Erik K. Grossman

The appellant insurer appealed a tribunal reconsideration decision that found its counsel was in a conflict of interest for acting in both a priority dispute and a benefits dispute against the same insured.

The tribunal also excluded examination under oath transcripts obtained in the priority dispute from being used in the benefits dispute.

The Divisional Court dismissed the appeal, holding that the tribunal's findings on conflict of interest and the circumvention of procedural protections under section 33 of the Statutory Accident Benefits Schedule were reasonable.

The applicant sought to set aside a full and final settlement of his statutory accident benefits claim, arguing he lacked the mental capacity to enter into the agreement due to a traumatic brain injury sustained in a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to rebut the statutory presumption of capacity.

The Tribunal preferred contemporaneous medical and vocational evidence showing the applicant had average cognitive abilities over a capacity assessment conducted three months after the settlement.

The settlement was deemed valid as it was not rescinded within the two-day cooling-off period.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming for occupational therapy services and a Muse wearable headband.

The Licence Appeal Tribunal found that the applicant had largely recovered from her injuries and returned to work and other activities shortly after the accident.

The Tribunal concluded that the proposed treatment plans were neither reasonable nor necessary, as the evidence did not support the need for the occupational therapy and the psychological treatment plan lacked identified goals.

The application was dismissed, and claims for interest and a special award were denied.