Ashu Ismail

The applicant sought reconsideration of a decision finding a settlement agreement valid under section 9.1 of Regulation 664.

The applicant argued the Tribunal erred in law and breached procedural fairness by not requiring the respondent to provide the commuted value of attendant care benefits.

The adjudicator dismissed the request, finding no error of law because the applicant had never claimed attendant care benefits, making it impossible to calculate a commuted value.

The adjudicator also found no breach of procedural fairness, as the applicant had the opportunity to reply to the respondent's submissions.

The applicant sought statutory accident benefits following a 2014 motor vehicle accident.

The respondent argued the application was barred because the parties had executed a full-and-final settlement in November 2016.

The applicant contended he lacked the mental capacity to enter into the settlement agreement at that time.

The Tribunal found that the applicant's contemporaneous academic records and cognitive test scores demonstrated he had the capacity to understand the agreement and instruct counsel.

The Tribunal held the settlement was valid and dismissed the application pursuant to s. 9.1(8) of Regulation 664.

The applicant sought to enforce a settlement agreement allegedly reached with the respondent insurer regarding her statutory accident benefits claim.

The parties had negotiated an agreement in principle via email, but the applicant refused to sign a release that included the tortfeasor (Ryder).

The Tribunal found that a mutually agreeable release was an essential term of the settlement.

Because the applicant amended the settlement disclosure notice without agreement and did not execute the required release, no binding and enforceable settlement agreement was reached.

The application to enforce the settlement was dismissed.

The plaintiffs sued multiple defendants, including an insurer and its subcontractors, for various torts arising from the handling of a statutory accident benefits claim.

The defendants brought Rule 21 motions to strike the claims for lack of jurisdiction and disclosing no reasonable cause of action.

The court refused to strike the action for lack of jurisdiction because of an outstanding constitutional challenge to the Insurance Act.

However, the court struck all tort claims against the moving defendants, except for the claim of intentional infliction of emotional distress, finding it was plain and obvious they could not succeed.

The court also struck the plaintiff's constitutional challenges to the Statutory Accident Benefits Schedule as an abuse of process.

The applicant requested a reconsideration of a decision that found she was not catastrophically impaired under criterion 8.

The applicant argued the Tribunal acted outside its jurisdiction, breached procedural fairness by limiting her testimony and allegedly diagnosing malingering, and erred in law by failing to follow the Pastore framework.

The Vice-Chair dismissed the request, finding that the original decision correctly applied the 'but for' test for causation, offered reasonable accommodations during testimony, and properly followed the legal tests without making an unauthorized medical diagnosis.

The applicant sought to rescind a settlement agreement reached with the respondent insurer regarding statutory accident benefits arising from two 1996 motor vehicle accidents.

The applicant argued the settlement was invalid because the Settlement Disclosure Notice failed to include the commuted value of attendant care benefits, as required by s. 9.1 of Regulation 664.

The Tribunal found that res judicata did not apply from prior proceedings.

However, the Tribunal held the settlement was valid because the applicant had not claimed attendant care benefits at the time of settlement, making it impossible and unnecessary for the insurer to provide a commuted value for a benefit with a quantum of zero.

The application was dismissed.

The insurer appealed a Licence Appeal Tribunal (LAT) decision finding that the insured's election of benefits under s. 31(5) of the Statutory Accident Benefits Schedule was invalid due to the insurer's non-compliance with s. 32(2)(b).

The Divisional Court dismissed the appeal, holding that the LAT's factual findings regarding the insurer's non-compliance were not reviewable on a question of law.

The Court agreed that because the initial election was invalid, the insured had not made an election within the meaning of the SABS, and therefore the general prohibition against changing an election did not apply.

The appellant, Shelly Legault, appealed a trial decision that dismissed her action against TD General Insurance Company for denial of a homeowner's insurance claim following a fire.

The trial judge found that Legault had made a fraudulent declaration regarding additional living expenses (ALE), leading to forfeiture of coverage, and granted TD damages on a counterclaim, plus costs.

The Court of Appeal dismissed the appeal, upholding the trial judge's findings that the appellant's fraud vitiated the policy, that the payment of professional witnesses was permissible, and that the costs award was within the trial judge's discretion.

The applicant sought statutory accident benefits following a 2015 motor vehicle accident, claiming catastrophic impairment under criterion 8 (mental or behavioural disorder) and entitlement to an income replacement benefit (IRB) and a chiropractic treatment plan.

The Tribunal dismissed the application, finding the applicant was not catastrophically impaired because her self-reported functional impairments were inconsistent with her history and objective findings, suggesting malingering or exaggeration.

The Tribunal also denied the IRB claim, finding the applicant failed to prove a complete inability to engage in employment, noting she had worked for 10-11 months post-accident.

Claims for the treatment plan, an award, interest, and costs were also dismissed.

The applicant sought a determination of catastrophic impairment under Criterion 6 of the Statutory Accident Benefits Schedule following a motor vehicle accident.

The applicant relied on a revised assessment by an orthopedic surgeon, which incorporated a whole person impairment rating from a chiropractor.

The Tribunal found the chiropractor was not qualified to make a catastrophic impairment determination and gave little weight to the revised assessment.

Relying on the respondent's orthopedic assessment and surveillance evidence showing the applicant functioning without walking aids, the Tribunal concluded the applicant did not meet the 55% whole person impairment threshold.

The application was dismissed, and no award for unreasonable delay was granted.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied her claims for various statutory accident benefits, including attendant care, housekeeping, and medical treatments.

The applicant argued that the adjudicator committed a material breach of procedural fairness, demonstrated institutional bias, and made several errors of law and fact.

The Tribunal dismissed the request, finding no reasonable apprehension of bias or breach of procedural fairness.

The Tribunal also concluded that the adjudicator made no errors of law or fact, noting that the applicant was improperly attempting to use the reconsideration process to reweigh the evidence.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that found the respondent insurer did not unreasonably delay the payment of medical or rehabilitation benefits and dismissed the applicant's claims.

The applicant argued the Tribunal made errors of law and fact, violated procedural fairness, and that new evidence was available.

The Vice-Chair dismissed the request for reconsideration, finding that the applicant failed to meet the high threshold under Rule 18.2.

The Vice-Chair also struck portions of the applicant's reply submissions that improperly raised allegations of bias for the first time.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied her entitlement to Income Replacement Benefits.

The applicant argued that new evidence demonstrated the respondent failed to comply with PIPEDA and the Schedule, that the Tribunal made errors of law and fact regarding the necessity of functional capacity examinations and the adequacy of IE notices, and that there was a reasonable apprehension of bias.

The Tribunal struck the applicant's bias arguments raised for the first time in reply submissions.

The Tribunal dismissed the reconsideration request, finding that the proposed new evidence did not meet the test for admission, the Tribunal did not err in its interpretation of the Schedule or its assessment of the IE notices, and the applicant failed to establish any reasonable apprehension of bias.

The appellant/applicant sought to appeal and judicially review interlocutory decisions of the Licence Appeal Tribunal (LAT) regarding the striking out and destruction of certain evidence.

The Divisional Court issued a notice under Rule 2.1.01 of the Rules of Civil Procedure.

The court dismissed the appeal for want of jurisdiction, as there is no right of appeal from an interlocutory LAT decision.

The court also dismissed the application for judicial review regarding the evidentiary rulings due to prematurity, but permitted the judicial review to proceed regarding the orders requiring the destruction of documents.

The defendants brought a motion for summary judgment, arguing that the motor vehicle accident was an "inevitable accident" due to the defendant driver suffering a severe anaphylactic shock from an allergic reaction to naproxen (Aleve).

The plaintiff opposed, asserting that genuine issues of fact and credibility required a trial.

The court dismissed the motion, finding that there were complex and highly disputed factual issues, particularly regarding the timing of the anaphylactic reaction, the driver's potential negligence in taking a double dose of medication without reading instructions, and when unconsciousness occurred.

The court determined it could not make the necessary factual findings for a fair and just determination without a full trial, even with enhanced fact-finding powers.

The applicant sought various statutory accident benefits following a motor vehicle accident, including attendant care benefits, housekeeping and home maintenance, multiple treatment plans, medical cannabis, and botox injections.

The Licence Appeal Tribunal dismissed the application in its entirety.

The adjudicator found that the applicant's claims for attendant care and housekeeping were inconsistent with her pre- and post-accident level of function, noting she continued to work full-time and her family performed most household chores.

The requested treatment plans and medical expenses were deemed not reasonable and necessary, as they were unsupported by the contemporaneous medical evidence and the applicant failed to provide adequate information to the insurer.

Claims for an award and interest were also dismissed as no benefits were overdue.

The plaintiff sought leave to amend her statement of claim to add a claim for punitive and aggravated damages against the defendants for intentional infliction of mental distress.

The proposed claim was based on the surveillance tactics of investigators retained by defence counsel and counsel's failure to respond to inquiries.

The court dismissed the motion, finding that the proposed amendments were not tenable at law because a party cannot be vicariously liable in punitive damages for the actions of their lawyer, and opposing counsel owes no duty of care to the plaintiff.

The court also found that granting the amendment would cause non-compensable prejudice by likely requiring all counsel to be removed from the record to testify.

The applicant sought retroactive attendant care benefits (ACBs), housekeeping and home maintenance benefits (HKHM), chiropractic services, and occupational therapy services following a 1997 motor vehicle accident that resulted in a catastrophic impairment.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove that the delay in submitting a retroactive Form 1 was due to urgency, impossibility, or impracticability, as required by the Morrissey decision.

The Tribunal also found no evidence that the ACB or HKHM expenses were actually incurred.

Furthermore, the requested chiropractic treatment and a one-year golf membership were deemed not reasonable and necessary based on the medical evidence.

Claims for a section 10 award, interest, and costs were also dismissed.

The applicant sought statutory accident benefits following a 2015 motor vehicle accident, including attendant care, housekeeping, and the cost of assessments.

The Licence Appeal Tribunal found the applicant entitled to a reduced amount of attendant care benefits ($448.49 per month) for feeding, but denied claims for dressing, shaving, mobility, and other items.

The Tribunal also found the applicant entitled to housekeeping benefits, but only payable from September 2022 due to a lack of accounting for prior incurred expenses.

Claims for assessment costs, a special award, and costs were dismissed.

The Tribunal also dismissed a preliminary motion to state a case for contempt regarding the insurer's surveillance.

The appellant appealed a Licence Appeal Tribunal (LAT) decision denying his claim for catastrophic impairment benefits following a motor vehicle accident.

The LAT found that a subsequent fall and seizure was an intervening event not caused by the accident.

On appeal, the appellant argued the LAT breached procedural fairness by allowing the insurer to raise causation late, and erred by applying the 'but for' causation test instead of the 'material contribution' test.

The Divisional Court dismissed the appeal, holding that the procedural fairness issue could not be raised for the first time on appeal, and that the LAT correctly applied the 'but for' test as this was not an exceptional case involving multiple tortfeasors.