Thérèse Reilly

The applicant sought reimbursement for mileage expenses incurred by her spouse while visiting her in the hospital following a motor vehicle accident.

The applicant claimed a rate of $0.54 per kilometre based on Revenue Canada guidelines, while the respondent insurer paid $0.40 per kilometre based on the Transportation Expense Guideline.

The adjudicator found that the spouse was acting as an aide when providing transportation services, and therefore the Transportation Expense Guideline applied.

The application for the higher mileage rate and interest was dismissed.

The applicant sought payment for various treatment plans and assessments, including psychological services, chiropractic services, an attendant care assessment, an orthopaedic assessment, and a naturopathic assessment, following a motor vehicle accident.

The respondent denied the claims based on independent medical examinations indicating the applicant had mostly resolved soft tissue injuries and was capable of self-care.

The Tribunal dismissed all claims, finding the applicant failed to prove the treatment plans and assessments were reasonable and necessary, and applied the FSCO Guidelines to cap the hourly rate for psychological services.

The applicant sought attendant care benefits following a motor vehicle accident.

The insurer stopped payment after the applicant failed to attend a scheduled insurer examination and argued the subsequent application was statute-barred under section 56 of the Schedule as it was filed more than two years after the refusal.

The Tribunal found that the examination was not properly constituted because the notice did not specify it was for attendant care benefits.

Furthermore, the refusal letter was not clear and unequivocal because it stated the benefit was suspended and would be reconsidered if the applicant attended a rescheduled examination.

The preliminary issue was resolved in favour of the applicant, allowing the claim to proceed.

The applicant sought attendant care benefits following a motor vehicle accident.

The insurer suspended the benefits after the applicant failed to attend an insurer examination and argued the subsequent application was statute-barred under section 56 of the Schedule as it was filed more than two years after the refusal.

The Tribunal found that the insurer's denial letter was not clear and unequivocal because it stated the benefit was suspended and would be reconsidered if the applicant attended a rescheduled examination.

As the denial merely suspended rather than terminated the benefit, the limitation period was not triggered, and the claim was allowed to proceed.

The applicant was injured in a motor vehicle accident as a pedestrian on her second day of a new job.

She applied for an income replacement benefit (IRB).

The insurer accepted entitlement but calculated the weekly benefit at $33.70 based on her earnings of $192.53 over the two days worked prior to the accident.

The applicant disputed the calculation, arguing it was unfair given her short tenure before the accident.

The Tribunal found that the insurer correctly applied the calculation provisions in sections 4 and 7 of the Statutory Accident Benefits Schedule, and that fairness could not override the clear legislative formula.

The weekly IRB was confirmed at $33.70.

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

The respondent denied the plan, arguing the applicant's physical injuries were minor and subject to the Minor Injury Guideline (MIG), although the applicant was removed from the MIG due to psychological impairment.

The Licence Appeal Tribunal found that the applicant failed to prove the treatment plan was reasonable and necessary, preferring the respondent's orthopaedic assessment which concluded the physical injuries had resolved.

The application for the treatment plan, an award, and interest was dismissed.

The applicant sought attendant care benefits following a motor vehicle accident, claiming 24-hour care provided by two non-professional service providers.

The insurer denied the benefits on the basis that the providers had not sustained an ongoing economic loss and that the applicant failed to comply with requests for income documentation under section 33 of the Statutory Accident Benefits Schedule.

The arbitrator found that the first provider did not sustain an ongoing economic loss and that both providers failed to provide timely income documentation as reasonably requested by the insurer.

Consequently, the claims for attendant care benefits were dismissed due to non-compliance with section 33.

The insurer was entirely successful in the underlying arbitration regarding accident benefits and sought its expenses of $33,653.57.

The arbitrator reviewed the criteria under Rule 75.2 of the Dispute Resolution Practice Code and section 12(2) of Ontario Regulation 664.

The arbitrator found the insurer's claimed legal fees and disbursements to be excessive, noting repetitive file reviews by multiple law clerks and students, and disallowed costs for court reporting and transcripts.

The arbitrator also limited the attendance fee for the applicant's family doctor, who was treated as an expert witness, to the tariff rate.

The applicant was ordered to pay the insurer's expenses fixed at $12,910.40 inclusive of HST.

The applicant applied for statutory accident benefits following a motor vehicle accident.

After disputes arose, the applicant filed for arbitration but subsequently failed to attend the scheduled hearing.

The insurer presented evidence that the parties had previously agreed to dismiss the application without costs.

The arbitrator accepted the evidence of the settlement agreement and dismissed the application for arbitration without costs.

The Applicant applied for accident benefits following a motor vehicle accident.

The Insurer repeatedly requested information, including a Disability Certificate and income documentation, to assess the Applicant's claim for Income Replacement Benefits.

The Applicant failed to provide the requested information and eventually ceased participating in the proceedings.

The Arbitrator held that the Applicant failed to comply with his notice and disclosure obligations under the Statutory Accident Benefits Schedule.

Consequently, the Applicant was barred from proceeding to Arbitration under section 55(1) of the Schedule.

The Insurer was awarded its expenses for the proceeding.

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

After the applicant's representative was removed from the record, the applicant failed to attend the scheduled arbitration hearing despite receiving notice.

The insurer brought a motion to dismiss the application for non-attendance.

The arbitrator granted the motion, dismissing the application and ordering the applicant to pay $1,400 in expenses to the insurer.

The applicant applied for arbitration to resolve a dispute over statutory accident benefits following a motor vehicle accident.

After his representative was removed from the record, the applicant failed to attend the scheduled arbitration hearing or contact the tribunal.

The arbitrator proceeded in his absence and dismissed the application, finding that the applicant failed to meet his burden of proof and had abandoned his claim.

The insurer was awarded $750 in expenses.

The applicant applied for statutory accident benefits following a motor vehicle accident.

The parties were unable to resolve their disputes, and the applicant applied for arbitration.

The applicant failed to attend the scheduled hearing and a resumed hearing, despite being given proper notice.

As the applicant bore the onus of proving entitlement to the claimed benefits and presented no evidence, her claims were dismissed.

The insurer was awarded its expenses in the amount of $5,973.84 due to the applicant's failure to participate and her provision of false particulars during the process, which caused delay and unnecessary expense.

The applicant sought Income Replacement Benefits (IRBs) and medical benefits following a rear-end motor vehicle accident.

The insurer denied the claims, arguing the applicant did not suffer a substantial or complete inability to work and that the medical treatments were not reasonable and necessary.

The arbitrator found that the applicant continued to work for 14 months post-accident and that her subsequent medical complaints, including blackouts and incontinence, were not causally linked to the accident by the medical experts.

The arbitrator dismissed the application, concluding the applicant failed to prove entitlement to IRBs, medical benefits, or a special award.

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

The applicant failed to attend the scheduled arbitration hearing despite being served with notice.

The arbitrator proceeded in the applicant's absence and dismissed the application for arbitration because the applicant failed to meet the onus of proving entitlement to the claimed benefits.

The insurer was awarded $2,500 in expenses.

The applicant was injured in a motor vehicle accident in 2004 and sought payment for two chiropractic treatment plans (OCF-18 and OCF-21) submitted near the end of the 10-year limitation period.

The insurer denied payment, arguing the treatments were not actually received within the 10-year period.

The arbitrator applied the test from Monks v. ING Insurance, finding that an expense is 'incurred' if its reasonable necessity and amount are determined with certainty before the limitation period expires.

Since the amounts were clearly outlined and reasonably certain before the 10-year mark, the expenses were deemed incurred and payable by the insurer.

The applicant, who sustained catastrophic impairments in a motor vehicle accident, brought a motion for an interim payment of $427,751 for home modifications.

The insurer had requested a section 44 examination involving both a housing expert and an occupational therapist to assess the claim.

The applicant consented to the housing expert but refused to attend an examination involving the occupational therapist.

The arbitrator dismissed the motion, finding that the insurer's request for an occupational therapist assessment was reasonable and necessary to evaluate the applicant's functional requirements.

Because the applicant failed to attend the section 44 examination, he was in breach of the Schedule, making an award of interim benefits inappropriate.

The applicants sought accident benefits following a motor vehicle accident.

After failing to attend a pre-hearing discussion and losing contact with their legal representative, the representative brought a motion to be removed from the record due to a breakdown in the solicitor-client relationship.

The insurer subsequently brought a motion to dismiss the applications for arbitration.

The arbitrator granted the representative's motion to be removed and dismissed the applications for arbitration with costs, noting the applicants' failure to participate or respond to notices.

The applicant's representative brought a motion to be removed from the record due to a material breakdown in the solicitor-client relationship, as the applicant failed to communicate or attend proceedings.

The insurer brought a motion to dismiss the application for arbitration.

The arbitrator granted the representative's motion to be removed and dismissed the application for arbitration without costs, noting the applicant had ample notice and failed to participate.

The applicants sought accident benefits following a motor vehicle accident.

After their representative was removed from the record due to a breakdown in the solicitor-client relationship, the applicants failed to attend scheduled pre-hearing discussions and the motion hearing.

The insurer brought a motion to dismiss the applications for arbitration.

The arbitrator granted the motion, dismissing the applications without costs due to the applicants' failure to participate.