter, the Vice-Chair dismissed the application for the treatment plan.

The Vice-Chair concluded that the applicant failed to establish that an orthopaedic assessment conducted entirely over the telephone, without any visual or video component, was reasonable and necessary to identify impairments or increase range of motion.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied his claim for a dental services treatment plan and interest.

The applicant argued that proceeding by way of a written hearing was procedurally unfair because he could not summons the respondent's dental assessor, and that medical issues prevented him from submitting his materials on time.

The Tribunal dismissed the request, finding that the applicant had an opportunity to dispute the hearing format at the case conference and that his medical note post-dated the deadline for his written submissions.

The applicant failed to establish any grounds for reconsideration under Rule 18.2.

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

The matter proceeded to a written hearing, but the applicant failed to file any submissions or evidence despite receiving notice.

Pursuant to section 7(2) of the Statutory Powers Procedure Act, the Tribunal proceeded in the applicant's absence.

The Tribunal found that the applicant failed to meet the onus of demonstrating removal from the Minor Injury Guideline or entitlement to the disputed benefits.

The application was dismissed.