Andrew Franzke

The plaintiff sought long-term disability (LTD) benefits and general damages for breach of contract, claiming total disability due to chronic back and leg pain, anxiety, and depression.

The plaintiff had not submitted a formal LTD application, seeking relief from forfeiture.

The court granted relief from forfeiture, finding imperfect compliance.

However, the court ultimately dismissed the plaintiff's claim for LTD benefits and general damages, finding that he failed to prove total disability as defined by the policy, largely due to inconsistencies between his subjective complaints, objective medical evidence, video surveillance, and his work history.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming entitlement to a functional abilities evaluation and additional funds for psychological treatment.

The Licence Appeal Tribunal found that the functional abilities evaluation was not reasonable and necessary, as the applicant's own medical reports did not recommend it.

The Tribunal also denied the additional funds for psychological treatment, finding that the disputed amounts were administrative surcharges not payable under the Professional Services Guideline and that the social work services provided were exempt from HST.

The application was dismissed in its entirety.

This appeal arose from a tragic boat accident involving multiple fatalities and injuries.

The Court of Appeal addressed three consolidated appeals: liability of government respondents, interpretation of the Marine Liability Act's monetary cap, and costs.

The court upheld the motion judge's finding that the boat operators were solely liable for the accident, dismissing the appeal against the government respondents.

It also affirmed that the Marine Liability Act's monetary cap for maritime claims for loss of life or personal injury does not include costs and interest.

While leave to appeal the quantum of costs and the Sanderson Order was denied, leave was granted on one specific costs issue, resulting in both estates being held jointly and severally liable for one plaintiff's costs.

The applicant failed to appear for a scheduled four-day video conference hearing and served a notice of withdrawal shortly after the hearing was set to begin.

The respondent sought costs under Rule 19 of the Tribunal's Common Rules.

The Tribunal found the applicant's failure to provide timely notice of the withdrawal and failure to respond to communications to be unreasonable and disrespectful, causing an unnecessary expenditure of resources.

Costs of $400 were awarded to the respondent to deter future unreasonable conduct.

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

The insurer denied income replacement benefits, arguing the applicant's policy was cancelled for non-payment and he failed to submit a disability certificate (OCF-3).

The Licence Appeal Tribunal found the insurer did not prove the applicant knew or ought reasonably to have known his vehicle was uninsured at the time of the accident.

However, the Tribunal held the applicant was not entitled to income replacement benefits for any period prior to submitting a completed OCF-3, as he failed to provide a reasonable explanation for the delay.

The Tribunal also ruled it lacked jurisdiction to grant relief from forfeiture.

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

The respondent insurer denied benefits and scheduled insurer's examinations, which the applicant failed to attend.

The respondent argued the applicant was barred from proceeding to a hearing under section 55 of the Schedule.

The Tribunal found that the respondent's notices of examination did not comply with section 44(5) because they failed to provide sufficient medical reasons, relying only on the passage of time and an unspecified impairment.

As the notices were deficient, the applicant was not barred from proceeding with her application.

The applicant sought payment for a witness fee and a chiropractic treatment plan following a 2015 motor vehicle accident.

The Tribunal found that the witness fee was not a payable expense under section 38(2) of the Statutory Accident Benefits Schedule.

The Tribunal also found that the chiropractic treatment plan was not reasonable and necessary, noting the lack of contemporaneous medical records and drawing an adverse inference from the applicant's failure to produce updated records requested by the respondent.

The claims for an award and interest were also dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the partial denial of two treatment plans for psychological services and assistive devices.

The Licence Appeal Tribunal found the applicant was not entitled to the disputed interpretation and transportation expenses for psychological services, as they were not shown to be reasonable and necessary.

The Tribunal partially approved the assistive devices plan, granting a neck massager but denying the remaining items.

The applicant's request for a special award was dismissed, as the respondent's conduct did not amount to unreasonably withholding benefits.

The applicant sought reconsideration of a Licence Appeal Tribunal decision that dismissed her claims for income replacement benefits (IRBs) and other benefits following a motor vehicle accident.

The applicant argued the Tribunal erred in its IRB calculations, improperly allowed the deduction of Employment Insurance benefits, failed to dismiss the respondent's repayment claim, and exhibited racial bias during the hearing.

The adjudicator dismissed the reconsideration request, finding no errors of law or fact that would change the outcome.

The adjudicator held that the applicant failed to meet her burden of proving entitlement to a higher IRB quantum, the Tribunal correctly applied binding precedent regarding EI deductions, and there was no reasonable apprehension of bias.

The applicant sought statutory accident benefits after slipping and falling on an icy driveway while loading the trunk of his parked vehicle.

The respondent denied benefits, arguing the incident did not meet the definition of an 'accident' under s. 3(1) of the Statutory Accident Benefits Schedule.

The Tribunal applied the two-part test from Chisholm and Greenhalgh, finding that loading a trunk is an ordinary use of an automobile and that this use directly caused the applicant's injuries.

The Tribunal concluded the incident was an accident and ordered the application to proceed to a hearing on the substantive issues.

The applicant requested a reconsideration of a preliminary issue decision which found that he did not provide a reasonable explanation for the delay in reporting his intention to seek accident benefits.

The applicant argued that the Tribunal violated procedural fairness by rendering legally insufficient reasons in its application of the Horvath test.

The Adjudicator dismissed the request, finding that the original decision provided clear and cogent reasons and that the applicant was attempting to re-argue his case.

The request for reconsideration was dismissed.

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

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and the treatment plans were not reasonable and necessary.

The Tribunal found that the issue of whether the applicant's injuries were predominantly minor was already determined in a 2020 Tribunal decision and was therefore subject to res judicata.

The Tribunal declined to waive res judicata, finding no new evidence to impeach the original decision.

The Tribunal also concluded that the disputed treatment plans for chiropractic services and a chronic pain assessment were not reasonable and necessary.

The application was dismissed.

The applicant sought statutory accident benefits following a 2013 motor vehicle accident where he was struck while riding a bicycle.

The respondent denied the benefits, arguing the applicant's current physical and psychological impairments were not caused by the subject accident, but rather by prior and subsequent accidents.

The Tribunal applied the 'but for' and material contribution tests for causation and found the applicant failed to establish that the 2013 accident caused his impairments, noting a lack of contemporaneous medical evidence of injury.

Furthermore, the applicant failed to demonstrate that his pre-existing conditions prevented maximal medical recovery under the Minor Injury Guideline (MIG).

Consequently, the claims for medical and rehabilitation benefits, interest, and a special award were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident but failed to notify the respondent insurer within the seven-day timeline prescribed by section 32(1) of the Schedule.

The applicant argued the delay was reasonable due to psychological distress over his son's criminal proceedings and lack of access to insurance documentation.

The Tribunal found the applicant failed to provide sufficient evidence, such as medical records, to substantiate his psychological distress and noted he had the insurance information at the time of the accident.

The Tribunal concluded there was no reasonable explanation for the delay, finding the respondent would be prejudiced if the application proceeded.

The application was dismissed as statute-barred under section 55(1)1 of the Schedule, and no costs were awarded to either party.

The applicant requested a reconsideration of a Tribunal decision that found her application for statutory accident benefits was statute-barred.

The Tribunal had previously found that the insurer failed to provide the applicant with the OCF-1 application forms, but still barred the application under section 32(5) of the Schedule.

On reconsideration, the adjudicator held that the Tribunal committed an error of law, as the 30-day time limit to submit the OCF-1 does not begin to run until the forms are received.

The reconsideration was granted and the matter was ordered to proceed to a substantive hearing.

The applicant sought statutory accident benefits following a motor vehicle accident, including attendant care benefits, income replacement benefits (IRBs), and a treatment plan for chiropractic and physiotherapy services.

The Licence Appeal Tribunal dismissed the claim for attendant care benefits because the applicant failed to prove the expenses were incurred and failed to comply with the insurer's requests for information under s. 33 of the Schedule.

The Tribunal found the applicant was entitled to IRBs for a closed period, but after deducting post-accident employment income (including Employment Insurance benefits), the payable amount was reduced to zero.

The claim for the treatment plan was dismissed as the applicant failed to establish it was reasonable and necessary, given a 19-month gap in treatment and lack of corroborating medical evidence.

The defendants brought a motion for leave to appeal the order of Parayeski J., dated August 18, 2022.

The Divisional Court granted the motion for leave to appeal.

Liability for costs of the motion was reserved to the panel hearing the appeal, with the quantum fixed at $5,000.

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

The respondent insurer refused the claim on the basis that the applicant failed to submit the Application for Accident Benefits (OCF-1) within the 30-day period prescribed by the Statutory Accident Benefits Schedule.

The applicant argued that the insurer failed to provide the OCF-1 form and that her medical conditions and life circumstances provided a reasonable explanation for the delay.

The Tribunal found that the applicant failed to submit the OCF-1 within the prescribed timelines and did not provide a reasonable explanation for the delay of over four years.

The application was dismissed pursuant to section 55 of the Schedule.

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

The insurer raised a preliminary issue, arguing the applicant was statute-barred from proceeding with the application under section 55(1)2 of the Schedule because he failed to attend scheduled section 44 insurer's examinations.

The Tribunal found that the insurer's notices for the examinations were not compliant with section 44(5) of the Schedule, as they failed to provide the medical and other reasons for assessing the applicant's entitlement to medical benefits, focusing instead only on non-earner benefits which were no longer at issue.

Consequently, the applicant was permitted to proceed with his application, and the insurer's request for costs was denied.

The applicant requested a reconsideration of a decision that found her application for statutory accident benefits was statute-barred.

The respondent brought a motion to strike the applicant's reply submissions on the reconsideration, arguing they improperly raised new issues.

The Tribunal granted the motion to strike the reply submissions but declined to award costs.

On the reconsideration, the Tribunal found no error of law or fact in its previous application of the Manuel test for extending limitation periods or its interpretation of s. 56 of the Schedule.

The request for reconsideration was dismissed.