David S. Wilson

The applicant sought statutory accident benefits following a 2019 motor vehicle accident, specifically a $19,097.00 treatment plan for a catastrophic impairment (CAT) assessment and an award for unreasonable delay.

The Tribunal found the applicant was entitled to $9,266.00 for the CAT assessment, approving the physiatry, psychiatry, and occupational therapy components, but denying duplicative or premature elements like the intake assessment and OCF-19 completion.

The Tribunal admitted several late or disputed medical reports, finding them relevant and not prejudicial.

The claim for a special award was dismissed as the insurer's denial was not unreasonable, though interest was awarded on the overdue assessment costs.

The applicant requested a reconsideration of a previous LAT decision that denied her motion to exclude four insurer's examination (IE) reports and found she was not entitled to post-104-week income replacement benefits (IRBs).

The applicant argued the adjudicator erred in law by misstating the test under s. 44(5)(a) of the Schedule and erred in fact by improperly weighing medical and surveillance evidence.

The adjudicator acknowledged a minor misstatement during oral reasons but concluded it would not have changed the outcome, as the collective correspondence provided sufficient medical reasons for the IEs.

The adjudicator also found no errors of fact in the weighing of evidence regarding the applicant's entitlement to IRBs.

The request for reconsideration was dismissed.

The Licence Appeal Tribunal initiated a reconsideration of a previous decision after discovering the former adjudicator had accepted an offer of employment with the respondent's parent company, Aviva, prior to hearing the matter.

The Associate Chair found that the former adjudicator's failure to disclose this conflict and recuse herself created a reasonable apprehension of bias, violating the rules of procedural fairness.

The original decision was cancelled, and a new oral hearing with a different adjudicator was ordered.

The applicant sought attendant care benefits following a motor vehicle accident.

The respondent denied the claim, and the applicant applied to the Tribunal.

The respondent argued the application was barred by the two-year limitation period under s. 56 of the Schedule.

The Tribunal found that the claim for pre-104 week benefits was statute-barred as it was not filed within two years of the clear denial.

However, applying the discoverability principle from Tomec, the Tribunal held that the limitation period for post-104 week benefits did not run while the applicant's catastrophic impairment designation was stayed and dismissed pending appeal.

Therefore, the claim for post-104 week benefits was not statute-barred.

The applicant requested a reconsideration of a previous Tribunal decision which found she was not catastrophically impaired and denied certain benefits.

The applicant argued the Tribunal made errors of law and fact regarding the interpretation of marked versus moderate impairment, concentration, persistence and pace, social functioning, attendant care, and occupational therapy.

The Tribunal dismissed the request, finding no errors of law or fact and noting that the reconsideration process is not an opportunity to re-weigh evidence or re-litigate the case.

The applicant sought reconsideration of a Licence Appeal Tribunal decision that denied her entitlement to post-104 week Income Replacement Benefits (IRBs).

The applicant argued that the Tribunal violated procedural fairness by allowing the respondent to shield an expert witness from cross-examination, and that the Tribunal made errors of law or fact by providing inadequate reasons and failing to consider critical evidence.

The Vice-Chair dismissed the request for reconsideration, finding that the issue of the witness was properly addressed in a prior motion order and that the original decision met the legal standard for adequate reasons.

The Tribunal concluded that the applicant was attempting to relitigate the issues and reweigh the evidence, which are not valid grounds for reconsideration.

The applicant requested a reconsideration of a prior Licence Appeal Tribunal decision which found she did not sustain a catastrophic impairment and was not entitled to disputed medical and attendant care benefits.

The applicant argued the adjudicator breached procedural fairness and made errors of fact and law, including misapprehending medical evidence and improperly admitting a prior court decision to impeach her credibility.

The adjudicator dismissed the reconsideration request, finding no breach of procedural fairness and concluding that the applicant was attempting to relitigate issues and re-weigh evidence already considered.

The applicant sought statutory accident benefits following a 2018 motor vehicle accident, claiming catastrophic impairment due to psychological disorders.

The Tribunal found the applicant was not catastrophically impaired, as she sustained only moderate impairments in concentration, persistence, and pace, and social functioning.

However, applying the Sabadash causation test, the Tribunal found the applicant's impairments were caused by the 2018 accident, despite being aggravated by a subsequent 2020 accident involving the death of her son.

The Tribunal awarded attendant care benefits of $2,327.87 per month, along with specific treatment plans for occupational therapy and a rehabilitation support worker.

Claims for housekeeping benefits, a second occupational therapy plan, and a special award were dismissed.

The applicant brought a motion to determine the interest payable on a previously approved treatment plan for home modifications and a 25% special award.

The respondent argued that interest on the special award was discretionary under s. 10 of Regulation 664.

The Tribunal applied the modern approach to statutory interpretation and found that the 2% compounded interest on an award is mandatory, not discretionary.

The Tribunal ordered the respondent to pay $154,028.00 for the outstanding interest on the OCF-18 and the award.

The applicant was injured in a motor vehicle accident and sought post-104 weeks income replacement benefits (IRBs), arguing she suffered a complete inability to engage in suitable employment.

The Tribunal preferred the respondent's expert evidence, finding the applicant retained the functional capacity for sedentary work and did not meet the complete inability test.

The Tribunal also held that the respondent correctly deducted the applicant's maternity leave Employment Insurance benefits from her pre-104 weeks IRBs, as they constitute gross employment income under the Schedule.

Finally, the Tribunal dismissed the claim for a special award, finding the respondent's handling of the claim and temporary stoppages of benefits pending further medical information were not unreasonable.

The plaintiff sought an assessment of costs after accepting a Rule 49 offer to settle from State Farm Mutual Automobile Insurance Company and Certas Home and Auto Insurance Company, statutory third parties.

The court had previously awarded the plaintiff partial indemnity costs for the tort action but denied costs related to the recovery of statutory accident benefits (SABS) and Canada Pension Plan (CPP) disability benefits.

Both parties sought costs for the assessment motion.

The court found that success was divided, as the plaintiff succeeded on the quantum of legal fees for the tort action and disbursements, but failed on SABS and CPP costs.

State Farm failed to resist the quantum of legal fees.

Given the divided success and the complexity of some issues, the court ordered that each party bear their own costs.

The applicant insurer brought an application to the Licence Appeal Tribunal to vary or revoke a 2010 order issued by the Financial Services Commission of Ontario (FSCO) that required the payment of weekly income replacement benefits.

The Tribunal considered whether it had jurisdiction to amend a FSCO order.

Applying the transitional provisions of the Insurance Act regulations, the Tribunal found that it only had jurisdiction to vary or revoke FSCO orders if the proceeding was commenced before June 8, 2019.

Because the applicant commenced the proceeding on July 22, 2019, the Tribunal lacked jurisdiction to vary the order.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including attendant care and rehabilitation benefits.

The Licence Appeal Tribunal denied attendant care benefits for the initial period because the expenses were not incurred by the applicant's daughters.

However, the Tribunal granted attendant care benefits for a subsequent period, finding them reasonable and necessary, and deemed the expenses incurred because the insurer unreasonably withheld payment by relying on an insurer's examination without explaining why it preferred that report over contemporaneous medical evidence.

The Tribunal also approved a treatment plan for life skills training.

Due to the insurer's lack of transparency and unreasonable conduct in denying the attendant care benefits, the Tribunal ordered a special award of 35% under s. 10 of O. Reg. 664, plus interest.

This is a supplementary endorsement to a previous decision, clarifying and varying aspects of a costs award.

The court confirmed that HST is to be added to the partial indemnity costs and disbursements awarded to the plaintiff.

The amount of allowed disbursements was varied by agreement of the parties.

The court also addressed a request for reconsideration regarding the defendant's liability for the plaintiff's legal fees incurred in pursuing accident benefits, reiterating that all submissions and authorities, including the principles from Cadieux v. Cloutier, were considered in the original determination, and no further reconsideration was required on that point.

Following the settlement of a motor vehicle accident tort claim for $85,000, the plaintiff brought a motion to determine costs.

The plaintiff sought partial indemnity costs for the tort action, as well as recovery of substantial legal fees incurred in pursuing statutory accident benefits (SABs) and Canada Pension Plan (CPP) disability benefits.

The court awarded the plaintiff $84,075 in fees and $58,983.63 in disbursements for the tort action, rejecting the statutory third party insurer's argument that its exposure was limited to the $200,000 statutory minimum.

However, the court declined to award costs for the pursuit of SABs, finding the plaintiff failed to address the factors set out in Cadieux v. Cloutier, and denied costs for pursuing CPP benefits as they were not incidental to the proceeding.

The appellant appealed two decisions regarding her claims for statutory accident benefits following a 2007 motor vehicle accident.

The first appeal challenged a Licence Appeal Tribunal decision denying certain attendant care benefits and setting the interest accrual date, which the Divisional Court dismissed as raising questions of fact rather than law.

The second appeal challenged a Financial Services Commission of Ontario decision finding it lacked jurisdiction to adjudicate a claim for housekeeping benefits due to a 2011 consent order settling the issue.

The Divisional Court dismissed both appeals, finding no errors of law and upholding the lower tribunals' decisions.

The applicant sought a special award under section 10 of Regulation 664, alleging the respondent unreasonably withheld or delayed payment of income replacement benefits and a medical benefit for psychological treatment.

The adjudicator found that the applicant was responsible for delays by failing to provide medical documents in a timely manner and refusing to attend a functional abilities evaluation.

The respondent acted reasonably in scheduling independent examinations to assess the new medical information provided.

The claims for a special award and interest were dismissed.

The applicant sought income replacement benefits (IRBs) following a motor vehicle accident, claiming losses from her self-employment business.

The Tribunal found that the applicant failed to prove her business losses were caused by the accident, preferring the respondent's accounting report.

The Tribunal awarded $152,478.03 in past IRBs.

Additionally, while the respondent failed to provide the required notice to claim an overpayment under section 52 of the Schedule, the Tribunal held that the applicant was not entitled to interest on the overpaid amounts, as doing so would create an absurd result.

The applicant, catastrophically impaired following a bus-train collision, sought statutory accident benefits for home modifications, the purchase of a new home, and housekeeping services.

The Tribunal deemed the $166,437.70 home modification expense incurred under s. 3(8) of the Schedule due to the insurer's unreasonable delay and flawed reliance on its assessors, awarding a 25% special award.

The request for $839,104.50 to purchase a new home was dismissed as it exceeded the value of necessary home modifications under s. 16(4)(c).

Housekeeping benefits of $100 per week were granted from February 2019 onwards.

The insurer was found entitled to repayment of an $8,747.42 overpayment of income replacement benefits resulting from a failure to recalculate the benefit when the applicant turned 65.

The applicant sought judicial review of a decision by the Director's Delegate, which overturned an Arbitrator's finding that he suffered a catastrophic impairment as a result of a 2013 motor vehicle accident.

The applicant had previously been involved in two accidents in 2002.

The Director's Delegate found that the applicant was already catastrophically impaired before the 2013 accident and that the Arbitrator erred by applying the material contribution test instead of the 'but for' test.

The Divisional Court granted the judicial review, finding the Director's Delegate's decision unreasonable because it relied on an unestablished fact that the applicant was already catastrophically impaired.

The Court also held that the Arbitrator's use of the material contribution test was appropriate in circumstances involving multiple accidents where it is impossible to determine which accident caused the impairment.