Danielle Gauvreau

The applicant was involved in a motor vehicle accident and sought statutory accident benefits.

The respondent insurer denied the claim because the applicant failed to submit the OCF-1 application within the 30-day time limit prescribed by section 32(5) of the Schedule.

The Tribunal found that the insurer complied with its obligation to provide the forms and explain the consequences of delay.

The Tribunal rejected the applicant's explanation for the delay as not credible, noting a lack of supporting medical evidence.

The application was dismissed as time-barred.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied an adjournment request and dismissed her application for catastrophic impairment benefits.

The applicant argued that the denial of the adjournment was a material breach of procedural fairness, as her newly retained counsel had identified a potential conflict of interest with her litigation guardian on the eve of the hearing, alongside ongoing capacity concerns.

Applying the Divisional Court's reasoning in Riddell regarding the need for flexibility in complex catastrophic impairment cases, the Tribunal found that the combination of the potential conflict, capacity issues, and recently retained counsel constituted compelling circumstances.

The Tribunal concluded that denying the short adjournment was a material breach of procedural fairness, cancelled the initial decision, and ordered a rehearing before a new adjudicator.

The applicant requested reconsideration of a decision that denied an oral adjournment request and dismissed her application for catastrophic impairment determination.

The applicant argued that her newly retained counsel had identified a potential conflict of interest with her litigation guardian on the eve of the hearing, alongside concerns about her capacity.

The Tribunal found that denying the adjournment in these complex circumstances constituted a material breach of procedural fairness.

The reconsideration request was granted, the initial decision was cancelled, and a rehearing was directed.

An appeal from an arbitration decision under the Insurance Act concerning priority of payment of statutory accident benefits.

The claimant, a 25-year-old who suffered severe traumatic brain injury in a motorcycle accident, was deemed catastrophically impaired.

The arbitrator determined that the claimant was principally dependent on his sister, who was insured by the appellant, rather than on his parents or the motorcycle insurer.

The appeal challenged the arbitrator's application of the dependency test, arguing that the arbitrator failed to properly apply all four criteria from the leading case and failed to conduct a precise calculation of the 51% threshold.

The court upheld the arbitrator's decision, finding no error of law or palpable and overriding error in the arbitrator's reasoning and factual conclusions.

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

The insurer denied a treatment plan for chiropractic services on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.

The Tribunal found that the applicant failed to provide compelling medical evidence to warrant removal from the MIG, noting that imaging showing a shoulder tear was conducted 16 months post-accident and was not causally linked to the collision.

As the MIG limit was exhausted, the treatment plan and claim for interest were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming catastrophic impairment.

At the hearing, the applicant did not appear, and her counsel made an oral request for an adjournment, citing newly discovered concerns about the applicant's capacity to instruct counsel.

The adjudicator denied the adjournment request, noting that counsel was retained by the applicant's mother acting as litigation guardian, making the capacity issues foreseeable, and that insufficient medical evidence was provided to support the request.

As the applicant filed no evidence and made no submissions to meet her burden of proof, the application was dismissed.

The applicant requested a reconsideration of a preliminary issue decision which found him statute-barred from proceeding with his application for accident benefits due to an unexplained delay.

The applicant argued the Tribunal breached procedural fairness and erred in law by failing to properly assess the credibility and reasonableness of his explanation for the delay.

The Tribunal dismissed the request, finding no evidence of procedural irregularities and concluding that the adjudicator correctly applied the legal test in determining the applicant's explanation was not credible.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits.

He failed to notify the insurer of his intention to apply for benefits within the seven-day time limit prescribed by section 32(1) of the Schedule, submitting his application over a year later.

The Tribunal found that the applicant did not provide a credible or reasonable explanation for the delay, rejecting his arguments that he was unaware of his injuries or his right to claim benefits.

The application was dismissed as statute-barred.

The applicant was injured in a rear-end motor vehicle accident and sought statutory accident benefits, which the respondent insurer denied.

The applicant applied to the Licence Appeal Tribunal to dispute the denials, arguing her injuries warranted removal from the Minor Injury Guideline (MIG) due to chronic pain and psychological impairments.

The Tribunal found the applicant's claim for a non-earner benefit was statute-barred under section 56 of the Schedule.

Furthermore, the Tribunal held the applicant failed to provide compelling evidence of a pre-existing condition, chronic pain syndrome, or psychological injuries that would prevent maximal recovery within the MIG.

As the applicant's injuries were deemed minor and the $3,500 MIG limit was exhausted, the claims for further treatment plans and assessments were dismissed.

Claims for interest and an award for unreasonable delay were also dismissed.

This appeal arose from a priority dispute between insurance companies concerning accident benefits coverage following a motor vehicle accident.

The appellant, Trafalgar Insurance Company, appealed an arbitration decision that found the injured party was not insured by Economical Insurance Company and not entitled to Statutory Accident Benefits from them.

The Superior Court dismissed the appeal, upholding the arbitrator's findings that the vehicle in question was not an 'owned automobile' under Economical's standard Ontario Garage Policy (OAP 4) because its use (leased to a rental company) was outside the scope of the insured's business and was specifically excluded by the policy.

The court also affirmed that section 233(2) of the Insurance Act did not apply as the issue was the vehicle's insured status, not a breach of contract or misrepresentation.

The applicant sought accident benefits following a motor vehicle accident, disputing the respondent's determination that her injuries fell within the Minor Injury Guideline (MIG).

The applicant claimed entitlement to a $2,260.00 treatment plan for psychological services, arguing that pre-existing anxiety and chronic pain removed her from the MIG.

The Tribunal found that the applicant's physical injuries were soft-tissue in nature and that she failed to establish a nexus between her pre-existing anxiety or chronic pain and the accident.

As the $3,500.00 MIG limit was already exhausted, the treatment plan was not payable and the application was dismissed.

The appellants, Trafalgar Insurance and Economical Insurance, appealed an arbitrator's decision in a priority dispute regarding statutory accident benefits.

The arbitrator had found that Arch Insurance was not the insurer of the vehicle involved in the accident because the vehicle was not owned or leased by Arch's named insured, despite being mistakenly listed on a fleet schedule.

The Superior Court of Justice dismissed the appeal, finding no palpable and overriding error or error of law in the arbitrator's conclusion that the vehicle did not qualify as a 'described vehicle' under the OPCF 21A endorsement.

A related costs appeal was also dismissed as premature.