Jesse A. Boyce

The applicant sought entitlement to statutory accident benefits for treatment expenses and a chronic pain assessment following a 2015 motor vehicle accident.

The Tribunal dismissed the claim for $763.40 in treatment expenses because they were incurred prior to the submission of an OCF-18, contrary to s. 38(2) of the Schedule.

The Tribunal also dismissed the claim for a $2,400 chronic pain assessment, finding it was not reasonable and necessary as it duplicated services the applicant was already receiving in the United States.

Although the insurer issued a defective denial notice, the Tribunal applied the Divisional Court's ruling in Catic, holding that the insurer was not obligated to fund the assessment because it was not incurred during the period of non-compliance.

The respondent insurer requested a reconsideration of a decision finding that the parties had reached a binding settlement agreement regarding the applicant's accident benefits claims.

The insurer argued that the Tribunal erred in concluding that an email from the mediator constituted minutes of settlement and that an executed Settlement Disclosure Notice was not an essential term.

The Tribunal dismissed the request, finding no significant legal or evidentiary mistake that would have affected the outcome, and held that the insurer was attempting to re-litigate arguments that failed at first instance.

The applicant sought a $10,000 death benefit under the Statutory Accident Benefits Schedule following the death of her husband in a motor vehicle accident.

The respondent insurer denied the claim on the basis that the applicant was not "principally dependent" on her late husband for financial support.

The Tribunal applied the criteria from Miller v. Safeco, analyzing the applicant's financial situation in the six months prior to the accident.

The Tribunal found that the applicant's own income was sufficient to cover more than 51% of her financial needs, meaning she was not principally dependent on her husband.

The application for the death benefit, along with claims for interest and a special award, was dismissed.

The applicant sought reconsideration of a preliminary issue decision that found his claims for attendant care benefits were statute-barred under s. 56 of the Schedule.

The applicant argued he was denied procedural fairness because his former counsel abandoned him right before the hearing and failed to file submissions.

The Tribunal granted the reconsideration, finding that the applicant was unable to participate through no fault of his own.

Furthermore, the Tribunal found it was an error of law to statute-bar the claims, as the pre-emptive denial of benefits before the applicant's condition deteriorated engaged the doctrine of discoverability as set out in Tomec.

The preliminary decision was set aside, and the applicant was permitted to proceed with his claim at a substantive hearing.

The respondent insurer requested a reconsideration of a preliminary issue decision which found that the applicant was involved in an 'accident' when he fell from the roof of his transport truck while inspecting it.

The insurer argued the Tribunal failed to properly apply the 'but for' and 'intervening act' tests for causation.

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

The Tribunal confirmed that the use and operation of the truck was a direct cause of the impairments and that the ladder sliding away was not an intervening act that broke the chain of causation.

The applicant requested a reconsideration of a decision that found her statute-barred from proceeding with her application for statutory accident benefits due to her failure to attend a properly scheduled insurer's examination.

The applicant argued the Tribunal erred in its interpretation of the Statutory Accident Benefits Schedule and failed to apply its remedial purpose.

The Tribunal dismissed the request, finding no error of law or fact, as the applicant failed to attend the examination and the insurer's notices were proper.

The applicant requested a reconsideration of a preliminary issue decision that found his application for income replacement benefits was statute-barred.

The Vice-Chair granted the reconsideration, applying the recent Divisional Court decision in Varriano v. Allstate, which held that insurers must provide medical and other reasons for discontinuing benefits under s. 37(4) of the Schedule.

Because the insurer's denial cited only a return to work and failed to include a medical reason, it was invalid and did not trigger the limitation period.

The applicant was permitted to proceed with his application.

The applicant sought statutory accident benefits following a motor vehicle accident, including removal from the Minor Injury Guideline (MIG), a Non-Earner Benefit (NEB), and funding for a psychological assessment.

The Tribunal found that the applicant's chronic pain warranted removal from the MIG and approved the psychological assessment as reasonable and necessary to investigate the pain symptomology.

However, the claim for an NEB was dismissed because the medical evidence and the applicant's post-accident activities, including returning to part-time work, did not demonstrate a complete inability to carry on a normal life.

The applicant requested a reconsideration of a preliminary issue decision that found he failed to demonstrate his accident-related impairments warranted removal from the Minor Injury Guideline (MIG).

The applicant argued the adjudicator erred in fact and law regarding his chronic pain claim and sought to introduce a new CT scan.

The Tribunal dismissed the request, finding no error of law in referencing the AMA Guides for chronic pain in the absence of a diagnosis.

Furthermore, the new CT scan evidence was available prior to the hearing and failed to establish causation.

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

The insurer denied a treatment plan on the basis that the applicant's injuries fell within the Minor Injury Guideline.

After the applicant provided new medical records, the insurer scheduled an insurer's examination under s. 44 of the Schedule to determine if the new information altered her entitlement.

The applicant failed to attend the examination.

The Tribunal held that the insurer's notice was compliant and the examination was reasonably necessary.

Consequently, the applicant was statute-barred from proceeding with her application under s. 55 of the Schedule.

The applicant sought payment for a $5,140.00 treatment plan for case manager services following a motor vehicle accident, along with interest and a section 10 award.

The insurer denied the claim on the basis that the services were not reasonable and necessary.

The Tribunal found that the applicant failed to demonstrate the necessity of the services, noting that the treatment plan was premature, lacked supporting reasons, and the applicant was already successfully managing her treatment and recovery without a case manager.

The application was dismissed.

The applicant requested a reconsideration of a decision finding him statute-barred from proceeding with his application for an income replacement benefit due to his failure to attend a scheduled insurer's examination.

The applicant argued the adjudicator erred in fact and law regarding the insurer's accommodation, the right to insist on an in-person examination, and the reasonableness of his explanation for non-attendance.

The Tribunal dismissed the request, finding no significant legal or evidentiary mistake, as the applicant chose to leave the province for a hockey opportunity mere days before the scheduled examination.

The respondent insurer requested a reconsideration of an adjudicator's decision to unilaterally declare a mistrial and order a new hearing on the second day of a three-day hearing.

The Licence Appeal Tribunal granted the reconsideration, finding that the adjudicator committed errors of law and fact that resulted in procedural unfairness.

The Tribunal cancelled the order for a re-hearing and directed that the hearing continue before a new adjudicator using the transcript from the first two days, subject to the applicant's right to bring motions regarding evidence.

The applicant was involved in two motor vehicle accidents and reached a global settlement with the respondent insurer at mediation.

Ten days later, before signing the settlement disclosure notice (SDN) and release, the applicant was killed by her mother.

The insurer argued the settlement was unenforceable because the applicant did not personally sign the SDN and release, and because the common law slayer rule prevented the funds from flowing to the mother.

The Tribunal found that a binding settlement was reached at mediation and that the applicant's estate could execute the SDN and release on her behalf.

The Tribunal also found that the slayer rule did not invalidate the settlement, as the family committed to ensuring the funds would flow only to the applicant's sister.

The applicant was involved in two motor vehicle accidents.

She received non-earner benefits (NEBs) for the first accident until the insurer terminated them and began paying NEBs at a lower rate for the second accident.

The applicant disputed the termination, arguing her impairments stemmed from the first accident.

The Tribunal found that the second accident merely exacerbated the first accident's impairments and that the applicant continued to suffer a complete inability to carry on a normal life due to the first accident until October 31, 2019.

The Tribunal ordered the insurer to pay NEBs at the higher rate for the period of July 4, 2018 to October 31, 2019, with interest, but declined to order an award for unreasonable delay.

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).

The applicant argued that her diagnosis of sciatica and chronic pain warranted removal from the MIG.

The Tribunal found that the applicant failed to provide compelling medical evidence, such as a formal diagnosis or evidence of functional impairment, to justify removal.

The insurer's examination report diagnosing minor injuries was accepted.

As the MIG limits were exhausted, the disputed treatment plan was deemed not reasonable and necessary, and the application was dismissed.

The applicant sought payment for a treatment plan for physiotherapy and massage therapy following a motor vehicle accident.

The respondent denied the plan.

The Licence Appeal Tribunal found the treatment plan to be reasonable and necessary, noting the applicant's consistent reporting of pain and medical recommendations.

The Tribunal ordered the respondent to pay for the treatment plan once incurred, along with interest on overdue benefits, but declined to make a special award under s. 10 of O. Reg. 664.

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

The respondent denied the claims, asserting the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant applied to the Licence Appeal Tribunal but failed to file submissions or evidence.

The Tribunal found the applicant did not meet his burden of proof to establish his injuries warranted treatment beyond the MIG.

The application was dismissed, and the applicant was found not entitled to the disputed treatment plans or interest.

The applicant insurer sought repayment of income replacement benefits paid to the respondent after he had returned to work.

The respondent had entered into a settlement agreement to repay the funds but failed to make consistent payments.

The Tribunal found that the respondent committed wilful misrepresentation by failing to advise the insurer of his return to work while continuing to receive benefits.

The Tribunal ordered the respondent to repay the outstanding balance of $4,528.56, plus interest.

The applicant was injured in a motor vehicle accident and sought $2,212 for a chiropractic treatment plan, which the respondent denied.

The Tribunal found that the treatment plan was reasonable and necessary to treat the applicant's ongoing pain, despite the applicant's delay in providing updated medical records.

The applicant was awarded the cost of the treatment plan upon proof of it being incurred, plus applicable interest.

However, the Tribunal declined to order an award for unreasonable delay under Regulation 664 because the applicant failed to provide the respondent with updated clinical notes in a timely manner.