Anna-Marie Musson

The applicant sought statutory accident benefits for a chronic pain assessment and a psychological assessment following a motor vehicle accident.

The respondent denied the treatment plans.

The Tribunal found that the applicant failed to prove on a balance of probabilities that either assessment was reasonable and necessary.

The Tribunal preferred the respondent's medical evidence, which included in-person assessments and psychometric testing, over the applicant's evidence, which relied on phone screens and lacked corroborating medical records.

The application was dismissed, and claims for a special award and interest were denied.

The applicant sought ongoing income replacement benefits (IRBs) more than 104 weeks after a motor vehicle accident, claiming a complete inability to work due to chronic pain and psychological impairments.

The respondent insurer terminated IRBs based on insurer examinations indicating the applicant could perform alternative employment.

The Licence Appeal Tribunal found that the applicant's condition had improved, she had reached maximum medical improvement, and she possessed transferable skills suitable for roles such as a beauty salon attendant or cashier.

The Tribunal concluded the applicant failed to meet the post-104 week disability test.

Additionally, the applicant's claim for the cost of a chronic pain assessment was denied because it was incurred before submitting a treatment plan, contrary to section 38(2) of the Schedule.

The application was dismissed.

The defendant insurer moved for summary judgment to dismiss the plaintiff's claim under the uninsured provisions of his automobile insurance policy.

The plaintiff alleged the accident was caused by an unidentified vehicle, but his own evidence and initial reports contradicted this, attributing the rear-end collision to his own faulty driving.

The court found no corroborating material evidence of an unidentified vehicle's involvement, as required for claims over $200,000, and insufficient evidence to establish a triable issue for claims under $200,000.

The motion was granted, and the action dismissed.

The applicant was injured in a motor vehicle accident in 2004 and sought funding for a catastrophic impairment assessment completed in 2015.

The insurer paid $11,500 but denied the remaining $11,599.99, relying on the $2,000 per assessment cap introduced in the 2010 Statutory Accident Benefits Schedule.

The applicant argued she had a vested right to the pre-2010 rules, which had no monetary cap, because her accident occurred in 2004.

The arbitrator rejected this argument, finding that section 268 of the Insurance Act allows the legislature to amend the Schedule and that the 2010 cap applied to all assessments conducted after August 31, 2010.

Furthermore, the applicant failed to prove that the disputed costs were reasonable.

The claim was dismissed.

The Applicant was injured in a motor vehicle accident and applied for statutory accident benefits.

A preliminary issue hearing was held to determine whether the Applicant was injured as a result of an 'accident' as defined in section 3(1) of the Schedule.

At the hearing, the Insurer conceded that the Applicant was indeed injured as a result of an accident.

The arbitrator ordered that the Applicant was injured as a result of an accident and scheduled a full hearing on the merits.

The applicant was injured in a motor vehicle accident and sought attendant care benefits and the cost of an in-home assessment from her insurer.

The insurer denied both claims in 2012.

The applicant filed for mediation in October 2014, more than two years after the denials.

The insurer raised a preliminary issue that the claims were statute-barred under subsection 56(1) of the Statutory Accident Benefits Schedule.

The arbitrator applied the objective test from Turner, finding that the insurer's notices of refusal were clear and unequivocal, and that subsequent communications did not create an estoppel or waiver.

The arbitrator concluded that the application was statute-barred and dismissed the claims, awarding expenses to the insurer.

The Applicant sought costs and an award under s. 10 of O. Reg. 664 after the Insurer approved a treatment plan prior to the case conference.

The Applicant alleged the Insurer acted in bad faith and unreasonably delayed payment by refusing to pay a disbursement fee for medical records.

The Insurer also sought costs, arguing the Applicant's conduct was frivolous and vexatious.

The Tribunal dismissed both costs requests, finding neither party's conduct during the proceeding met the threshold under Rule 19.1.

The Tribunal also denied the Applicant's request for an award, concluding the Insurer acted reasonably in waiting for updated medical records before approving the treatment plan.

The applicant sought statutory accident benefits and filed an application for dispute resolution after the insurer denied a treatment plan.

Prior to the case conference, the insurer approved the treatment plan, but the applicant sought costs for preparing the application.

The Tribunal held a preliminary issue hearing to determine if it had jurisdiction to consider the costs request after the main issue was resolved.

The Tribunal found that the proceeding had not ended because the application was not withdrawn and the costs issue remained outstanding, concluding it had jurisdiction to consider the request under Rule 19.1.

The insured was involved in two motor vehicle accidents and claimed statutory accident benefits.

After disputes arose, the insured elected to have her claims determined by a FSCO arbitrator.

The parties attended a settlement meeting where the insured signed a release for $165,000, but she subsequently sought to rescind the settlement, claiming she did not understand its finality.

The insurer applied to the Superior Court of Justice for a declaration that a binding settlement was reached.

The court dismissed the application, holding that under the Insurance Act, once an insured elects arbitration, the FSCO arbitrator has exclusive jurisdiction to determine all questions of fact and law, including whether a binding settlement was reached and whether it was validly rescinded.

The applicant's representative, Yeung & Associates, brought a motion to withdraw as the representative of record in a statutory accident benefits dispute.

The arbitrator found that there had been a breakdown of communication in the solicitor-client relationship and that the applicant had apparently retained another representative.

The motion was granted, and Yeung & Associates was permitted to withdraw without terms.

The applicant was injured while riding as a passenger on an ATV.

The insurer denied certain accident benefits on the basis that the applicant knew or ought to have known the driver was operating the ATV without the owner's consent.

The applicant brought a motion for the production of the Ontario Provincial Police investigation file.

The arbitrator held that under section 22 of the Insurance Act, a FSCO arbitrator has the power to issue a Wagg order compelling the production of police records.

As the OPP and Attorney General were served but did not appear to assert any public interest immunity, and the documents were already vetted in a related tort action, the arbitrator ordered the OPP to produce the unredacted file.

The insurer applied for a determination of whether s. 45 of the Statutory Accident Benefits Schedule requires an insured to identify a single accident when applying for a catastrophic impairment designation.

The insured had been involved in three motor vehicle accidents and submitted a single OCF‑19 application claiming catastrophic impairment based on the cumulative effects of all three accidents.

The court interpreted the legislation and regulatory scheme and concluded that the catastrophic impairment determination must be anchored to a single identified accident.

However, the insured may still rely on the cumulative impact of prior accidents where the specified accident represents the tipping point leading to catastrophic impairment.

The court therefore granted the application in part and declared that the application must specify one accident.

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

The insurer denied her claim for catastrophic impairment and terminated her income replacement benefits.

The applicant brought a motion for interim benefits, seeking funding for a catastrophic assessment rebuttal report and the reinstatement of her income replacement benefits.

The arbitrator applied a holistic approach to interim benefits and found that the applicant had a strong prima facie case.

The arbitrator held that the applicant had a vested contractual right to funding for a rebuttal report because her accident occurred before the 2010 SABS amendments eliminated that benefit.

The arbitrator ordered the insurer to pay $10,500 for rebuttal reports and to reinstate the applicant's income replacement benefits at $374.16 per week pending the final arbitration.

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

After her representative was removed from the record, the applicant failed to attend a pre-hearing and the scheduled arbitration hearing.

The arbitrator proceeded in her absence and dismissed the application, finding there was no evidence presented and no case for the insurer to meet.

The insurer was awarded $750 in expenses for its preparation and attendance.

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

The insurer denied the claims, and the matter proceeded to arbitration.

The applicant failed to attend the pre-hearing and the hearing.

The arbitrator dismissed the application for arbitration due to the applicant's failure to attend and lack of evidence.

The insurer was awarded $750 in expenses.

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

The insurer denied payment for various medical benefits, assessments, and treatment plans.

At the arbitration hearing, the applicant withdrew her claims for non-earner and attendant care benefits.

The arbitrator found the applicant's evidence regarding her remaining claims to be evasive and lacking in credibility, noting her inability to recall details of the treatments and assessments.

The arbitrator concluded that the applicant failed to prove on a balance of probabilities that the claimed expenses were reasonable and necessary.

The application was dismissed.

The applicant was injured in a motor vehicle accident and claimed statutory accident benefits, including housekeeping, attendant care, medical benefits, and the cost of examinations.

The insurer denied further benefits, arguing the claims were excessive and unsupported.

The arbitrator found the applicant's evidence vague and contradictory, and noted significant discrepancies between the billed services and the applicant's testimony.

The arbitrator concluded the applicant failed to prove the claimed benefits and examinations were reasonable and necessary.

All claims were dismissed.

An insurer applied for judgment enforcing a settlement agreement governing loss transfer claims under s. 275 of the Insurance Act.

The respondent insurer argued the applicant breached the agreement by failing to submit indemnity requests quarterly and asserted it was discharged from further performance.

The court interpreted the settlement term as requiring quarterly submissions where file activity existed and found the applicant breached the provision in some instances.

However, the breach was classified as a breach of warranty rather than a fundamental term, and time was not of the essence.

The respondent was therefore not entitled to terminate the agreement and remained obligated to pay properly submitted claims.

The moving party, a declared vexatious litigant, brought a motion to set aside an order dismissing his request for a stay of a Superior Court order.

The respondents brought a cross-motion to quash the motion on the basis that the moving party failed to obtain leave from the Superior Court before initiating further proceedings.

The Court of Appeal found the moving party's motion was moot as his appeal had already been dismissed for delay.

The Court granted the cross-motion, quashed the moving party's motion as an abuse of process, and ordered that he may not bring any further proceedings in the Court of Appeal without leave.

The applicant brought a motion for interim benefits pending the determination of her entitlement and that of her husband's estate to statutory accident benefits.

The insurer opposed, arguing prejudice if the applicant were required to repay the benefits.

The arbitrator found that the applicant demonstrated a prima facie case, need, and urgency, noting the family's precarious financial situation and the previous preliminary finding that the impairments were caused by the accident.

The arbitrator ordered the insurer to pay $30,000 in interim benefits.