Daniel Mark Himelfarb

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

The Tribunal found that the applicant failed to establish a psychological impairment warranting removal from the Minor Injury Guideline, as the medical evidence showed only intermittent symptoms without a formal diagnosis or ongoing treatment.

The applicant also failed to prove a substantive inability to perform the essential tasks of her employment to qualify for income replacement benefits.

However, because the insurer delayed issuing a denial after the applicant complied with section 33 requests, income replacement benefits were payable for a four-month period due to procedural non-compliance.

Claims for disputed treatment plans and an award were dismissed.

The defendant brought a motion to add Shreeji Hospitality of University, LLC Ramada Clarion (the "Owner") as a third party for contribution and indemnity, stemming from a separate incident in North Carolina involving the plaintiff.

The Owner opposed the motion on grounds of delay, non-compensable prejudice, and lack of jurisdiction.

The court dismissed the motion to add the Owner, finding inordinate and unexplained delay, non-compensable prejudice due to loss of records and reduced ability to obtain information from the original third party, and an absence of a real and substantial connection to Ontario for the Owner.

The court also made limited production orders against Progressive Insurance, the insurer for the original third party and the Owner, but declined to order the production of the entire underwriting file.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming catastrophic impairment due to a subdural hematoma, as well as entitlement to attendant care benefits, non-earner benefits, and various treatment plans outside the Minor Injury Guideline (MIG).

The Tribunal found that the subdural hematoma was a spontaneous occurrence unrelated to the accident.

The Tribunal further held that the applicant's injuries were predominantly minor, keeping her subject to the MIG limits.

Consequently, the claims for attendant care benefits, non-earner benefits, and treatment plans exceeding the MIG were dismissed.

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

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

The applicant argued for removal from the MIG based on a pre-existing right shoulder injury, multiple morbidities, and chronic pain.

The Tribunal found that the applicant failed to provide compelling medical evidence that his pre-existing conditions would preclude maximal recovery within the MIG.

Furthermore, applying the AMA Guides, the Tribunal concluded the applicant did not demonstrate chronic pain with functional impairment.

The disputed treatment plans for chiropractic services and the cost of an OCF-3 were deemed not reasonable and necessary.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's denial of several treatment plans.

The Licence Appeal Tribunal found the applicant was entitled to psychological services and a driver's reintegration assessment, as medical evidence and consistent reporting supported her psychological symptoms and driving anxiety.

However, the Tribunal denied the claims for a speech language pathology assessment and treatment, finding the applicant's self-reported cognitive and communication issues were contradicted by multiple assessors who observed no such impairments.

The Tribunal awarded interest on the overdue benefits but declined to order an award under s. 10 of O. Reg. 664, finding the respondent did not unreasonably withhold or delay payment.

The applicant, an international student who was struck by a vehicle while cycling, sought income replacement benefits, medical benefits, and lost educational expenses from the respondent insurer.

The adjudicator dismissed the applicant's claims, finding that he failed to establish his pre-accident employment and income, and did not provide compelling medical evidence of disability.

The claims for medical benefits were dismissed because the applicant had exhausted the $65,000 non-catastrophic funding limit.

Furthermore, the adjudicator ordered the applicant to repay $10,513.56 in overpaid income replacement benefits, concluding that the applicant committed wilful misrepresentation by failing to disclose his return to work and post-accident earnings.

The applicants sought judicial review of an umpire's appraisal award under s. 128 of the Insurance Act following a house fire.

They alleged procedural fairness violations, bias, and unreasonableness, citing the aggressive conduct of the insurer's appraiser and the umpire's independent site visit.

The Divisional Court dismissed the application, finding that despite the insurer's appraiser's poor behavior, the applicants had a full opportunity to present their case.

The court held the umpire's process was fair, unbiased, and the resulting valuation was reasonable and intelligible.

The applicant was injured in a motorcycle accident and sought various statutory accident benefits, including the cost of a replacement helmet, visitor expenses, assistive devices, and the unapproved balances of numerous treatment plans.

The Tribunal found that a helmet constitutes clothing under s. 24(1) of the Schedule and awarded its replacement cost.

The Tribunal also awarded a portion of the claimed visitor expenses that were supported by evidence.

However, the claims for assistive devices and the unapproved balances of the treatment plans were dismissed, as the applicant failed to prove they were reasonable and necessary or that they had been submitted to his extended health care provider.

The claim for a special award was also dismissed.

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

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

The Tribunal found the applicant suffered from a psychological impairment and chronic pain that warranted removal from the MIG.

The Tribunal ordered the respondent to pay for the disputed psychological and chronic pain assessments and treatment plans, with interest.

However, the Tribunal declined to order an award under s. 10 of O. Reg. 664, finding the respondent's denials were not unreasonable as they relied on available medical evidence.

The respondent brought a preliminary motion to determine whether the applicant's slip and fall incident constituted an 'accident' under section 3(1) of the Statutory Accident Benefits Schedule.

The applicant had loaded a clothes dryer onto a pickup truck and subsequently slipped on an icy road, causing the dryer to allegedly fall on him.

The Tribunal applied the purpose and causation tests, finding that while the purpose test was met, the causation test was not.

The Tribunal concluded that the icy road was an intervening cause and the vehicle was not the dominant feature of the injuries.

The application for benefits was dismissed.

The applicant sought statutory accident benefits following a 2018 motor vehicle accident, including a determination of catastrophic impairment, income replacement benefits (IRBs), attendant care benefits (ACBs), and medical benefits.

The Tribunal found the applicant was barred from claiming IRBs because she failed to apply or qualify within 104 weeks of the accident.

The Tribunal also determined the applicant did not sustain a catastrophic impairment, finding the impairment ratings provided by her assessors were inflated and unsupported by the medical record.

The applicant was awarded ACBs of $905.34 per month from May 31, 2022, subject to proof the expenses were incurred, but her claims for medical benefits, examination expenses, and an award for unreasonable delay were dismissed.

The applicant requested a reconsideration of a decision denying her non-earner benefits and physiotherapy treatment plans.

She argued the adjudicator erred in weighing surveillance evidence against her self-reports and failed to properly consider her treating practitioners' reports.

She also sought to introduce a new psychiatric report.

The adjudicator dismissed the request, finding no error of law or fact in the original weighing of evidence, and concluded the new medical report was not contemporaneous and would not have affected the outcome.

The applicant insurer sought judicial review of a decision by the Director's Delegate of the Financial Services Commission of Ontario.

The Delegate held that the applicant was not entitled to deduct a lump sum amount received by the respondent for long-term disability benefits from an amount owing for past income replacement benefits.

The Divisional Court found the Delegate's interpretation of s. 7(1) of the Statutory Accident Benefits Schedule to be reasonable, as the long-term disability benefits were not 'available' to the respondent at the time the income replacement benefits were due.

The application for judicial review was dismissed.

The moving parties sought leave to appeal an associate justice's costs orders and an order dismissing a motion to increase the pre-judgment interest rate.

The Divisional Court dismissed the motion for leave to appeal the costs orders and noted that leave to appeal the pre-judgment interest order was not required.

No costs were awarded for the motion.

The applicant sought reconsideration of a decision finding she had not sustained a catastrophic impairment.

She argued the adjudicator violated procedural fairness by granting an insufficient adjournment after her counsel's files were lost to ransomware, allowing a witness order change, failing to provide adequate reasons, relying on outdated surveillance evidence, and accepting a novel 'substitution test' for causation.

The Tribunal dismissed the request, finding the adjournment was reasonable, the witness change was minor, the reasons were adequate, the surveillance was properly considered as part of a global assessment, and the correct 'but for' causation test was applied.

The applicant sought statutory accident benefits, including non-earner benefits and medical benefits for physiotherapy, following a motor vehicle accident.

The insurer denied the claims based on insurer's examinations and surveillance evidence showing the applicant working at a nail salon, which contradicted her self-reported limitations.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove a complete inability to carry on a normal life and that further physiotherapy was not reasonable and necessary.

Claims for an award and interest were also dismissed.

This judgment addresses the costs awarded in relation to applications concerning the appointment of an umpire under the Insurance Act.

Wawanesa's application was dismissed due to the respondent's reasonable apprehension of bias caused by Wawanesa's conduct in the umpire selection process.

The respondent's cross-application for umpire selection was successful.

The court awarded the respondent full indemnity costs, finding Wawanesa's conduct "high-handed and oppressive" demonstrating bad faith and disregard for proper procedure.

Despite the respondent's separate application being deemed unnecessary, the court fixed the full indemnity costs at $35,000.00, inclusive of HST and disbursements.

The applicant sought various statutory accident benefits following a 2015 motor vehicle accident, including attendant care benefits, occupational therapy assessments, and a concussion assessment.

The Licence Appeal Tribunal denied the claims for attendant care and occupational therapy, finding the applicant had returned to full-time work and was independent in his activities of daily living.

However, the Tribunal granted the request for a concussion assessment, noting the applicant's ongoing headache and balance issues warranted further investigation, and preferred the evidence of concussion experts over the insurer's physiatrist.

The claim for a special award under O. Reg. 664 was dismissed as the insurer reasonably relied on its assessors' reports.

The applicant sought statutory accident benefits following a motor vehicle accident in August 2015.

She claimed entitlement to medical benefits for occupational therapy assessments, a concussion assessment, assistive devices, and retroactive attendant care benefits.

The Licence Appeal Tribunal dismissed all claims, finding that the applicant failed to demonstrate the treatment plans were reasonable and necessary.

The Tribunal preferred the respondent's expert evidence, noting the significant passage of time since the accident and the applicant's self-reported independence with activities of daily living.

The claims for retroactive attendant care benefits were denied as the applicant did not provide a reasonable explanation for the delay in submitting the required forms, nor did she prove the expenses were incurred.

Claims for interest and a special award were consequently dismissed.

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 Tribunal found the applicant's chronic pain and psychological impairments warranted removal from the MIG.

The Tribunal ordered the respondent to pay for a psychological assessment and occupational therapy treatment, plus interest on overdue payments.

The applicant's request for a special award under s. 10 of Regulation 664 was dismissed, as there was no evidence the respondent unreasonably withheld or delayed payments.