Arthur Robert Camporese

The applicant requested that the adjudicator recuse himself and void his previous decision dismissing the applicant's motion to strike the respondent's preliminary issue, alleging a reasonable apprehension of bias.

The adjudicator applied the test for reasonable apprehension of bias and found that the applicant failed to meet the high threshold required to overcome the presumption of impartiality.

The request for recusal was refused and the previous decision was confirmed.

The applicant sought funding for catastrophic impairment (CAT) assessments totaling $15,872.00, which the insurer denied on the basis that the applicant had exhausted her $50,000 medical and rehabilitation benefit limit.

The Licence Appeal Tribunal held that CAT assessments do not constitute a medical or rehabilitation benefit and therefore do not fall within the section 18 funding limits.

Finding the assessments to be reasonable and necessary based on the medical evidence, the Tribunal ordered the insurer to fund them.

The applicant's request for an award for unreasonable delay was dismissed.

The applicant brought a motion to strike a preliminary issue raised by the respondent regarding her alleged non-attendance at insurer's examinations.

The applicant argued the preliminary issue lacked a foundational basis and the examinations were non-compliant with the Schedule and privacy legislation.

The adjudicator dismissed the motion, finding that the respondent provided sufficient information about the preliminary issue and that the applicant's arguments were best heard at the preliminary issue hearing itself.

The adjudicator also declined to award costs to the applicant.

The applicant sought reconsideration of a Tribunal decision finding she did not prove entitlement to treatment beyond the Minor Injury Guideline (MIG).

The applicant argued the Tribunal erred in law by finding the insurer's denial notices complied with s. 38(8) and s. 38(9) of the Statutory Accident Benefits Schedule.

The Adjudicator found no error regarding s. 38(9) as the issue was not raised at the hearing.

However, the Adjudicator found a significant error of law regarding s. 38(8), as the insurer failed to provide sufficient medical reasons for denying two treatment plans.

Consequently, under s. 38(11), the insurer is prohibited from taking the position that the MIG applies and must pay for the disputed treatment plans.

The respondent insurer filed a request for reconsideration of an adjudicator's preliminary decision which found that an attendant care benefit claim was not statute-barred.

The Associate Chair dismissed the request, noting that under the amended Licence Appeal Tribunal Rules of Practice and Procedure, requests for reconsideration are only accepted for decisions that finally dispose of an appeal.

The respondent insurer requested a reconsideration of a preliminary decision which found that the applicant's claims for attendant care and medical benefits were not statute-barred.

The original adjudicator had concluded that the insurer's denial notices were not 'clear and unequivocal' because they included an application for catastrophic impairment, which might confuse an unsophisticated person.

On reconsideration, the Associate Chair found that the adjudicator made a significant error of law or fact.

The Associate Chair held that the denial notices, which included standard-form disclosures of the right to appeal and the two-year limitation period, were clear and unequivocal.

Consequently, the reconsideration was granted, and the applicant's claims for the disputed benefits were dismissed as statute-barred.

The applicant sought attendant care benefits following a motor vehicle accident.

The insurer raised a preliminary issue, arguing the appeal was statute-barred because it was not commenced within two years of a 2012 denial letter.

The Tribunal found the 2012 letter was not a clear and unequivocal denial, as it was contingent on the applicant's status under the Minor Injury Guideline.

A subsequent 2014 letter confirming removal from the guideline reset the limitation period, and the true denial occurred in 2018.

The Tribunal held the appeal was not statute-barred and could proceed.

The applicant was injured in a motor vehicle accident and sought payment for the cost of examinations to determine catastrophic impairment.

The respondent denied the request, arguing that its own catastrophic examinations had already been completed and that the applicant's request was not for the purpose of preparing an application under section 45 of the Schedule.

The Tribunal found that the applicant was not precluded from seeking funding for her own examinations after submitting an OCF-19 application, as this ensures procedural fairness.

The Tribunal partially approved the treatment plan, finding that certain psychological and cognitive assessments, as well as a WPI rating assessment, were reasonable and necessary, while others were duplicative or unnecessary.

The applicant was also awarded interest on the overdue payments.

The applicant sought statutory accident benefits for prescription medication expenses following a 2011 motor vehicle accident.

The insurer denied the expenses, arguing they were not reasonable, necessary, or caused by the accident.

The Tribunal found that the accident exacerbated the applicant's pre-existing condition and caused new impairments, including chronic pain syndrome and depression.

Relying on the evidence of the applicant's family physician, the Tribunal concluded that several medications, including Oxycodone and Fentanyl, were reasonable and necessary.

The application was partially granted, and the applicant was awarded entitlement to specific medications along with interest on overdue payments.

The appellant was injured in a 2006 motor vehicle accident and sought funding for six catastrophic impairment rebuttal reports in 2015.

The insurer paid $2,000 per report under the new SABS (2010), but the appellant claimed the balance, arguing the old SABS (1996) applied because his right to a rebuttal report had vested.

The Director's Delegate dismissed the appeal, holding that section 268(1) of the Insurance Act and the transitional provisions of the SABS clearly apply the $2,000 cap to assessments conducted after August 31, 2010, regardless of the accident date.

The concept of vested rights does not apply to statutory accident benefits.

The plaintiff, William Conners, was injured as a passenger in a car accident.

He initiated two actions: one against the driver, owner, and their insurer, Gore Mutual, and another against Unica Insurance, an insurer of a past employer.

Both Gore Mutual and Unica brought motions for summary judgment, seeking dismissal of the actions against them.

Gore Mutual argued lack of coverage due to the driver operating the vehicle without the owner's consent.

Unica contended no coverage as Conners was no longer an employee for whom a vehicle was furnished.

The court dismissed both actions, finding that Conners was not an "insured person" under either policy based on the Insurance Act and relevant policy exclusions.

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

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

The applicant argued that she should be removed from the MIG due to a pre-existing condition, psychological injuries, and chronic pain, and that the insurer's denial notices were non-compliant with s. 38(8) of the Schedule.

The Tribunal found that the insurer's notices were compliant and that the applicant failed to prove her injuries fell outside the MIG.

The Tribunal noted that the applicant's self-reporting to WSIB assessors following a subsequent workplace assault contradicted her claims of accident-related psychological injury and chronic pain.

The application was dismissed.

CUMIS General Insurance Company appealed a trial judgment finding that an unlicensed driver operated the respondent's vehicle without consent, either express or implied.

CUMIS argued the trial judge made palpable and overriding errors in her factual findings and failed to establish the tort of negligent entrustment.

The appellate court rejected all of CUMIS's arguments, finding no palpable and overriding errors in the trial judge's credibility assessments and factual conclusions.

The court also held that even if negligent entrustment exists in Ontario, it could not be established given the finding of no implied consent.

The appeal was dismissed with costs awarded to the respondent.

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

The respondent insurer raised preliminary issues, arguing that several of the applicant's claims were statute-barred because she failed to appeal within the two-year limitation period, and that other claims were barred because she failed to submit them within the prescribed timelines.

The Tribunal found that the insurer's explanation of benefits for the attendant care and certain medical benefits did not constitute a clear and unequivocal denial, meaning the limitation period was not triggered and those claims could proceed.

However, the Tribunal found that the denial for the cost of examinations was clear and unequivocal, barring that claim.

The Tribunal also held that the applicant lacked a reasonable explanation for her late submission of transportation claims, barring those from proceeding.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that dismissed his claim for an income replacement benefit (IRB) following a motor vehicle accident.

The applicant argued the Tribunal erred by refusing to consider medical evidence generated more than 104 weeks after the accident.

The Executive Chair agreed that the Tribunal misinterpreted the case law and erred in excluding the post-104 week evidence, as such evidence can be relevant to determining whether the applicant suffered a substantial inability to perform essential tasks within the first 104 weeks.

However, the Executive Chair found the error was inconsequential because the post-104 week evidence did not establish the required connection between the accident and the impairments.

The request for reconsideration was denied.

The applicant requested a reconsideration of a case conference order regarding disclosure obligations in an accident benefits dispute.

The applicant argued that the Tribunal failed to include documents the respondent consented to produce and that the order requiring her to produce medical records violated procedural fairness and was based on an error of law.

The Executive Chair varied the order to include the consented disclosure but dismissed the remainder of the request, finding the applicant had sufficient notice that disclosure would be discussed and that the Tribunal did not err in its statement of the test for attendant care benefits.

Following an arbitration where the applicant withdrew all issues except the cost of catastrophic impairment assessments, and the arbitrator ruled in favour of the insurer on that remaining issue, the insurer sought its expenses of the arbitration.

The insurer claimed $23,931.42 in fees and disbursements.

The arbitrator found that the insurer was successful, as the applicant withdrew the catastrophic impairment issue shortly before the hearing and lost on the assessment cost issue.

However, the insurer's claimed expenses were excessive and lacked supporting documentation for disbursements.

Taking a pragmatic approach, the arbitrator awarded the insurer $1,500.00 inclusive of fees, disbursements, and taxes.

The Applicant sought payment for the outstanding costs of catastrophic impairment assessments, arguing that the $2,000 cap under the new SABS did not apply because the assessments were rebuttal reports, a vested right under the old SABS.

The Arbitrator held that while the right to reimbursement for a rebuttal report survived as a vested right, the legislature expressed a clear intention in the new SABS to cap the costs of all assessments at $2,000, regardless of whether the entitlement arose under the old or new SABS.

The claim for the outstanding amount of $10,359.90 was dismissed.

The applicant was injured in a motor vehicle accident and sought various statutory accident benefits, including a determination of catastrophic impairment due to a mental or behavioural disorder.

The arbitrator found that the applicant did not suffer a marked impairment in any area of function and therefore was not catastrophically impaired.

Claims for a non-earner benefit, housekeeping benefits, and certain medical benefits were dismissed.

The arbitrator awarded a limited attendant care benefit of $364.67 per month for a one-year period from September 2012 to September 2013.

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

The insurer raised a preliminary issue that the applicant failed to apply for the benefit within 104 weeks of the accident.

The Tribunal found that the applicant did submit a completed disability certificate within the 104-week period, satisfying the application requirement.

However, on the substantive issue, the Tribunal dismissed the claim because the applicant failed to provide sufficient medical evidence demonstrating a substantial inability to perform the essential tasks of his employment during the first 104 weeks, which is a prerequisite for claiming post-104 week IRBs.