Dale Rosenberg

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to a non-earner benefit and various treatment plans outside the Minor Injury Guideline (MIG).

The respondent denied the benefits, arguing the injuries were minor.

The Licence Appeal Tribunal found the applicant failed to provide sufficient medical evidence to support claims of chronic pain or psychological injury warranting removal from the MIG.

Furthermore, the applicant did not demonstrate a complete inability to carry on a normal life, as he maintained or increased his pre-accident activities, including working as an Uber driver.

The application was dismissed.

The applicant sought accident benefits following a rear-end motor vehicle collision.

The insurer denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued her pre-existing chronic neck and back pain warranted removal from the MIG.

The Tribunal found the applicant failed to provide compelling medical evidence that her pre-existing conditions precluded recovery within the MIG, preferring the insurer's physiatry assessment.

The Tribunal also dismissed the claim for non-earner benefits, finding the applicant's self-reported limitations were contradicted by pre-accident medical records and lacked corroborating medical evidence.

The application was dismissed.

The applicant sought statutory accident benefits after being assaulted while stopped in his vehicle in traffic.

The respondent denied benefits on the basis that the incident was not an 'accident' under the Schedule.

The Tribunal applied the purpose and causation test, finding that while the vehicle was being used for an ordinary purpose, the assault was an intervening act that broke the chain of causation.

The use or operation of the vehicle was not the direct cause or dominant feature of the applicant's injuries.

The application was dismissed.

The applicant was a passenger in a motor vehicle accident and did not apply for statutory accident benefits until nine months later.

The insurer argued the claim was barred under s. 32(1) of the Schedule for failing to provide notice within seven days.

Applying the recent Divisional Court decision in Hussein v. Intact, the Tribunal found that the driver's report of the accident on the day it occurred triggered the insurer's positive obligation to inquire about injuries and assist the applicant.

Because the insurer failed to fulfill this obligation, and the applicant provided a credible explanation for the delay, the Tribunal held the applicant was not barred from proceeding with her claim.

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

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued she should be removed from the MIG due to chronic pain, relying on clinical notes from a rheumatologist.

The Tribunal found the clinical notes were from more than two years post-accident and contained no records of chronic pain caused by the accident.

The Tribunal concluded the applicant failed to prove she suffered from chronic pain with functional impairment as a result of the accident, and therefore her injuries were subject to the MIG limit.

The application for various treatment plans was dismissed.

The applicant sought statutory accident benefits after allegedly being struck by a vehicle while crossing the street.

The respondent denied benefits, arguing no accident occurred as there was no physical contact.

The Tribunal found the applicant credible and, supported by surveillance video and hospital records, concluded he was struck by the vehicle.

Applying the purpose and causation tests, the Tribunal determined the incident met the definition of an 'accident' under s. 3(1) of the Schedule.

The Tribunal awarded the claimed $2,200 for a psychological assessment, finding the $200 fee for reviewing the treatment plan is separate from the $2,000 assessment cap, and $2,200 for physiotherapy services.

The respondent insurer sought reconsideration of a Tribunal decision which held that the cost of a catastrophic impairment assessment is not deducted from the $50,000 monetary limit for medical and rehabilitation benefits under the Statutory Accident Benefits Schedule.

The insurer argued that the Tribunal made a significant error of law.

The Vice-Chair dismissed the request for reconsideration, finding no significant error of law.

The Vice-Chair confirmed that a catastrophic impairment is a designation, not a benefit, and therefore an assessment for it is not 'in connection with any benefit or payment' under section 18(5) of the Schedule.

Consequently, the cost of the assessment is payable over and above the $50,000 limit.

The applicant sought a non-earner benefit following a motor vehicle accident, claiming a complete inability to carry on a normal life due to physical and psychological impairments.

The respondent denied the benefit, relying on independent medical examinations and surveillance evidence that contradicted the applicant's reported limitations.

The Tribunal found the applicant's evidence inconsistent and preferred the respondent's medical reports, which were corroborated by surveillance showing the applicant driving, shopping, and socializing.

The application for the non-earner benefit was dismissed.

The applicant sought a preliminary determination on whether the costs of catastrophic impairment assessments are included in the $50,000 limit on medical and rehabilitation benefits under the Statutory Accident Benefits Schedule.

The Tribunal held that catastrophic impairment assessments are not included in the $50,000 cap and are instead payable under section 25 of the Schedule.

The respondent was ordered to restore $18,434.00 to the applicant's medical and rehabilitation benefit limit.

The applicant insurer sought repayment of $16,325.12 in Income Replacement Benefits (IRBs) paid to the respondent following a motor vehicle accident.

The overpayment occurred because the respondent received retroactive Long Term Disability benefits from Manulife, which are deductible from IRBs under the Statutory Accident Benefits Schedule.

The respondent acknowledged liability to repay but argued the insurer was limited to collecting the overpayment by reducing subsequent IRB payments.

The Tribunal found that the insurer was not obligated to use the claw-back provisions and ordered the respondent to repay the full amount plus interest.

The applicant was injured in a slip and fall accident while exiting his vehicle and sought statutory accident benefits.

He submitted a treatment plan for psychological assessment and therapy, which the respondent denied based on an insurer's examination finding no diagnosable psychological impairment.

The adjudicator found the treatment plan was neither reasonable nor necessary, noting it duplicated an earlier plan and the applicant's psychologist failed to review relevant medical records or explain why the symptoms were attributed to the first accident despite an intervening second accident.

The application was dismissed, and the respondent's request for costs was also dismissed for failing to provide required particulars.

The Appellant appealed an arbitration decision that denied her claim for post-104 week income replacement benefits (IRBs) and ordered each party to bear their own legal expenses.

The Director's Delegate upheld the denial of IRBs, finding no error of law in the Arbitrator's assessment of the evidence and credibility, noting that an appellate officer cannot retry the case or substitute findings of fact.

However, the Delegate found that the Arbitrator breached procedural fairness by deciding the issue of legal expenses without providing the parties an opportunity to make submissions.

The legal expenses issue was remitted to arbitration for redetermination.

The Appellant was awarded $500 in appeal costs.