Cara L. Boddy

The applicant, a self-employed painter injured in a motor vehicle accident, sought income replacement benefits (IRBs) and the cost of an accounting report.

The Tribunal found that the applicant's IRBs should be calculated based on the last completed taxation year under section 4(3) of the Schedule, not the 52 weeks prior to the accident, and dismissed the claim for increased IRBs.

The respondent agreed to pay for the accounting report during the proceeding.

The Tribunal awarded interest on the overdue payment of the accounting report and a $500 award under Ontario Regulation 664, finding that the respondent unreasonably delayed payment for the report.

The applicant sought medical and rehabilitation benefits following a motor vehicle accident, arguing her injuries were not predominantly minor due to chronic pain, a psychological condition, and a pre-existing condition.

The Licence Appeal Tribunal found that the applicant's physical injuries were predominantly minor (sprains, strains, whiplash).

The tribunal rejected the applicant's evidence of chronic pain syndrome and found her mild psychological condition did not inhibit useful functioning.

Furthermore, there was insufficient evidence of a pre-existing condition that would prevent maximal recovery.

Consequently, the applicant was subject to the $3,500 treatment limit, and her claims for further benefits and interest were dismissed.

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, injured in a motor vehicle accident, sought non-earner benefits from the respondent insurer.

The Licence Appeal Tribunal applied the Heath test to compare the applicant's pre- and post-accident activities.

The Tribunal found that the applicant's post-accident activities, including caring for his daughters, cleaning, and watching movies, were not so significantly restricted as to constitute a complete inability to carry on a normal life.

The application for non-earner benefits, interest, and costs was dismissed.

The applicant sought funding for a multidisciplinary catastrophic impairment assessment after exhausting the $50,000 non-catastrophic limit for medical and rehabilitation benefits.

The respondent insurer denied the treatment plan, arguing that the non-catastrophic limit applied and that sufficient medical documentation already existed.

The Tribunal held that the cost of catastrophic assessments is not subject to the $50,000 non-catastrophic limit under section 18(3) of the Schedule, but rather falls under section 25.

The Tribunal found the requested assessments reasonable and necessary, but denied the separate fees for file and medical document review, finding them to be an inherent component of the assessments subject to the $2,000 cap per assessment.

The applicant, a tow truck driver, was injured when a glass pane broke while he was helping an auto body shop owner open a garage bay door after delivering a broken-down taxi.

He applied for an income replacement benefit, which the insurer denied on the basis that the incident was not an 'accident' under the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal initially agreed.

On reconsideration, the Associate Chair upheld the decision, finding that while the purpose test was met, the causation test failed because the shop owner's request for help was an intervening act that broke the chain of causation between the use of the tow truck and the injury.

The applicant, a tow truck driver, sought statutory accident benefits after sustaining injuries while opening a garage bay door at a mechanic's shop.

The respondent denied benefits, arguing the incident was not an 'accident' under section 3(1) of the Statutory Accident Benefits Schedule.

The Tribunal applied the purpose and causation tests, finding that the use of the tow truck had ended prior to the incident and did not directly cause the impairment.

The Tribunal concluded the applicant was not involved in an accident and dismissed the appeal.

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

After disputes arose, she applied for arbitration but subsequently failed to communicate with her counsel or attend the hearing.

At the hearing, the applicant's counsel successfully moved to be removed from the record due to a breakdown in the solicitor-client relationship.

The insurer then moved to dismiss the application with costs.

The arbitrator granted the dismissal, finding the applicant had abandoned her claim, and ordered her to pay $1,000 in costs to the insurer.

The respondent insurer requested a reconsideration of a Licence Appeal Tribunal decision that awarded the applicant income replacement benefits (IRBs) until a specified future date at a rate of $184.13 per week.

The Executive Chair granted the reconsideration, finding that the Tribunal made a significant error of law by ordering benefits payable to a future date, as entitlement to IRBs is a point-in-time inquiry.

Furthermore, the Tribunal misapprehended the evidence regarding the quantum of the IRBs, mistakenly attributing the applicant's own accountant report to the respondent and failing to provide reasons for its calculation.

The matter was remitted to the Tribunal to rehear the issue of the appropriate quantum of IRBs.

The Applicant sought accident benefits for two separate motor vehicle accidents (1990 and 1996).

In a preliminary issue hearing, the Arbitrator determined whether the arbitrations could proceed.

For the 1990 accident, the Arbitrator found that the arbitration was barred because the Applicant had signed a Full and Final Release in 2003 to settle a related civil action, and the right to rescind under the Settlement Regulation did not apply to settlements reached in court proceedings.

For the 1996 accident, the Arbitrator found that the claim for income replacement benefits was not time-barred because the Insurer's termination notice failed to clearly and unequivocally inform the Applicant of the dispute resolution process and time limits, as required by the Smith v. Co-operators test.

The insured was injured in a motor vehicle accident and sought a determination of catastrophic impairment.

The insurer denied the designation, and the insured filed an Application for Mediation.

Before the 60-day mediation period expired and before mediation had failed, the insured filed an Application for Arbitration.

The insurer requested a preliminary issue hearing to determine if the arbitrator had jurisdiction.

The arbitrator held that the Application for Arbitration was barred because the statutory pre-condition of a failed mediation under s. 281(2) of the Insurance Act had not been met at the time the application was filed.

The appellant insurer appealed an arbitrator’s decision that snow plow vehicles involved in a motor vehicle accident were “commercial vehicles” under Ontario Regulation 664 and therefore subject to the statutory loss transfer regime under the Insurance Act.

The appellant argued the definition required that a vehicle first be used primarily to transport goods, tools, or equipment before falling within the enumerated list following the phrase “and includes.” The court held that the enumerated list broadens the definition and captures vehicles such as those designed for construction or maintenance purposes even if they are not primarily used for transporting materials.

Applying a contextual and purposive approach to statutory interpretation, the court found the arbitrator correctly interpreted the regulation.

The appeal was dismissed and the arbitrator’s conclusion that the snow plows were heavy commercial vehicles subject to loss transfer was upheld.

The Applicant was injured in a motor vehicle accident and applied for a determination of catastrophic impairment.

The parties agreed on a 34% physical whole person impairment but disputed the mental and behavioural impairment rating.

The arbitrator preferred the evidence of the Applicant's psychological expert, finding that the Applicant suffered a marked impairment in adaptation to work environments due to severe panic disorder and agoraphobia.

The arbitrator concluded that the Applicant sustained a catastrophic impairment under both clause 2(1.2)(g) (marked mental impairment) and clause 2(1.2)(f) (combined physical and mental impairment of 60%).

The defendants, Aviva Canada Inc. and Pilot Insurance Company, brought summary judgment motions to dismiss two actions by the plaintiff arising from a motor vehicle accident.

The insurer denied coverage, alleging the plaintiff failed to notify them of a material change in risk (using a personal vehicle for a driving school) and made false statements about his claim.

The court dismissed the motions, finding that the statutory condition regarding change in risk did not apply to uninsured coverage.

Furthermore, the court held that genuine issues requiring a trial existed regarding whether the failure to notify was intentional and whether the plaintiff willfully made false statements, as these issues required credibility assessments best suited for a trial judge.

The Applicant was injured in a motor vehicle accident and sought statutory accident benefits for massage therapy, chiropractic care, and a magnetic resonance stimulation machine (MRS 2000).

The Insurer denied the claims.

The Arbitrator found the Applicant to be highly credible and motivated, and concluded that the massage therapy and chiropractic care were reasonable and necessary to support her active rehabilitation and pain management goals.

The claim for the MRS 2000 was dismissed as its cost was not reasonable given the minor degree of success and lack of supporting evidence.

Interest was awarded on the overdue benefits.

The insurer sought its expenses following a successful preliminary issue hearing where the applicant's claim for income replacement benefits was found to be statute-barred.

The arbitrator determined that the insurer was entitled to its expenses, as it was entirely successful and the applicant did not raise any novel issues.

The arbitrator awarded the insurer $2,627.86 in expenses, adjusting the claimed hourly rates to align with the Legal Aid Services Act and denying the disbursement for a court reporter.

The applicant was injured in a motor vehicle accident and received income replacement benefits (IRBs) until they were terminated by the insurer.

More than two years after the termination, the applicant sought reinstatement of IRBs, arguing that her condition had deteriorated.

The insurer denied the request on the basis that the claim was statute-barred.

The arbitrator held that the applicant could not avoid the limitation period by submitting a new request for IRBs based on a subsequent deterioration in her condition.

The claim was found to be statute-barred under section 281.1 of the Insurance Act and section 51 of the Schedule.

The appellant was injured in a motor vehicle accident in the course of his employment.

He claimed and received statutory accident benefits but did not claim workers' compensation benefits.

After his accident benefits were terminated, he commenced a tort action just days before an arbitration pre-hearing.

The arbitrator found that the appellant's election to bring a tort action was made primarily for the purpose of claiming accident benefits, precluding him from relying on the exception in subsection 59(2) of the SABS-1996.

The Director's Delegate dismissed the appeal, finding no error in the arbitrator's consideration of the appellant's failure to pursue the tort claim as evidence of his primary purpose.

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

The arbitrator found that the insurer was entirely successful and therefore entitled to expenses under section 12(2) of O. Reg. 664/90.

The arbitrator adjusted the claimed hourly rate to the maximum permitted under the Legal Aid Services Act, 1998, awarding the insurer $4,067.36 in fees and disbursements.

The applicant was injured in a motor vehicle accident and sought caregiver and housekeeping benefits.

She had been injured in a prior accident seven months earlier, which had prevented her from performing these activities at the time of the second accident.

The arbitrator held that entitlement to these benefits is based on the activities the insured actually performed at the time of the accident, not on a retained status.

Because the applicant was not the primary caregiver and did not normally perform housekeeping activities at the time of the second accident due to impairments from the first, she was not entitled to the claimed benefits.

The application was dismissed.