Sandeep Johal

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

The Associate Chair initiated a review and found that the Tribunal committed a material breach of procedural fairness by relying on the respondent's expert report after the expert was not made available for cross-examination.

The Tribunal's failure to allow cross-examination on central evidence, while still relying on the report to support its conclusions, warranted cancelling the original and reconsideration decisions.

A new hearing was ordered.

The respondent insurer requested a reconsideration of a Licence Appeal Tribunal decision that granted the applicant relief from forfeiture, allowing her to rescind an application to one insurer and apply to the respondent.

The Vice-Chair granted the reconsideration, finding that the original decision contained an error of law.

The Tribunal, as a statutory creature, does not have the inherent jurisdiction of a court to grant equitable remedies such as relief from forfeiture under section 129 of the Insurance Act.

The original decision was rescinded, and the applicant was found not entitled to relief from forfeiture.

The respondent requested a reconsideration of a Licence Appeal Tribunal decision that granted the applicant relief from forfeiture, allowing them to rescind an application to one insurer and apply to the respondent.

The respondent argued the Tribunal lacked jurisdiction to grant equitable remedies.

The Vice-Chair agreed, finding that the Tribunal, as a statutory body, does not have the inherent jurisdiction of a court to grant equitable relief such as relief from forfeiture under section 129 of the Insurance Act.

The reconsideration was granted, and the original decision ordering relief from forfeiture was rescinded.

The respondent requested a reconsideration of a Tribunal decision finding the applicant was employed at the time of the accident and entitled to an income replacement benefit.

The respondent argued the Tribunal made errors of law and fact by failing to apply the eligibility criteria in s. 5(1) of the Schedule and failing to consider the impact of the applicant's WSIB benefits under s. 47(3)(e) of the Schedule and s. 43(3) of the Workplace Safety and Insurance Act.

The Vice-Chair agreed, finding the original decision lacked the necessary analysis of these provisions.

The request for reconsideration was granted, the original decision was cancelled, and a rehearing by written submissions before a different adjudicator was ordered.

The applicant and respondent both requested a reconsideration of a previous Licence Appeal Tribunal decision.

The applicant argued the Tribunal provided inadequate reasons and erred in finding she was not catastrophically impaired, denying a psychological treatment plan, and denying an award.

The respondent argued the Tribunal erred in awarding post-104-week income replacement benefits.

The Vice-Chair dismissed both requests, finding no errors of law or fact and concluding that the original decision provided adequate reasons and properly weighed the evidence.

The applicant was catastrophically injured in a motor vehicle accident and sought Income Replacement Benefits (IRB).

Prior to the accident, the applicant was participating in a Work Transition Program through the WSIB, which included a work placement.

The insurer denied IRB, arguing the applicant was not employed but receiving disability benefits.

The Tribunal found that the work placement created an employer/employee relationship, as the applicant was required to perform specific duties and report to a supervisor.

The Tribunal concluded the applicant was employed at the time of the accident and entitled to IRB.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including housekeeping and home maintenance benefits and an income replacement benefit.

The Licence Appeal Tribunal found that the applicant failed to provide compelling and contemporaneous medical evidence to prove a substantial inability to perform housekeeping tasks or the essential tasks of her employment.

The respondent's claim for repayment of an income replacement benefit was also dismissed as no evidence was provided.

All claims were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including an income replacement benefit.

A videoconference hearing was scheduled to determine the income replacement benefit issue, with remaining issues to be heard in writing.

The applicant, who was self-represented after his counsel withdrew, failed to attend the hearing despite being properly served with the notice of hearing.

The Tribunal proceeded in his absence pursuant to the Statutory Powers Procedure Act.

As the applicant provided no submissions or evidence, he failed to meet his burden of proof.

The Tribunal dismissed the claim for an income replacement benefit and set a schedule for written submissions on the remaining issues, including the respondent's request for costs.

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

The parties agreed the applicant was entitled to an income replacement benefit (IRB) but disputed the quantum.

The Tribunal found it had no jurisdiction to hold a hearing on the undisputed issue of entitlement.

On quantum, the Tribunal preferred the respondent's accounting report, applying the Divisional Court's decision in Surani to find that post-accident sub-contractor expenses should be apportioned to the entire business, not just the applicant's share.

The Tribunal also approved a treatment plan for physical therapy as reasonable and necessary, but denied the applicant's claim for an award, finding the respondent did not unreasonably withhold or delay benefits.

The applicant sought statutory accident benefits following a 2017 motor vehicle accident, claiming catastrophic impairment, income replacement benefits (IRB), and various medical and rehabilitation benefits.

The Licence Appeal Tribunal found the applicant was not catastrophically impaired, as she did not demonstrate Marked or Class 4 impairments in three of four functional domains, relying partly on surveillance evidence showing her ability to socialize and complete tasks.

Consequently, her claim for attendant care benefits was dismissed.

However, the Tribunal granted her claim for a post-104-week IRB, finding her severe chronic pain and heavy medication use rendered her completely unable to engage in suitable employment.

Several treatment plans, including for medical marijuana and lidocaine injections, were approved as reasonable and necessary for pain relief, while others were denied.

The claim for an award for unreasonably withheld benefits was dismissed.

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

Neither the applicant nor her counsel attended the scheduled videoconference hearing, and no evidence was filed.

The Tribunal proceeded in their absence under section 7 of the Statutory Powers Procedure Act and dismissed the claims for lack of evidence.

The respondent's request for costs was also dismissed, as the Tribunal found that the failure to attend and comply with orders was attributable to the applicant's counsel, and awarding costs would unfairly punish the applicant.

The applicant was injured in a motor vehicle accident and deemed catastrophically impaired.

She sought attendant care benefits, which the respondent denied.

The Tribunal found that while the applicant required some attendant care services for feeding and hygiene, she was not entitled to payment because she failed to prove that the services were 'incurred' under s. 3(7) of the Schedule, as there was no evidence of economic loss by her husband or mother who provided the care.

The Tribunal also dismissed the applicant's claim for an award under s. 10 of Regulation 664, finding no evidence that the respondent unreasonably withheld or delayed benefits.

The application was dismissed.

The applicant was injured in a motor vehicle accident and received income replacement benefits (IRBs) from the respondent.

The applicant had long-term disability (LTD) benefits available through his employer but failed to apply for them within the required 90-day limitation period, resulting in a denial of his LTD claim.

The respondent sought to deduct the LTD benefits from the applicant's IRBs, arguing that the applicant's failure to apply on time should be treated as if he had foregone the benefits.

The Tribunal agreed, finding that the applicant had an obligation to diligently pursue collateral benefits and that the accident benefits insurer is the payor of last resort.

The respondent was permitted to deduct the LTD benefits that would have been available had the applicant applied in time.

The respondent insurer brought a motion to compel the applicant's counsel, who was also her former employer, to testify as a witness at the hearing regarding her claim for attendant care benefits.

The respondent argued the evidence was relevant to the applicant's capabilities since the accident.

The Tribunal dismissed the motion, finding the respondent failed to meet the high threshold of showing the lawyer's evidence was highly material or necessary, particularly since the benefits in dispute were from 2020 onwards while the employment occurred in 2013-2014.

The Tribunal also noted the motion was untimely and compelling the lawyer would improperly deprive the applicant of her choice of counsel.

The applicant sought reconsideration of a preliminary issue decision which found he was barred from proceeding with his dispute over medical benefits due to his failure to attend insurer examinations under s. 44 of the Schedule.

The applicant argued the Tribunal made errors of law and fact and sought to introduce new evidence regarding his requests for virtual examinations.

The Tribunal dismissed the request, finding the new evidence would not have changed the outcome and that no errors of law or fact were made in the original decision.

The applicant was injured in a motor vehicle accident and sought an income replacement benefit (IRB).

The respondent insurer sought to deduct the applicant's Employment Insurance (EI) sickness benefits from the IRB as "gross employment income" and requested a repayment of previously paid IRBs.

The Tribunal held that EI sickness benefits are not deductible from an IRB, as they are not considered gross employment income and are specifically excluded from being deductible as temporary disability benefits under the Schedule.

Furthermore, the Tribunal found the respondent's repayment notice was deficient and unclear.

The applicant's claims for a special award and costs were dismissed, as the respondent's conduct in taking a position on a novel legal issue did not meet the threshold of being unreasonable, frivolous, vexatious, or in bad faith.

The applicant sought statutory accident benefits after fracturing her ankle when she stepped onto a gravel strip while attempting to open the door of her newly purchased van at a dealership.

The respondent denied the claim on the basis that the incident did not meet the definition of an 'accident' under s. 3(1) of the Statutory Accident Benefits Schedule.

The Tribunal found that while the purpose test was met, the causation test was not.

The Tribunal concluded that the unmarked gravel construction area was an intervening cause and the dominant feature of the incident, not the use or operation of the vehicle.

The application for accident benefits was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits.

The respondent denied treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued that pre-existing conditions and psychological impairments warranted removal from the MIG.

The Licence Appeal Tribunal found that the applicant failed to provide compelling evidence of a psychological impairment or that a pre-existing condition would prevent maximal recovery within the MIG limits.

However, as the MIG limit had not been exhausted, the Tribunal approved the physiotherapy treatment plan up to the remaining limit.

Claims for a psychological assessment, an award, and costs were dismissed.

The applicant sought statutory accident benefits for chiropractic treatment and various medical expenses following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the chiropractic treatment plan was not reasonable and necessary as the medical evidence did not support the claimed functional limitations.

Furthermore, the Tribunal denied the OCF-6 expenses because the applicant, an international student, failed to first submit the claims to her available collateral benefits provider (UHIP) as required by section 47(2) of the Schedule.

The applicant requested a reconsideration of a decision finding the respondent was not liable to pay an income replacement benefit due to a material misrepresentation.

The applicant argued the Tribunal exceeded its jurisdiction, denied procedural fairness, failed to apply strict statutory interpretation, and erred in declining to apply equitable principles of waiver and estoppel.

The Tribunal dismissed the request, finding no breach of procedural fairness, no ambiguity requiring strict statutory interpretation, and confirming that the Tribunal lacks jurisdiction to apply equitable remedies under the Statutory Accident Benefits Schedule.