7 total
Request for reconsideration of decision denying attendant care benefits and treatment plan dismissed.
The applicant requested a reconsideration of a prior LAT decision denying attendant care benefits (ACBs) and a treatment plan for social rehab counselling.
The applicant argued the adjudicator erred in law and fact by mischaracterizing compliance with s. 3(7)(e) of the Schedule and by rejecting medical evidence.
The Tribunal found no errors of law or fact, noting the applicant failed to provide sufficient particulars for the ACBs and failed to demonstrate the treatment plan was reasonable and necessary.
The request for reconsideration was dismissed.
Reconsideration granted; discoverability applies to limitation period for accident benefits following catastrophic impairment determination.
The applicant requested a reconsideration of a preliminary issue decision that found his claims for attendant care and housekeeping benefits were statute-barred.
The Tribunal originally held that the two-year limitation period began when the insurer pre-emptively denied the benefits in 2005, long before the applicant was determined to be catastrophically impaired in 2015.
Applying the recent Court of Appeal decision in Tomec, the adjudicator found that the doctrine of discoverability applies.
The applicant did not discover his eligibility for the benefits until he was deemed catastrophically impaired.
Therefore, the limitation period did not begin in 2005, and the applicant's claim is not statute-barred.
The reconsideration was granted.
Insurer ordered to pay interest and a special award for unreasonably terminating income replacement benefits.
The applicant was injured in a motor vehicle accident and received income replacement benefits (IRBs) until the insurer terminated them.
Prior to the arbitration hearing, the insurer conceded the issue and paid the IRBs retroactively.
The arbitrator held that interest on the overdue IRBs began to accrue from the date they were initially terminated, as the insurer bears the consequence of a decision not to pay benefits later found owing.
The arbitrator also awarded a special award of $36,280.00, finding the insurer acted unreasonably by ignoring the conclusions of its own medical and vocational assessors, who noted that the alternative job options proposed did not provide the same remuneration as the applicant's pre-accident employment.
The insurer was ordered to pay $25,000.00 in expenses.
Summary judgment granted dismissing a slip and fall action against an adjacent property owner where the fall occurred on a municipal road.
The plaintiff initiated an action against Toronto Community Housing Corporation (TCHC) for damages resulting from a slip and fall on January 3, 2011.
TCHC brought a motion for summary judgment, arguing that the plaintiff's injuries occurred on a road owned and maintained by the City of Toronto, thus precluding TCHC's liability.
The court granted summary judgment, dismissing the action against TCHC, finding no genuine issue requiring a trial.
The uncontradicted evidence showed the fall occurred on municipal property, and there was no evidence TCHC had assumed maintenance responsibilities or contributed to the incident.
Costs were awarded to TCHC.
Summary judgment granted dismissing occupiers' liability claim by contractor who fell from residential roof.
The plaintiff sued the defendants for injuries sustained after falling from the roof of their home while performing renovations.
The defendants brought a motion for summary judgment to dismiss the action.
The court found that the plaintiff was acting as a contractor and the defendants, as occupiers, had no duty to provide safety equipment or supervise his work.
The court granted the motion and dismissed the action, finding no genuine issue requiring a trial.
Accident benefits denied as physical injuries were attributed to pre-existing conditions and a subsequent workplace accident.
The Applicant sought accident benefits for medical treatment plans and assessments following a motor vehicle accident.
The insurer denied the claims, arguing the Applicant's injuries were minor, pre-existing, or caused by a subsequent workplace accident.
The arbitrator applied the material contribution test and found that the motor vehicle accident did not materially contribute to the Applicant's physical complaints, which were largely attributable to a pre-existing history of back pain and a significant workplace injury that occurred days after the motor vehicle accident.
The arbitrator dismissed the claims for a chronic pain program, physiotherapy, and an orthopaedic assessment, finding them not reasonable and necessary.
However, $300 was awarded for a psychological assessment report.
The Applicant's claim for a Special Award was dismissed, as the insurer did not unreasonably withhold payments.
The Applicant was ordered to pay $11,863.52 for the insurer's expenses due to the insurer's near-total success in the proceeding.
Collision found to be a genuine accident, not staged; applicants may proceed with benefits arbitration.
The applicants sought accident benefits following a motor vehicle collision where their minivan struck a Honda Civic making a left turn.
The insurer denied the claims, alleging the collision was a deliberate, staged accident orchestrated with the help of an unidentified third vehicle.
The arbitrator found the insurer's witnesses to be inconsistent and unreliable, and preferred the applicants' straightforward evidence that the collision was a genuine left-turn accident.
The arbitrator concluded the incident was an 'accident' within the meaning of the Statutory Accident Benefits Schedule, allowing the applicants to proceed with their arbitration applications.
