Andrew Smith

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to income replacement benefits (IRB) and treatment plans outside the Minor Injury Guideline (MIG) due to chronic pain.

The Licence Appeal Tribunal found that the applicant failed to prove his injuries fell outside the MIG, as the medical evidence did not support a diagnosis of accident-related chronic pain with functional impairment.

The Tribunal also dismissed the claim for IRB, finding the applicant had returned to work and failed to establish a substantial inability to perform the essential tasks of his pre-accident employment.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically the unapproved balance of a physiotherapy treatment plan.

The insurer had approved 60-minute sessions but denied funding for an additional 90 minutes per session and transportation expenses.

The Tribunal found that the applicant was not entitled to the benefits by operation of section 38(11) of the Schedule because no unapproved goods or services were incurred during the period of the insurer's non-compliance.

Furthermore, the applicant failed to demonstrate that the transportation expenses or the extended treatment sessions were reasonable and necessary.

The application was dismissed, along with claims for interest and an award.

The applicant sought statutory accident benefits following a motor vehicle accident, including attendant care benefits and a treatment plan for an ocular assessment.

The Licence Appeal Tribunal dismissed the application.

The adjudicator found the applicant failed to prove that the attendant care services provided by her mother were 'incurred' under s. 3(7)(e) of the Schedule, as no evidence of economic loss was provided.

Furthermore, the proposed ocular assessment was deemed not reasonable and necessary, as it was recommended by a chiropractor outside their scope of practice and unsupported by the applicant's treating specialists or the respondent's s. 44 neurological assessment.

The applicant sought a special award and interest under the Statutory Accident Benefits Schedule, alleging the respondent insurer unreasonably delayed and withheld payment of non-earner and medical benefits.

The Licence Appeal Tribunal found that while the insurer made adjusting errors, including a 44-day delay in initial payment and a 7-month delay in providing section 44 assessment reports, these errors did not amount to unreasonable withholding or delay of benefits.

The application was dismissed, and no award or additional interest was ordered.

The applicant sought medical and rehabilitation benefits following a motor vehicle accident.

The insurer denied the benefits on the basis that the applicant's injuries were predominantly minor and subject to the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's diagnostic imaging showed pre-existing degenerative changes rather than accident-related impairments.

The applicant failed to prove that her pre-existing conditions, alleged chronic pain, or psychological impairments warranted treatment outside the MIG.

The application was dismissed.

The applicant sought payment for a treatment plan in the amount of $2,672.45 for an EMG and nerve conduction studies following a motor vehicle accident.

The respondent denied the treatment plan outside the 10-day period required by section 38(8) of the Statutory Accident Benefits Schedule and provided insufficient medical reasons.

However, the applicant incurred the cost of the examination on the 11th day after submitting the plan, which was prior to the 11th business day.

The Tribunal held that section 38(11)2 limits entitlement to goods and services incurred starting on the 11th business day.

Because the expense was incurred prematurely, the applicant was not entitled to the cost of the examination, and the application was dismissed.

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

The respondent denied chiropractic treatment, a psychological assessment, and a chronic pain assessment on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant suffered from meralgia paresthetica and chronic pain as a result of the accident, removing him from the MIG.

In an addendum decision, the Tribunal found the chiropractic treatment and chronic pain assessment to be reasonable and necessary, subject to the $2,000 cap for assessments.

The psychological assessment was denied as not reasonable and necessary.

The applicant was awarded interest on overdue payments but denied an award under O. Reg. 664.

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

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

The Tribunal found that the applicant suffered from meralgia paresthetica and chronic pain as a result of the accident, which removed him from the MIG.

However, the Tribunal concluded that the applicant did not suffer a psychological impairment.

Because the applicant failed to submit the disputed treatment plans (OCF-18s) into evidence, the Tribunal could not determine whether the claimed medical benefits and examination costs were reasonable and necessary, and allowed the applicant 30 days to submit them.

The applicant sought an income replacement benefit following a motor vehicle accident.

The matter was scheduled for a four-day hearing, but the applicant failed to appear.

As the applicant bore the onus to prove entitlement and called no evidence, the application was dismissed.

The respondent's request for costs was also denied, as the unrepresented applicant's failure to appear did not meet the high standard of unreasonable, frivolous, vexatious, or bad faith conduct under Rule 19.

The applicant was injured in a rear-end motor vehicle accident and sought a medical benefit of $3,581.53 for chiropractic, physiotherapy, and massage services.

The respondent denied the treatment plan on the basis that it was not reasonable and necessary, relying on an insurer's examination report.

The Tribunal dismissed the application, finding that the applicant's own medical expert report did not recommend the specific services claimed and contained inconsistent statements.

As the treatment plan was not reasonable and necessary, no interest was payable.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for chiropractic and massage treatment.

The insurer denied the treatment plan, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and that she had reached maximum recovery.

The arbitrator found that the applicant suffered from chronic pain syndrome exacerbated by pre-existing arthritis and osteoporosis, placing her injuries outside the MIG.

The arbitrator preferred the evidence of the applicant's family physician over the insurer's orthopaedic assessor, finding the treatment plan reasonable and necessary.

The insurer was ordered to pay the disputed medical benefits with interest.

The applicant was injured as a pedestrian in a motor vehicle accident and sought a medical benefit of $4,447.56 for a physiotherapy treatment plan under the Statutory Accident Benefits Schedule.

The respondent conceded that the applicant sustained an impairment.

However, the Tribunal found that the applicant failed to prove the treatment plan was reasonable and necessary.

The Tribunal preferred the evidence of the respondent's insurer examination chiropractor, who found full range of motion and no objective need for facility-based treatment, over the applicant's medical evidence which lacked clarity and corroboration.

The claim for the medical benefit was denied.

The applicant brought a motion to stay proceedings for driving while under suspension and failing to properly wear a seatbelt, alleging a breach of his section 11(b) Charter right to be tried within a reasonable time.

The Crown argued the matter should be assessed under the Morin framework, while the applicant relied on the newly released Jordan framework establishing an 18-month presumptive ceiling for provincial court cases.

The court found that although the total delay was 17 months and 1 day, the case became significantly more complex mid-proceedings when the Crown discovered the defendant had multiple driver's licences that had been merged by the Ministry of Transportation.

The court held that the time spent on judicial pre-trial conferences constituted inherent time requirements of the case and that the Crown had acted expeditiously throughout.

The motion to stay was dismissed.

The appellant insurer appealed an arbitrator's decision in two priority disputes regarding liability for statutory accident benefits (SABs).

In both cases, the appellant had issued motor vehicle liability policies that were later reduced to comprehensive coverage without the use of the prescribed OPCF 16 form, and subsequently renewed.

The arbitrator held that the failure to use the prescribed form meant the policies continued as motor vehicle liability policies with SABs coverage.

The Superior Court of Justice dismissed the appeals, affirming that an insurer can only eliminate SABs coverage by cancelling the existing policy and issuing a new non-liability policy, or by using the mandatory OPCF 16 form.

The appellant appealed his conviction for permitting a motor vehicle to be operated without insurance contrary to s. 2(1)(b) of the Compulsory Automobile Insurance Act.

The Justice of the Peace convicted the appellant based on hearsay evidence regarding vehicle ownership and circumstantial evidence that the owner permitted the driver to use the vehicle.

The appellate court found that the Justice of the Peace erred in law by accepting proof of ownership that violated the best evidence rule and by drawing an unreasonable inference from circumstantial evidence.

The court allowed the appeal and entered an acquittal.

The appellant appealed her conviction on four provincial offences: failing to surrender an insurance card, proceeding contrary to an intersection sign, driving without a current plate validation, and driving while under suspension.

The trial justice found all charges proven beyond a reasonable doubt and imposed fines totalling $1,270.

The appellant raised two grounds of appeal: first, that the Crown failed to prove the location of the offences was in Toronto, an essential element; and second, that the trial justice provided excessive assistance to the prosecution, creating a reasonable perception of bias.

The appellate court dismissed both grounds, finding that the well-known intersection of Queen Street West and Bathurst could be judicially noticed, and that while the trial justice's interventions were unfortunate, they did not compromise the overall fairness of the trial when assessed in their totality.

The Crown appealed a Justice of the Peace's decision dismissing a charge against the respondent for permitting a motor vehicle to be operated without insurance under s. 2(1)(b) of the Compulsory Automobile Insurance Act.

The Crown argued the Justice of the Peace failed to consider circumstantial evidence.

The appeal judge held that the offence is one of strict liability, not requiring proof of mens rea.

However, even considering the circumstantial evidence, the evidence was insufficient to prove the respondent permitted the vehicle to be driven.

The appeal was dismissed.