D. Gregory Flude

The appellants appealed a Notice of Proposal to Revoke a Registration issued by the Registrar under the Motor Vehicle Dealers Act, 2002.

The parties subsequently entered into Minutes of Settlement and requested that the Licence Appeal Tribunal dispose of the appeal without a hearing.

The Tribunal issued a consent order requiring the appellants to reimburse the Motor Vehicle Dealers Compensation Fund in the amount of $8,688.80 and vacated the scheduled hearing dates.

The applicant sought reconsideration of a Licence Appeal Tribunal decision that denied his claims for treatment plans, interest, and an award under O. Reg 664 following a motor vehicle accident.

The applicant argued the Tribunal erred by not addressing the respondent's delay in removing him from the Minor Injury Guideline and by finding no objective evidence of a traumatic brain injury.

The Vice-Chair dismissed the request for reconsideration, finding that the applicant failed to identify a material error of fact or law and was merely attempting to reweigh the evidence.

The applicant sought further statutory accident benefits, including treatment plans, after a prior Tribunal decision found his injuries were predominantly minor and subject to the $3,500 coverage limit.

The respondent raised a preliminary issue that the claim was barred by res judicata.

The Tribunal held that while res judicata does not strictly prevent an insured from bringing new evidence of a worsening condition under the Schedule, the applicant failed to provide conclusive new evidence of deterioration.

The medical records showed his condition was largely unchanged since the prior decision.

The claims for treatment plans were dismissed.

The appellant towing company appealed a Cancellation and Seizure Order issued by the Registrar of Motor Vehicles, which cancelled its Commercial Vehicle Operator Registration certificate and seized its commercial vehicle plates.

At the outset of the hearing, the parties settled all outstanding issues and the appellant withdrew its appeal.

The Tribunal closed the file.

The applicant, an Ontario resident, was involved in a motor vehicle accident in Quebec and elected to receive statutory accident benefits under the Quebec legislative framework.

A dispute arose regarding his entitlement to a lump sum payment, and he applied to the Licence Appeal Tribunal.

The respondent insurer brought a preliminary issue motion arguing that the Tribunal lacked jurisdiction because the applicant elected Quebec benefits.

The Tribunal held that it has jurisdiction under section 280 of the Insurance Act to resolve disputes regarding entitlement to benefits, and section 59 of the Schedule does not require an insured to pursue dispute resolution in the jurisdiction where the accident occurred.

The respondent's motion was dismissed.

The applicant sought reconsideration of a preliminary issue decision that barred her from proceeding with a claim for an income replacement benefit (IRB) due to her failure to attend an insurer's examination under s. 44 of the Statutory Accident Benefits Schedule.

The applicant argued that the insurer could not require an examination after she had returned to work and was no longer entitled to an IRB.

The Tribunal found no material error of fact or law in the original decision, noting that the applicant continued to assert her claim for an IRB, which preserved the insurer's right to assess her entitlement.

The request for reconsideration was denied.

The applicant's estate sought a non-earner benefit following a motor vehicle accident.

Prior to the accident, the applicant had been diagnosed with progressive, metastatic breast cancer and chronic renal failure.

The Tribunal dismissed the application, finding that the applicant's impairments and declining ability to lead a normal life were caused by her terminal cancer rather than the soft-tissue injuries sustained in the accident.

The Tribunal concluded the applicant did not suffer a complete inability to carry on a normal life as a result of the accident.

Claims for interest and costs were also dismissed.

The applicant sought an income replacement benefit (IRB) following a motor vehicle accident, claiming he was substantially unable to perform the essential tasks of his pre-accident employment as a warehouse manager.

The respondent denied the benefit.

The Tribunal found that the applicant's injuries from the minor collision had resolved within a few months and that his ongoing pain was attributable to a pre-existing degenerative back condition rather than the accident.

The Tribunal concluded the applicant failed to prove a substantial inability to perform his employment tasks and dismissed the application for the IRB, along with claims for an award and interest.

The applicant sought statutory accident benefits, claiming that a motor vehicle accident caused her to subsequently develop meningitis and an empyema.

The applicant's expert theorized that the accident caused a rupture in the dura mater, allowing a middle ear infection to migrate to the brain.

The Tribunal found the expert's theory to be overly speculative and concluded that the applicant failed to prove on a balance of probabilities that the accident was a necessary cause of her meningitis.

The preliminary issue was answered in the negative.

The applicant sought a non-earner benefit following a 2014 motor vehicle accident.

The insurer denied the benefit in July 2014.

The applicant applied to the Licence Appeal Tribunal in December 2019, over five years later.

The insurer brought a preliminary motion arguing the claim was barred by the two-year limitation period under the Insurance Act and the Statutory Accident Benefits Schedule.

The applicant argued the denial was equivocal, the discoverability principle applied, and alternatively sought an extension under s. 7 of the Licence Appeal Tribunal Act.

The Tribunal found the July 2014 denial was clear and unequivocal, the discoverability principle did not apply as the applicant had all necessary facts, and declined to extend the limitation period due to the lengthy delay and resulting prejudice to the insurer.

The appeal was dismissed.

The applicant sought a determination that he sustained a catastrophic impairment due to a psychological condition resulting from a 2014 motor vehicle accident.

The respondent insurer argued the applicant was malingering and that any impairment stemmed from a prior 2011 accident.

Despite evidence of the applicant deliberately frustrating the respondent's psychological assessments, the Tribunal preferred the evidence of the applicant's neuropsychiatrist, finding a marked deterioration in the applicant's mental health.

The Tribunal concluded the applicant suffered a Class 4 marked impairment in three spheres and that, but for the 2014 accident exacerbating his pre-existing condition, he would not have sustained a catastrophic impairment.

The applicant requested a reconsideration of a preliminary issue decision which found her application for an income replacement benefit premature due to her failure to submit a Disability Certificate (OCF-3).

The applicant argued that the adjudicator made material errors of fact and law regarding the delivery of the OCF-3 to the insurer.

The Tribunal dismissed the request, finding that the applicant was merely attempting to relitigate the matter and reweigh the evidence, and failed to identify any material error that would have changed the outcome.

The applicant requested a reconsideration of a decision denying a declaration of catastrophic impairment, income replacement benefits, and medical/rehabilitation benefits following a motor vehicle accident.

The applicant argued the Tribunal erred in law by excluding a 3% rating for medication and an 18% rating for future surgery from the Whole Person Impairment calculation, and by misinterpreting the eligibility criteria for income replacement benefits.

The Vice-Chair dismissed the request, finding no significant errors of fact or law.

The Tribunal affirmed that the catastrophic impairment assessment must be based on the applicant's current condition, not a projected condition following future surgery, and that the applicant failed to prove he was self-employed at the time of the accident.

The applicant sought interest and a special award under Regulation 664 for delayed and suspended income replacement benefits (IRBs) following a motor vehicle accident.

The Tribunal found the insurer liable for interest for a brief period in 2018 when it failed to respond to the initial application within the required 10 days under s. 36 of the Schedule.

However, no interest was payable for 2019 as the applicant's self-employment income resulted in a zero IRB entitlement, and the applicant conceded to repaying a $20,856 overpayment for that year.

The Tribunal also awarded interest on a lump-sum back payment for a period in 2020 when benefits were temporarily suspended based on medical assessments but later reinstated.

The claim for a special award was dismissed, as the insurer actively and reasonably adjudicated the file based on the available medical evidence.

The applicant was injured in a motor vehicle accident and sought ongoing income replacement benefits (IRBs) after the insurer terminated them.

The insurer argued the applicant's impairments were due to pre-existing degenerative disc disease and osteoarthritis.

The Tribunal found that the applicant suffered from chronic pain syndrome caused by the accident, applying the AMA Guides criteria.

Given her limited English, lack of higher education, and history of physically demanding work, the Tribunal concluded she met both the substantial inability test and the complete inability test.

The Tribunal ordered the insurer to pay the ongoing IRBs with interest.

The respondent insurer sought reconsideration of a preliminary issue decision which found that the applicant was a dependent of his mother and therefore an insured under her policy.

The Tribunal dismissed the request for reconsideration, holding that under Rule 18.1 of the Licence Appeal Tribunal Rules, reconsideration is only available for decisions that finally dispose of an appeal.

Because the preliminary issue decision allowed the applicant's claim to proceed, it was not a final disposition, and the request was premature.

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits and medical benefits for physiotherapy.

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline limit of $3,500.

The Tribunal found that the applicant's injuries were predominantly minor, rejecting his expert's diagnosis of chronic pain syndrome as it relied on an outdated and misapplied test.

The Tribunal also dismissed the claim for income replacement benefits, finding insufficient evidence that the applicant suffered a substantial or complete inability to work.

All claims were dismissed.

The respondent insurer brought a preliminary issue motion to stay the applicant's claim for an income replacement benefit (IRB) on the basis that it was premature.

The insurer argued the applicant failed to submit a Disability Certificate (OCF-3) prior to applying to the Licence Appeal Tribunal.

The applicant contended the OCF-3 was faxed to the insurer in December 2017 or included in a bundle of clinical notes in November 2019.

The Tribunal found that the applicant did not properly submit the OCF-3 until May 2020, after the Tribunal application was commenced.

As there was no valid application for the benefit and no denial at the time of filing, there was no dispute over entitlement.

The claim for an IRB was dismissed as premature.

The respondent sought costs following the dismissal of the applicant's motion to recuse the adjudicator.

The Tribunal found that the applicant acted unreasonably and in bad faith by bringing a motion for relief previously denied with no new grounds, and by making a collateral attack on another Tribunal order.

The applicant was ordered to pay $1,000 in costs to the respondent.

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

The insurer determined the applicant suffered predominantly minor injuries and denied treatment beyond the $3,500 limit, as well as income replacement and non-earner benefits.

The Tribunal found the applicant's claim for a non-earner benefit was barred because he qualified for an income replacement benefit and missed the two-year limitation period.

The Tribunal declined to extend the limitation period.

On the merits, the Tribunal concluded the applicant's injuries were predominantly minor and that he was not entitled to an income replacement benefit, as surveillance evidence and his failure to report income undermined his claims.