Arthur Robert Camporese

The respondent sought costs following the dismissal of the applicant's motion to recuse the adjudicator.

The Tribunal found that the applicant acted unreasonably and in bad faith by bringing a motion for relief previously denied with no new grounds, and by making a collateral attack on another Tribunal order.

The applicant was ordered to pay $1,000 in costs to the respondent.

The respondent insurer requested a reconsideration of a Licence Appeal Tribunal decision that awarded the applicant attendant care benefits for meal preparation and medical benefits for Whole Therapy.

The Vice Chair dismissed the request regarding attendant care, finding the adjudicator properly weighed the evidence and applied the 'but for' causation test.

However, the Vice Chair granted the request regarding the Whole Therapy expenses, finding the adjudicator erred in law by relying on the insurer's previous approval of travel expenses to determine the treatment was reasonable and necessary.

The Vice Chair denied the Whole Therapy expenses because the applicant failed to submit a treatment plan prior to incurring the expenses, contrary to s. 38(2) of the Schedule.

The respondent insurer requested a reconsideration of a Tribunal decision which found that the applicant sustained a catastrophic impairment and was entitled to a Non-Earner Benefit (NEB).

The respondent argued the Tribunal made significant errors of fact and law regarding the Whole Person Impairment (WPI) percentages assigned for medication use, sleep disorder, occipital neuralgia, and mental and behavioural disorders, as well as in applying the legal test for the NEB.

The Adjudicator found that while the Tribunal erred in assigning a 3% WPI for medication use, deducting this amount still left the applicant meeting the catastrophic impairment threshold.

The Adjudicator dismissed the remaining arguments, finding no significant errors of law or fact in the Tribunal's assessment of the medical evidence or its application of the Heath test for the NEB.

The request for reconsideration was dismissed.

The applicant brought a motion requesting the Vice-Chair recuse himself due to a reasonable apprehension of bias arising from a remark made two years prior, and a motion to reconsider a previous interlocutory decision.

The Tribunal dismissed the recusal motion, finding no reasonable apprehension of bias given the context and an unreserved apology, and noting the motion was brought after an unexplained seven-month delay following an adverse decision.

The request for reconsideration was also dismissed as the Tribunal's rules do not permit reconsideration of interlocutory orders, and there was no denial of procedural fairness.

The applicant sought statutory accident benefits for injuries sustained in a motor vehicle accident, including treatment plans for occupational therapy, physiotherapy, and psychological assessments.

The respondent insurer denied the benefits, relying in part on surveillance evidence.

The Tribunal gave little weight to the surveillance evidence, finding it unreliable and not contradictory to the applicant's self-reported limitations.

The Tribunal found the applicant was entitled to the costs of an attendant care assessment and occupational therapy, as well as physiotherapy, finding them reasonable and necessary.

The claim for a second psychological assessment was dismissed as it exceeded the statutory cap for a single assessment.

The Tribunal also awarded the applicant a 35% special award under O. Reg. 664, finding the respondent unreasonably withheld approval of the attendant care assessment after the applicant was removed from the Minor Injury Guideline.

The applicant sought payment of $11,533.24 for the unapproved balance of a treatment plan (OCF-18) for multi-disciplinary catastrophic impairment assessments.

The insurer had partially approved the plan for $12,000.

The Tribunal found that the unapproved assessment items were needless bifurcations or duplications of assessments already conducted by the insurer, and the applicant failed to prove they were reasonable and necessary.

The Tribunal awarded $400 for the cost of completing the OCF-18 and OCF-19 forms, but denied the remainder of the claim.

The applicant sought medical benefits for physiotherapy and occupational therapy following a motor vehicle accident.

The insurer denied the treatment plans and sought to rely on Insurer's Examination reports.

The Tribunal found that the insurer failed to provide adequate 'medical and any other reasons' for the examinations as required by s. 44(5) of the Schedule, and excluded the reports as a remedy.

Applying the 'but for' test for causation, the Tribunal found that the subject accident was a necessary cause of the applicant's impairments, despite pre-existing injuries and a subsequent accident.

The Tribunal ordered the insurer to pay the disputed treatment plans with interest.

The applicant, injured in utero during a motor vehicle accident and born prematurely with cerebral palsy, sought attendant care benefits.

The insurer initially approved the benefits based on a medical report but later sought to raise a causation defence relying on a new report from an obstetrician.

The applicant argued the insurer was precluded from raising causation due to the two-year limitation period and waiver, and sought to exclude the new report.

The Adjudicator held that the insurer was not precluded from arguing causation, finding no waiver and that the limitation period in s. 56 of the Schedule applies to claims, not defences.

The Adjudicator also permitted the insurer to rely on the new medical report, finding it was validly obtained under s. 44.

The applicant sought a reconsideration of a decision that found her entitled to a treatment plan but denied her request for a special award under section 10 of Ontario Regulation 664.

The applicant argued the adjudicator erred in law and fact by finding the insurer's reliance on an unsolicited prognosis in an insurer's examination report was not unreasonable.

The adjudicator dismissed the reconsideration request, finding no significant error of law or fact that would have led to a different result, as the insurer's reliance on a regulated healthcare professional's opinion was not unreasonable.

Following a successful arbitration where the applicant's claims for caregiver benefits were dismissed, the insurer sought its arbitration expenses.

The arbitrator reviewed the criteria under Rule 75.2 of the Dispute Resolution Practice Code, noting the insurer's complete success, the applicant's failure to beat the insurer's settlement offer, and the applicant's improper conduct in resisting production of records.

The arbitrator awarded the insurer $18,000.00 in expenses, inclusive of legal fees calculated at Legal Aid rates and disbursements including court reporter fees.

The applicant brought a motion to compel the respondent's adjuster to answer questions refused during a cross-examination on her affidavit.

The respondent argued that the questions had already been answered during a subsequent day of the cross-examination.

The Tribunal found that the adjuster had indeed answered the disputed questions regarding communications about undertakings and refusals.

The motion to compel was dismissed.

The applicant sought statutory accident benefits following a 2012 motor vehicle accident, including attendant care benefits and various medical and rehabilitation expenses.

The Tribunal found that the applicant's need for attendant care was caused by the accident, given her diagnoses of chronic pain, possible traumatic brain injury, and aggravated psychological conditions.

However, based on surveillance evidence and the applicant's pre-accident baseline, the Tribunal reduced the claimed attendant care for meal preparation from seven days a week to three days a week, and denied claims for bathroom and medication management assistance.

The Tribunal denied claims for optometric, hearing aid, and psychotherapy services because the applicant failed to submit treatment plans prior to incurring the expenses, as strictly required by s. 38(2) of the Schedule.

The claim for Whole Therapy expenses was allowed, as a treatment plan had been submitted and the insurer had previously approved mileage for the same treatment.

The claim for pelvic floor physiotherapy was denied for failing to establish causation.

The applicant requested reconsideration of a case conference order that directed a preliminary issue to be heard in writing.

The Tribunal dismissed the request, finding that the procedural order did not finally dispose of the appeal as required by Rule 18.1 of the Tribunal's rules.

The respondent insurer requested a reconsideration of a decision granting the applicant funding for a multi-disciplinary catastrophic impairment assessment.

The insurer argued the Tribunal erred in law by applying the 'reasonable and necessary' test under section 15 of the Statutory Accident Benefits Schedule instead of section 25, and by relying on procedural fairness to justify the funding.

The Tribunal dismissed the request, finding that while referencing section 15 was an error, it was not significant enough to change the outcome because section 25 still requires assessments to be necessary and costs to be reasonable.

The Tribunal also held that denying the applicant her first set of catastrophic assessments would be procedurally unfair, as it would leave her with no evidence to challenge the insurer's denial.

The applicant was involved in a motor vehicle accident and applied for a determination of catastrophic impairment and entitlement to non-earner benefits.

The Licence Appeal Tribunal found that the applicant sustained a 55% whole person impairment due to a combination of physical and psychological impairments, meeting the threshold for catastrophic impairment under Criterion 7 of the Schedule.

The Tribunal also found that the applicant suffered a complete inability to carry on a normal life, entitling him to non-earner benefits.

The applicant sought statutory accident benefits following a motor vehicle accident, including the cost of catastrophic impairment assessments, physiotherapy, and medication.

The insurer denied the catastrophic assessments on the basis that the applicant had exhausted the monetary limit for medical and rehabilitation benefits.

The Tribunal held that catastrophic assessments are covered under section 25(1)5 of the Schedule and are not subject to the monetary limits set out in section 18(3)(a).

The applicant was awarded $16,272.00 for the assessments.

However, the claims for physiotherapy and medication were dismissed as the applicant failed to provide evidence that they were reasonable and necessary.

The claim for a special award was also dismissed.

The applicant sought weekly caregiver benefits following a 2010 motor vehicle accident.

The insurer terminated benefits in September 2012.

The arbitrator found the applicant's evidence lacked credibility, noting numerous inconsistencies regarding her injuries, substance abuse, and the fact that her children had been removed from her care by Family and Children's Services in 2011 for reasons unrelated to the accident.

The arbitrator preferred the evidence of the insurer's assessors and concluded the applicant was not the primary caregiver at the time of the accident, did not suffer a complete inability to carry on a normal life, and did not incur the claimed caregiving expenses.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought medical benefits for physiotherapy, massage therapy, and swim passes.

The respondent denied the treatment plan based on an insurer's examination report which opined that no further facility-based treatment was required.

The Tribunal found the treatment plan was reasonable and necessary to address the applicant's ongoing pain and functional limitations, preferring the clinical notes and records over the insurer's examination prognosis.

The Tribunal ordered the respondent to pay the treatment plan with interest, but declined to grant an award under section 10 of Regulation 664, finding the respondent did not act unreasonably in relying on the assessment report.

The appellant, a passenger in a vehicle driven by an unlicensed driver without the owner's permission, sustained injuries in a motor vehicle accident.

He sued the driver, vehicle owner, and the owner's liability insurer, claiming entitlement to uninsured motorist coverage under section 265(1) of the Insurance Act.

The motion judge dismissed the claim on summary judgment, finding that section 1.8.2 of the standard Ontario Automobile Policy excluded uninsured motorist coverage where the vehicle was operated without the owner's consent.

The Court of Appeal upheld this decision, applying the precedent established in Shipman v. Dominion of Canada General Insurance Co. The appellant was limited to Statutory Accident Benefits and could pursue other claims through the Motor Vehicle Accident Claims Fund.

The applicant in a statutory accident benefits dispute brought a motion to compel the respondent's claims adjuster and lead counsel to give oral evidence at an upcoming hearing for three other motions.

The applicant alleged improprieties and coaching during the adjuster's cross-examination.

The Tribunal dismissed the motion, finding that the five days of cross-examination transcripts were sufficient for the applicant to present her case, and that fairness did not dictate turning the motion into a trial by requiring oral evidence from the adjuster or opposing counsel.