Alexander M. Voudouris

The appellant sought judicial review and appealed a Licence Appeal Tribunal decision finding that her application for statutory accident benefits was time-barred.

The appellant argued the insurer's notice of refusal did not comply with s. 54 of the SABS because it failed to detail all levels of appeal and misleadingly stated a hard two-year limitation period without explaining discoverability.

The Divisional Court dismissed the appeal, holding that s. 54 only requires notice of the right to dispute the refusal at the Tribunal, not subsequent appeal rights.

The Court also found the notice was not misleading, as detailing discoverability principles could detract from the clarity of the warning and confuse claimants.

The respondent suffered injuries after slipping and falling on ice in a parking lot while reaching for his vehicle's door handle.

He received statutory accident benefits (SABs) after a LAT adjudicator found the incident was an 'accident' under the SABs Schedule.

He subsequently sued the parking lot owner and winter maintenance provider for occupiers' liability.

The appellants moved to determine whether any damages awarded must be reduced by the SABs received under s. 267.8 of the Insurance Act, and whether OHIP's subrogated claim was barred under s. 30(5) of the Health Insurance Act.

The motion judge found the tort claim did not arise directly or indirectly from the use or operation of an automobile, meaning the statutory deductions and subrogation bars did not apply.

The Court of Appeal dismissed the appeal, finding no error in the motion judge's substantive approach or her conclusion that the context and purpose of the LAT proceeding differed from the tort action, precluding abuse of process or issue estoppel.

The appellant was severely injured in a bicycle collision and rendered mentally incapable of making decisions.

She applied for non-earner benefits under the Statutory Accident Benefits Schedule (SABS) but was denied benefits for the period before her disability certificate was submitted, pursuant to s. 36(3).

The Licence Appeal Tribunal upheld the denial.

On appeal, the Divisional Court held that the Tribunal erred by failing to consider s. 34 of the SABS, which excuses non-compliance with time limits if there is a reasonable explanation.

The Court found that s. 34 applies to the requirement in s. 36(3), and remitted the matter to the Tribunal to determine if the appellant's incapacity constituted a reasonable explanation.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied her non-earner benefits for a specific period due to her failure to submit a completed disability certificate (OCF-3) under s. 36(3) of the Schedule.

The applicant argued that the Tribunal erred in its strict interpretation of s. 36(3), asserting that the provision should not apply to an incapable applicant, and that the Tribunal failed to properly consider the Human Rights Code and the Charter.

The Vice-Chair dismissed the reconsideration request, finding that the applicant was attempting to re-litigate arguments made at the initial hearing and had failed to establish any error of law or fact under Rule 18.2(b).

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

The insurer partially denied an OCF-18 for catastrophic assessments and issued an Explanation of Benefits.

The applicant filed an application with the Licence Appeal Tribunal more than two years after the denial.

At a preliminary issue hearing, the applicant argued the limitation period was not triggered because the denial notice did not detail the entire dispute resolution process up to the Supreme Court of Canada or address discoverability.

The Tribunal rejected this argument, finding the denial notice was compliant with section 54 of the Schedule and the principles in Smith v. Co-operators, as it provided sufficient information for the applicant to decide whether to dispute the refusal.

As the applicant provided no submissions for an extension under section 7 of the LAT Act, the application was dismissed as statute-barred.

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

The respondent insurer denied several treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline.

The applicant challenged the denials, arguing that the respondent's notices failed to comply with the medical reasons requirement under s. 38(8) of the Statutory Accident Benefits Schedule.

The Tribunal found that the initial denial letters for a psychological assessment, chiropractic services, and a chronic pain assessment were non-compliant, triggering the consequences under s. 38(11) and making the expenses payable until the defective notices were cured.

However, the denial for psychological treatment was found to be compliant.

The Tribunal awarded interest on the overdue benefits but declined to order an award under s. 10 of Reg. 664, finding the insurer's non-compliance was a wrong adjusting decision rather than unreasonable conduct.

The applicant was injured in a bicycle-automobile collision and suffered a traumatic brain injury.

She applied for a non-earner benefit but the insurer denied payment for the period before she submitted her disability certificate (OCF-3), relying on s. 36(3) of the Statutory Accident Benefits Schedule.

The applicant argued that s. 36(3) should be interpreted to exempt incapable applicants, or alternatively, that it violates the Charter and the Human Rights Code.

The Tribunal rejected the applicant's interpretation, finding the language of s. 36(3) clear and mandatory.

The Tribunal also found the applicant failed to establish a constitutional or Code violation.

The application was dismissed.

The appellant insurer appealed an arbitrator's preliminary decision finding that the definition of 'minor injury' and the requirement for documented pre-existing conditions in the Statutory Accident Benefits Schedule (SABS) violated section 15 of the Charter.

The Director's Delegate allowed the appeal, holding that the arbitrator erred by deciding the constitutional questions in a factual vacuum before determining whether the claimant actually suffered from chronic pain or had an undocumented pre-existing condition.

The arbitrator's order was rescinded, and the matter was remitted to arbitration for a determination on the merits of the claim for a psychological assessment.

The appellant appealed an arbitrator's denial of certain statutory accident benefits, and the insurer cross-appealed, arguing the arbitrator erred in applying the 'material contribution' test for causation rather than the 'but for' test.

The Ontario Trial Lawyers Association (OTLA) sought to intervene on the issue of causation.

The Director's Delegate granted OTLA's request to intervene, finding that the causation test in accident benefits cases is an important legal issue with broad implications, and that OTLA could provide helpful submissions from a broader perspective.

The Delegate also proposed inviting Canadian Defence Lawyers to intervene to ensure balance.

The applicant sought judicial review of a director's delegate's decision which overturned an arbitrator's finding that the applicant was not bound by the $3,500 limit for medical and rehabilitation benefits under the Statutory Accident Benefits Schedule (SABS).

The Divisional Court held that the director's delegate reasonably concluded that sections 14 and 18 of the SABS create limits on liability rather than exclusions, meaning the burden of proof remains on the insured.

However, the court found the director's delegate erred in concluding that the Minor Injury Guideline is entirely binding as if it were part of the SABS, holding instead that it is only incorporated by reference where expressly required for interpretation.

The application for judicial review was allowed and the matter remitted for a new preliminary issue hearing.

The insurer appealed an arbitrator's preliminary decision that the insured's medical and rehabilitation claim was not subject to the $3,500 limit under the Minor Injury Guideline (MIG).

The Director's Delegate allowed the appeal, finding that the arbitrator erred by failing to apply the correct test of whether the impairment was predominantly a minor injury, improperly shifting the burden of proof to the insurer, and incorrectly concluding that the MIG was non-binding.

Furthermore, the arbitrator breached procedural fairness by conducting independent research and relying on legal arguments without giving the parties an opportunity to respond.

The decision was rescinded and the matter remitted for a full hearing before a different arbitrator.

The respondents were injured in a motor vehicle accident and entered into a settlement with their insurer, Aviva Canada Inc., regarding statutory accident benefits.

They later sought to rescind the settlement after the two-day cooling-off period, arguing the Settlement Disclosure Notice (SDN) did not comply with the Settlement Regulation.

The Arbitrator found the SDN deficient and allowed the rescission.

On appeal, the Director's Delegate confirmed the Arbitrator's decision, holding that the SDN failed to provide the mandated information regarding rescission in clear and straightforward language directed towards an unsophisticated person, and that this defect was not merely technical.

The appellant insurer and respondent insured both sought their legal expenses following an appeal regarding the termination of statutory accident benefits.

The Director's Delegate had previously varied the arbitrator's decision by making the benefits order interim pending a final hearing.

Applying the criteria under section 12(2) of O. Reg. 664, the Delegate found that given the mixed success on appeal, the novelty of the legal issue, and the technicality of the question, it was appropriate for each party to bear its own legal expenses.

The insured was receiving income replacement and housekeeping benefits following a motor vehicle accident.

The insurer terminated these benefits after conducting insurer medical examinations (IMEs).

The insured disputed the termination, arguing the insurer failed to comply with section 37(1) of the Statutory Accident Benefits Schedule by not requesting a new disability certificate before scheduling the IMEs.

The arbitrator agreed and ordered the insurer to pay ongoing benefits.

On appeal, the Director's Delegate upheld the finding that the insurer breached section 37(1) but, following the Court of Appeal in Stranges, varied the order to make the benefits interim, requiring the insured to prove substantive entitlement at a final arbitration hearing.

The insurer appealed an arbitrator's preliminary decision that the claimant was not precluded from arbitration despite giving notice of his claim more than four years after the motor vehicle accident.

The claimant was 14 years old at the time of the accident.

The Director's Delegate upheld the arbitrator's finding that the claimant had a reasonable explanation for the delay under s. 31(1) of the SABS, considering his youth, his parents' ignorance of the law, their fear of authority, and the lack of prejudice to the insurer.

The appeal was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for various expenses, most notably over $100,000 for an unconventional treatment called 'Vistasp therapy'.

The arbitrator found that Vistasp therapy did not qualify as a 'good or service of a medical nature' under section 14 of the Schedule, as it lacked any scientific or medical basis, and was alternatively experimental, unreasonable, and unnecessary.

Claims for conventional therapies, Tai Chi, and dog-walking were allowed.

A special award of $1,000 was granted against the insurer for unreasonably denying the non-Vistasp claims.

The insurer brought a motion seeking to conduct an examination for discovery of the applicant and her treatment provider regarding the nature and medical benefits of a disputed treatment.

The arbitrator dismissed the motion, finding that the insurer had already received significant documentary disclosure and that ordering an oral examination for discovery would be a significant and inappropriate departure from the Commission's pre-hearing disclosure process.

The applicant sought interim income replacement benefits following a motor vehicle accident.

The insurer argued the applicant was not credible and was laid off due to a business downturn, not accident-related absences.

The arbitrator found the applicant provided prima facie evidence of an accident-related disability that precipitated his loss of work, relying on a contemporaneous email from his employer.

The arbitrator also applied the rule in Browne v. Dunn to disregard the insurer's collateral attack on the applicant's credibility, as the insurer chose not to cross-examine him.

Finding urgency from the date the claim was raised, the arbitrator ordered the insurer to pay interim benefits.

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

The insurer sought to compel the applicant to attend four insurer's examinations (neurological, physiatry, psychological, and functional abilities) pursuant to section 42 of the Statutory Accident Benefits Schedule.

The arbitrator found that the neurological and psychological evaluations were reasonably necessary due to new medical information provided by the applicant's experts.

However, the physiatry and functional abilities evaluations were deemed unreasonable as they were either duplicative of previous Designated Assessment Centre (DAC) assessments or lacked sufficient justification.

The appellant insurer appealed an arbitration order finding that the respondent was not precluded from receiving statutory accident benefits.

The insurer argued that the respondent's election to bring a tort action instead of claiming workers' compensation benefits was made primarily for the purpose of claiming accident benefits, as she had run a red light and her tort action was unlikely to succeed.

The Director of Arbitrations upheld the arbitrator's decision, finding that the arbitrator correctly applied the test under section 59(2) of the SABS-1996.

The arbitrator's factual finding that the respondent honestly believed she had a green light at the time she commenced her action, and thus made her election in good faith, was supported by the evidence and contained no error of law.

The appeal was dismissed.