Ashu Ismail

The applicant sought an order requiring the respondent insurer to produce all surveillance evidence, regardless of whether the respondent intended to rely on it at the hearing.

The Tribunal found that while the surveillance evidence was relevant, it was protected by litigation privilege.

Surveillance obtained after the applicant filed her application to the LAT was prepared for the dominant purpose of litigation.

Therefore, the respondent was not required to disclose the surveillance unless it intended to rely on it at the hearing.

The applicant, a personal support worker, was injured while riding as a passenger on a bus that was struck by a car.

She sought income replacement benefits (IRBs), medical benefits, and attendant care benefits (ACBs) after the insurer terminated them.

The arbitrator found the applicant was entitled to IRBs for both the pre-104 week and post-104 week periods, as well as the disputed medical benefits, but denied the claim for ongoing ACBs.

The arbitrator also ordered the insurer to pay a $6,500 special award for unreasonably terminating the applicant's IRBs despite objective medical evidence of a severe knee condition.

In a preliminary ruling, the arbitrator removed the insurer's in-house legal department as representatives of record due to a disqualifying conflict of interest, finding that the mandatory firewall between the insurer's accident benefits and tort files had been breached.

The applicant was injured in a motor vehicle accident and sought income replacement benefits.

The insurer argued the application was barred by the two-year limitation period, relying on an Explanation of Benefits (EOB) letter sent in July 2013.

The Tribunal found that the insurer breached its duty of good faith by failing to provide the required benefits information package.

Furthermore, the EOB letter did not constitute a clear and unequivocal denial because the applicant had not yet elected a specific benefit and the insurer's stated reason for denial was incorrect.

As a result, the limitation period was not triggered, and the applicant was permitted to proceed with her claim.

The applicant sought reconsideration of a Licence Appeal Tribunal decision that denied his claim for statutory accident benefits related to chronic pain.

The Executive Chair granted the reconsideration, finding that the Tribunal breached procedural fairness by failing to request complete copies of the OCF-18 treatment plans, which were central to the dispute.

Furthermore, the Tribunal erred in its evaluation of the medical evidence by inappropriately requiring the applicant's medical reports to explicitly reference the proposed treatment plans and by failing to consider the limits of the insurer's examination reports.

The matter was ordered to be reheard.

The applicant sought statutory accident benefits following a motor vehicle accident, including pre- and post-104 week income replacement benefits, chiropractic treatment plans, and the cost of a disability certificate.

The adjudicator found the applicant to be an unreliable witness due to inconsistencies in her testimony and self-reporting.

The adjudicator concluded the applicant did not suffer a substantial or complete inability to perform her employment tasks, noting her physical injuries were minor exacerbations of pre-existing conditions and there was no objective evidence of psychological impairment.

The claims for income replacement benefits, treatment plans, and the disability certificate were dismissed.

The respondent's request for costs of a motion was also dismissed.

The applicant was injured in a motor vehicle accident and sought medical and income replacement benefits.

The insurer denied two treatment plans and adjusted the income replacement benefit.

The Tribunal found that the applicant's injuries, which included possible carpal tunnel syndrome, fell outside the Minor Injury Guideline.

The Tribunal approved the disputed treatment plans as reasonable and necessary, and awarded interest.

The Tribunal also determined the applicant's weekly income replacement benefit to be $280.16, but held that he was not entitled to claim a weekly business loss amount because he was no longer operating his business.

The defendant, State Farm, brought a summary judgment motion to dismiss the plaintiff's claim for chiropractic treatments and a declaration of entitlement to future medical rehabilitation benefits following a motor vehicle accident.

The court found the case appropriate for summary judgment, noting the small amount in question ($4,090) and the availability of expert evidence.

The court concluded that the plaintiff failed to demonstrate that the proposed chiropractic treatment plan was reasonable and necessary, as expert opinions emphasized active, self-directed rehabilitation over passive treatments.

The motion was allowed, and the plaintiff's claims were dismissed.

Following the dismissal of the applicant's claim for housekeeping expenses due to the expiration of the limitation period, the arbitrator determined the quantum of expenses payable to the insurer.

The insurer submitted a bill of costs for 19.34 hours at the legal aid rate, totaling $1,740.01 including disbursements.

The applicant's counsel provided no substantive submissions opposing the amount.

The arbitrator found the claimed amount reasonable and ordered the applicant to pay $1,740.01 in expenses.

The Applicant was injured in a motor vehicle accident and received statutory accident benefits from the Insurer.

The Insurer terminated weekly housekeeping and home maintenance benefits in September 2007.

The Applicant applied for mediation in March 2010 and arbitration in February 2011.

The Arbitrator found that both applications were filed beyond the two-year limitation period set out in the Insurance Act and the Statutory Accident Benefits Schedule.

The application for arbitration was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, which the insurer denied on the basis that the accident was staged.

Both parties brought preliminary motions for the production of documents.

The arbitrator ordered the insurer to produce its complete adjuster's file and policy manuals, finding that the dominant purpose of an adjuster's file is the adjusting of the claim and is therefore producible, subject to specific claims of privilege.

The insurer was not required to produce legal opinions or reserves.

The applicant was ordered to produce his RBC insurance file, specific Ontario Works records, and clinical notes from one year prior to the accident.