Rebecca Hines

The applicant, who sustained a catastrophic impairment in a 2017 motor vehicle accident, sought attendant care benefits (ACBs) and various medical and rehabilitation benefits.

The Tribunal found the applicant entitled to ACBs for specific periods based on his psychological impairments, but held the benefits were not payable because the applicant failed to prove they were incurred.

The Tribunal partially approved treatment plans for social work, aquatherapy, concussion treatment, and a home renovation assessment, while denying others that were reasonably available through OHIP.

The Tribunal ordered Aviva to pay a special award of $9,041.12 under s. 10 of Regulation 664, finding that the insurer acted unreasonably and in bad faith by pre-emptively denying treatment plans and failing to comply with procedural timelines.

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

The insurer denied a treatment plan for chiropractic services on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.

The applicant argued that a pre-existing ACL tear warranted removal from the MIG.

The Tribunal found that the applicant failed to provide compelling medical evidence from a treating practitioner that his pre-existing condition would prevent him from achieving maximum medical recovery within the MIG.

As the MIG limits were exhausted, the claim for chiropractic services and interest was dismissed.

The insurer applied to the Licence Appeal Tribunal seeking repayment of income replacement benefits (IRBs) paid to the respondent, alleging wilful misrepresentation of post-accident employment.

The adjudicator found no wilful misrepresentation, as the respondent's singing activities did not generate proven income and she had disclosed her temporary spa employment to the insurer's medical examiner.

However, the insurer was entitled to repayment of $907.54 for overpayments made within the 12 months prior to its notice.

The adjudicator also determined that the respondent's injuries fell outside the Minor Injury Guideline (MIG) due to a concussion diagnosis supported by contemporaneous clinical notes.

The respondent was awarded costs for an accounting report and an oculo-visual assessment, but claims for a psychological assessment, chiropractic treatment, and a special award were dismissed.

The respondent insurer sought reconsideration of a decision finding the applicant entitled to post-104 income replacement benefits.

The insurer argued the adjudicator erred in law by applying the wrong legal test for suitable alternative employment based on Burtch v. Aviva.

The adjudicator dismissed the reconsideration request, finding that the correct disability test under s. 6(2)(b) of the Schedule was applied and that any alleged error regarding the comparability of alternative employment in status and reward would not have changed the result, as the applicant was functionally unable to work in the identified alternative occupations.

The respondent, Tarion Warranty Corporation, brought a motion to add the builder as a party to the appellant's warranty claim appeal.

The builder argued it had a significant interest due to reputational and financial risks, including potential indemnification claims.

The Tribunal denied the motion, finding that the builder's substantive rights would not be impeded by the decision and that adding the builder would unnecessarily complicate the consumer protection proceeding.

The builder's request for costs was also dismissed as it was not a party and the appellant's conduct was not unreasonable, frivolous, vexatious, or in bad faith.

The appellants appealed a Notice of Proposal to revoke their registrations as a motor vehicle dealer and salesperson.

The appellants failed to attend the hearing.

The Tribunal found that the individual appellant had furnished a falsified OMVIC wall certificate to an auction house and a financial institution in an attempt to pass off an unregistered business as a registered dealer.

The Tribunal concluded this past conduct afforded reasonable grounds for belief that the appellants would not carry on business in accordance with the law and with integrity and honesty.

The Tribunal directed the Registrar to carry out the proposal and revoke the registrations.

The applicant, a pedestrian struck by a vehicle, sought a determination that her accident-related psychological impairments met the definition of catastrophic impairment under Criterion 8 of the Statutory Accident Benefits Schedule.

The Tribunal reviewed expert assessments from both parties and found that while the applicant had a marked impairment in activities of daily living, she only had moderate impairments in concentration, persistence and pace, and adaptation.

As the applicant did not demonstrate a marked impairment in three of the four spheres of functioning, she did not meet the catastrophic impairment threshold.

Consequently, her claims for various medical and rehabilitation benefits were dismissed because the non-catastrophic limits had been exhausted.

The appellant, a licensed restaurant, appealed a Notice of Proposal refusing to remove a condition on its liquor licence that prohibited amplified music on its outdoor patio.

The condition was originally agreed to in 2018 following objections from a local community association.

The appellant argued that the economic impact of the COVID-19 pandemic constituted a change in circumstances, placing it at a competitive disadvantage.

The Tribunal found that the pandemic's effect on the restaurant industry was an unforeseeable change in circumstances.

Noting the appellant's history of compliance and support from nearby residents, the Tribunal directed the removal of the condition.

The applicant was injured in a motorcycle accident and sought attendant care benefits (ACBs) of $6,000 per month, claiming a need for 24-7 supervision due to physical, cognitive, and psychological impairments.

The respondent argued the applicant only required just under four hours of care per day.

The Tribunal found the applicant's evidence regarding cognitive decline unreliable and noted limitations in both parties' occupational therapy assessments.

Taking a practical approach based on the evidence, the Tribunal determined the applicant did not require 24-7 supervision but was entitled to ACBs in the amount of $2,724.28 per month.

The applicant sought a reconsideration of a previous decision denying her entitlement to an attendant care benefit, various medical benefits, and cost of examination expenses.

She argued the Tribunal committed a material breach of procedural fairness and made errors of law in assessing the evidence.

The Tribunal dismissed the request, finding no breach of procedural fairness as the applicant had the opportunity to respond to arguments and failed to submit key evidence.

The Tribunal also found no errors of law, concluding the applicant was attempting to relitigate issues already decided.

The applicant, a pedestrian struck by a vehicle, sought statutory accident benefits including attendant care benefits (ACBs) and various treatment plans.

The respondent initially denied benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG), but later removed him from the MIG.

The Tribunal found the applicant eligible for $686.92 per month in ACBs based on left shoulder limitations, but held the benefits were not payable because they had not been incurred.

The Tribunal approved a treatment plan for an optometric assessment but denied plans for Botox injections and an occupational therapy assessment.

Finally, the Tribunal ordered the respondent to pay a $3,473.20 award under s. 10 of O. Reg. 664, finding its 18-month delay in removing the applicant from the MIG was stubborn, unyielding, and unreasonable given the medical evidence.

The applicant sought accident benefits following a motor vehicle accident, arguing her injuries warranted removal from the Minor Injury Guideline (MIG) due to pre-existing conditions, psychological impairment, and chronic pain.

She also claimed entitlement to non-earner benefits and two treatment plans.

The Tribunal found the applicant's evidence insufficient to establish that her pre-existing conditions prevented recovery within the MIG.

The Tribunal preferred the respondent's expert evidence, concluding the applicant sustained only minor soft tissue injuries and no diagnoseable psychological impairment.

The claims for non-earner benefits and treatment plans outside the MIG limit were dismissed.

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

The insurer denied several treatment plans and an income replacement benefit, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant sustained a psychological impairment, removing her from the MIG.

The Tribunal approved treatment plans for psychological services, a psychological assessment, physiotherapy, and a chronic pain assessment, finding them reasonable and necessary.

However, claims for chiropractic services and an income replacement benefit were dismissed due to insufficient evidence.

The Tribunal awarded interest on the approved benefits but declined to order a special award, finding the insurer's conduct was not unreasonable.

The appellant appealed the 45-day impoundment of her vehicle under the Highway Traffic Act after a friend drove it while suspended.

The appellant argued the impoundment caused exceptional hardship because she suffers from chronic pain, relies on Ontario Works, and requires the vehicle for medical appointments and basic necessities.

The Licence Appeal Tribunal found that the appellant had no viable alternatives to the impounded vehicle due to physical and financial barriers to using public transit or taxis.

The Tribunal concluded that the impoundment posed a threat to the appellant's health and safety, satisfying the test for exceptional hardship, and ordered the vehicle released.

The applicant, who sustained a catastrophic impairment from a 2015 motor vehicle accident, sought $6,000 per month in attendant care benefits (ACBs), the cost of a cell phone and robotic vacuum, an award for unreasonable delay, and interest.

The Tribunal found the opinions of both parties' occupational therapists flawed and conducted its own assessment of the applicant's needs, awarding $3,062.92 per month in ACBs.

The Tribunal also approved $225 for the cell phone but denied the robotic vacuum.

The claim for a special award under s. 10 of Regulation 664 was dismissed as the applicant failed to prove the insurer acted unreasonably.

Interest was awarded on the overdue benefits.

The appellant applied for a liquor licence to operate a café and lounge.

The Registrar issued a Notice of Proposal to Review after receiving objections from local residents.

An added party opposed the licence, arguing it would negatively impact the neighbourhood and citing concerns over zoning, noise, and overcrowding.

The Tribunal found the added party's concerns were based on speculation and disagreements with city zoning decisions, failing to establish that granting the licence was contrary to the public interest.

The Tribunal directed the Registrar to issue the licence without conditions.

The appellant appealed a Notice of Proposal to refuse his registration as a motor vehicle salesperson.

The Registrar alleged the appellant misappropriated funds from consumers during his employment at two dealerships and made a false statement on his registration application by denying pending criminal charges.

The Tribunal found the appellant's past conduct afforded reasonable grounds for belief that he would not carry on business with honesty and integrity, and that he knowingly made a false statement on his application.

Finding that terms and conditions would not adequately protect the public interest, the Tribunal directed the Registrar to carry out the proposal to refuse the registration.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits, which the respondent insurer denied on the basis that the injuries fell within the Minor Injury Guideline (MIG).

The applicant applied to the Licence Appeal Tribunal, arguing for removal from the MIG due to a pre-existing condition, chronic pain, and a psychological impairment.

The Tribunal found that the applicant failed to provide sufficient evidence of a pre-existing condition preventing recovery, and preferred the insurer's medical examinations over the applicant's self-reports and expert evidence regarding chronic pain and psychological impairments.

Consequently, the Tribunal held that the applicant's injuries were predominantly minor, and dismissed the claims for four treatment plans and interest, as the plans exceeded the MIG limit and were not proven reasonable and necessary.

The respondent insurer sought reconsideration of a decision awarding the applicant $9,783.83 in past income replacement benefits.

The insurer argued the adjudicator erred in law by applying a remedy not found in s. 33 of the Schedule for deficient notices.

The Tribunal dismissed the reconsideration request, finding the insurer was attempting to relitigate issues and raise new legal arguments not made at the initial hearing.

The Tribunal affirmed that the insurer's s. 33 requests and notices denying benefits were vague, unclear, and deficient.

The applicant's request for costs was also dismissed.

The applicant was injured in a motorcycle accident and sought post-104 income replacement benefits (IRBs) and an occupational therapy assessment.

The respondent insurer denied the benefits, arguing the applicant could work in alternative occupations.

The Tribunal found that the applicant, a 63-year-old self-employed hairdresser with significant physical, cognitive, and psychological impairments, suffered a complete inability to engage in suitable alternative employment.

The Tribunal awarded the IRBs and the cost of the occupational therapy assessment, along with interest.

The applicant's request for a special award under s. 10 of Regulation 664 and costs was dismissed.