Catherine Korte

The applicant sought statutory accident benefits following a motor vehicle accident, including funding for a standby generator, massage therapy, and other goods and services.

The Tribunal found the standby generator was reasonable and necessary to ensure the applicant's safety during power outages due to her severe mobility impairments.

The Tribunal also approved the massage therapy for pain management.

The claim for other goods and services and a special award under s. 10 of Reg. 664 were dismissed.

The applicant, a Quebec resident injured in an Ontario motor vehicle accident, sought a medical benefit for assistive devices from the respondent insurer.

The respondent denied the claim, arguing the applicant was required to first seek benefits from the SAAQ under Quebec's Automobile Accident Insurance Act, as Ontario statutory accident benefits are excess insurance.

The Tribunal agreed the applicant was obliged to apply to the SAAQ and the respondent was generally entitled to deduct available collateral benefits.

However, the Tribunal found the respondent was estopped from doing so for this specific claim because it had adjusted the file for nearly two years and approved the devices in full without ever advising the applicant of her obligation to apply to the SAAQ.

The Tribunal ordered payment of the benefit with interest and granted a 50% award under section 10 of Regulation 664 due to the respondent's unreasonable delay and change in position.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that partially denied a treatment plan for home modifications, including the location of a new garage, new flooring, electrical rewiring, and a therapy room addition.

The applicant argued the adjudicator made errors of law and fact, specifically regarding the Tribunal's jurisdiction to consider municipal encroachment for the garage location and the assessment of tripping hazards.

The Tribunal dismissed the request, finding no errors of law or fact.

The adjudicator confirmed the Tribunal lacks jurisdiction under section 280 of the Insurance Act to determine municipal encroachment issues and held that the applicant was attempting to re-litigate findings of fact and raise new arguments not presented at the initial hearing.

The applicant, who sustained catastrophic impairments in a motor vehicle accident, sought $334,363.41 in disputed rehabilitation benefits for extensive home modifications, including new flooring, rewiring, and a home addition.

The Licence Appeal Tribunal found that the majority of the proposed modifications were not reasonable and necessary, as the applicant failed to establish a sufficient connection between the requested renovations and her accident-related impairments.

The Tribunal approved only the costs associated with relocating the kitchen fridge to allow access to the fuse panel, along with applicable interest, dismissing the remainder of the claim.

The applicant, who was catastrophically impaired following a 2011 motor vehicle accident, sought resolution of a dispute over statutory accident benefits.

The Tribunal found the applicant was entitled to reimbursement for medical records requested by the respondent, as well as the cost of float therapy, preferring the evidence of the treating psychologists over the respondent's paper review.

Regarding attendant care benefits, the Tribunal awarded $975.24 per month, finding that while the applicant required assistance with feeding, hygiene, and basic supervision, his claims for skilled supervisory care to address depression and suicidal ideation were better addressed through psychological treatment.

The Tribunal declined to deem the attendant care expenses incurred or to order a special award, finding the insurer had not acted unreasonably in relying on its assessments.

The appellant appealed a Licence Appeal Tribunal (LAT) decision that time-barred her application for a catastrophic impairment designation.

The LAT found the two-year limitation period expired because the appellant received the denial letter on the day it was written.

The Divisional Court allowed the appeal, finding the LAT erred in law by making a material finding of fact without evidence and by reversing the onus of proof onto the appellant to show when the letter was received.

The matter was remitted to the LAT for a new hearing.

The appellant insurer appealed an arbitrator's decision dismissing its motion to dismiss the respondent insurer's application for loss transfer indemnity under s. 275 of the Insurance Act.

The dispute arose after a pedestrian was struck by a vehicle insured by the appellant and claimed Statutory Accident Benefits under a motorcycle policy issued by the respondent to the pedestrian's father.

The Divisional Court upheld the arbitrator's findings that the priority scheme in s. 268 of the Insurance Act ranks insurers, not policies, and that the respondent was entitled to indemnification.

The appeal was dismissed.

The applicant requested a reconsideration of a previous decision that dismissed her application for caregiver and non-earner benefits on the grounds of res judicata and being statute-barred.

The applicant argued that the Tribunal erred in fact and law and violated procedural fairness, specifically regarding the start date of the limitation period and the deemed receipt of the denial letter.

The Vice Chair found no errors of fact or law, noting that the applicant failed to provide evidence at the original hearing that the denial letter was mailed rather than given on its date.

The request for reconsideration was dismissed as the applicant was attempting to re-argue her case.

The appellant, an environmental clean-up worker, suffered impairments from toxic exposure while cleaning up a chemical spill caused by a fatal collision between two trucks.

He applied for statutory accident benefits, which were denied on the basis that the incident was not an 'accident' under s. 3(1) of the SABS.

The Licence Appeal Tribunal upheld the denial, finding that while the use of the vac-truck met the purpose test, it did not meet the causation test as the toxic substances, not the vehicle, directly caused the injuries.

The Divisional Court dismissed the appeal, holding that the LAT made no errors of law in its articulation or application of the purpose and modified causation tests.

The applicant, who was catastrophically impaired following a motor vehicle accident, sought a rehabilitation benefit of $1,277,130.00 for the purchase and modification of a new single-level detached home.

The applicant relied on reports from an occupational therapist and a housing accessibility expert, arguing his current high-rise apartment was unsuitable.

The Tribunal dismissed the claim, finding the housing report unreasonable because it failed to assess the cost of modifying the applicant's existing apartment or consider a ground-floor apartment.

The Tribunal held that the insurer's cost obligations could not be determined without an assessment of the cost to renovate the existing home, and the applicant failed to meet his burden of proving the benefit was reasonable and necessary.

The applicant sought statutory accident benefits following a 2003 motor vehicle accident.

The respondent requested a preliminary issues hearing to dismiss the application on grounds of res judicata, expiry of the limitation period, and failure to attend insurer's examinations.

The Tribunal found that the claims for caregiver and non-earner benefits had already been denied in a 2013 FSCO decision and were res judicata.

Furthermore, the Tribunal held that the application was statute-barred as it was filed more than two years after the respondent's clear and unequivocal denial in 2018.

The Tribunal declined to extend the limitation period, finding no bona fide intention to appeal, excessive delay, and incurable prejudice to the respondent.

The application was dismissed.

The applicant was injured in a motor vehicle accident and received income replacement benefits (IRBs) for nearly four years before the insurer terminated them based on insurer's examinations.

The applicant sought ongoing IRBs, arguing she suffered a complete inability to engage in suitable employment due to severe physical and psychological impairments, including chronic pain syndrome and PTSD.

The Tribunal found that the applicant met the post-104 week disability test, preferring the evidence of her treating practitioners and experts over the insurer's assessors, who failed to consider her psychological impairments.

The Tribunal ordered the insurer to pay IRBs of $400 per week from the date of termination, plus interest.

However, the Tribunal dismissed the applicant's claim for an award under O. Reg. 664, finding the insurer's reliance on its medical assessments was not unreasonable or immoderate.

The applicant sought an order for the production of unredacted adjusting log notes and to add a claim for punitive damages to the hearing.

The applicant argued that the respondent's co-mingling of tort and accident benefits files resulted in an unfair litigation advantage and waived privilege.

The Tribunal denied the request for unredacted notes, finding no unfair advantage as the respondent had replaced both counsel and the adjuster and restricted access to the tort file.

The Tribunal also denied the request to add a claim for punitive damages, confirming it lacks jurisdiction to award punitive damages or damages based on bad faith.

The applicant requested a reconsideration of a Tribunal decision that found his physical and psychological impairments, sustained while cleaning up a toxic spill and viewing a deceased body following a fatal tractor-trailer collision, did not result from an 'accident' under the Statutory Accident Benefits Schedule.

The applicant argued the Tribunal misinterpreted the definition of an accident and misapplied the causation test.

The Tribunal dismissed the request, finding no errors of law or fact that would have led to a different result, as the impairments were caused by the aftermath of the collision rather than the direct use or operation of a vehicle.

The applicant was injured in a motor vehicle accident and sought a psychological assessment, which the insurer denied on the basis that the Minor Injury Guideline (MIG) applied.

At arbitration, the Arbitrator found the MIG unconstitutional under s. 15 of the Charter without making any factual findings about the applicant's condition or whether the MIG actually precluded his benefits.

The Director's Delegate overturned this decision, holding that constitutional issues cannot be decided in a factual vacuum.

The Divisional Court dismissed the applicant's judicial review, affirming that the Arbitrator erred by deciding the Charter issue without a proper factual foundation.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that awarded $3,047.27 in monthly attendant care benefits following a motor vehicle accident.

The applicant argued the Tribunal breached the rules of natural justice and procedural fairness by awarding an amount not specifically argued by either party.

The adjudicator dismissed the request, finding the Tribunal acted within its jurisdiction under the Insurance Act and based its quantum determination on a detailed analysis of the evidence and both parties' submissions.

The applicant failed to meet the high onus required to justify a reconsideration.

The appellant, an out-of-province insurer, appealed an arbitrator's decision finding that the priority provisions in s. 268 of the Insurance Act applied to it for a motor vehicle accident that occurred in Ontario.

The appellant argued that applying the Ontario legislation would have an extra-jurisdictional effect.

The Superior Court of Justice dismissed the appeal, applying the reasonableness standard of review.

The court held that because the accident occurred in Ontario and the appellant had signed a Power of Attorney and Undertaking (PAU), it was bound by the priority provisions of the Insurance Act.

The applicant, who was catastrophically impaired following a motorcycle accident, sought attendant care benefits of $6,000 per month for 24-7 supervision, along with medical benefits for physiotherapy and chiropractic treatment.

The Tribunal found that the applicant did not require 24-7 supervision, noting improvements in his condition and inconsistencies in the evidence regarding his need for constant care due to substance abuse and suicidal ideation.

The Tribunal awarded attendant care benefits of $3,047.29 per month.

The Tribunal also partially approved a physiotherapy treatment plan to help manage chronic pain, but denied a second treatment plan for chiropractic and physiotherapy services as excessive and duplicative.

Claims for interest and a special award were dismissed.

The applicant sought reconsideration of an adjudicator's order requiring him to produce his spouse's 2017 income tax return and notice of assessment.

The respondent requested the documents to determine if the spouse, who provided attendant care services, sustained an economic loss.

The Vice Chair dismissed the request for reconsideration, finding that the adjudicator did not breach procedural fairness, the documents were relevant to the issues in dispute, and the privacy arguments under PIPEDA were not raised in the initial submissions.

The appellant insurer appealed an arbitrator's preliminary decision finding that the definition of 'minor injury' and the requirement for documented pre-existing conditions in the Statutory Accident Benefits Schedule (SABS) violated section 15 of the Charter.

The Director's Delegate allowed the appeal, holding that the arbitrator erred by deciding the constitutional questions in a factual vacuum before determining whether the claimant actually suffered from chronic pain or had an undocumented pre-existing condition.

The arbitrator's order was rescinded, and the matter was remitted to arbitration for a determination on the merits of the claim for a psychological assessment.