David Borthwick

The applicant, who sustained a catastrophic impairment (traumatic brain injury) in a 2012 motor vehicle accident, sought $97,398.08 for home modifications.

The Licence Appeal Tribunal found the applicant was partially entitled to the modifications, specifically bilateral handrails on stairs and releveling of front steps, to address his ongoing intermittent dizziness and fall risk.

Requests for a curb-less shower, deck, and private therapy room were denied as not reasonable or necessary.

The Tribunal awarded interest on overdue benefits but dismissed the applicant's claims for a special award under s. 10 of Reg. 664 and costs under Rule 19.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that partially denied a treatment plan for home modifications, including the location of a new garage, new flooring, electrical rewiring, and a therapy room addition.

The applicant argued the adjudicator made errors of law and fact, specifically regarding the Tribunal's jurisdiction to consider municipal encroachment for the garage location and the assessment of tripping hazards.

The Tribunal dismissed the request, finding no errors of law or fact.

The adjudicator confirmed the Tribunal lacks jurisdiction under section 280 of the Insurance Act to determine municipal encroachment issues and held that the applicant was attempting to re-litigate findings of fact and raise new arguments not presented at the initial hearing.

The applicant, who sustained catastrophic impairments in a motor vehicle accident, sought $334,363.41 in disputed rehabilitation benefits for extensive home modifications, including new flooring, rewiring, and a home addition.

The Licence Appeal Tribunal found that the majority of the proposed modifications were not reasonable and necessary, as the applicant failed to establish a sufficient connection between the requested renovations and her accident-related impairments.

The Tribunal approved only the costs associated with relocating the kitchen fridge to allow access to the fuse panel, along with applicable interest, dismissing the remainder of the claim.

The applicant was catastrophically impaired in a motor vehicle accident and sought statutory accident benefits, including attendant care and home modifications.

The respondent insurer partially denied the claims based on its own assessments.

The Licence Appeal Tribunal found that the applicant's functional limitations, including cognitive and physical impairments, necessitated the maximum attendant care benefit of $6,000 per month and home modifications totaling $344,864, which included an in-home elevator and therapy room.

The Tribunal also awarded the cost of a housing analysis assessment but denied the cost of a second attendant care assessment submitted prematurely.

Finally, the Tribunal ordered a special award under s. 10 of Regulation 664, finding the respondent unreasonably withheld benefits by failing to properly investigate the applicant's functional needs despite having access to medical evidence supporting the claims.

The applicant, an 80-year-old pedestrian struck by a vehicle, sustained physical injuries and a traumatic brain injury, resulting in catastrophic impairment.

She sought a housing modification benefit of $158,476.89.

The respondent insurer partially approved $24,282.00 based on its own assessments, arguing the applicant's proposed modifications were excessive.

The Tribunal found the applicant's proposal largely unrealistic and disproportionate, preferring the respondent's more modest proposal.

However, the Tribunal also approved the applicant's request for an accessible kitchen package and closet organizers as reasonable and necessary to accommodate her accident-related impairments.

The applicant, who suffered a traumatic brain injury and mobility issues after being struck by a vehicle as a pedestrian, sought $415,334.00 in statutory accident benefits for extensive home modifications.

The proposed modifications included an elevator, a therapy room, and wheelchair-accessible features.

The Licence Appeal Tribunal found that the majority of the proposed modifications were not reasonable or necessary because they were predicated on the applicant using a wheelchair, whereas she actually used a walker.

The Tribunal approved modifications for a rear entrance, deck, intercom, and alarm system, but denied the elevator and additions.

The Tribunal also dismissed the applicant's claim for a special award, finding the insurer acted reasonably.

The applicant, who sustained catastrophic injuries rendering him a tetraplegic in a motor vehicle accident, sought a rehabilitation benefit for the construction of a new home.

The parties agreed that building a new home was more reasonable than renovating the applicant's existing home.

The Tribunal considered section 16(4)(c) of the Statutory Accident Benefits Schedule, which limits the cost of a new home to the notional cost of renovating the existing home.

The Tribunal preferred the applicant's expert evidence regarding the estimated renovation costs and awarded $64,615.00 in addition to the previously approved amount.

The Tribunal also found that, as a status Indian residing on a reserve, the applicant was exempt from paying HST on the construction costs.

The applicant, who was rendered a quadriplegic in a motor vehicle accident, sought a rehabilitation benefit of $204,130 for renovations to a newly purchased home.

The insurer had already paid $279,980, representing the estimated cost of renovating the applicant's existing rented home, which could not be renovated due to the landlord's refusal.

The applicant argued that the new home was now his 'existing home' and that the statutory limit did not apply because the rented home could not be renovated.

The arbitrator held that the rented home was the 'existing home' and that section 15(8) of the Statutory Accident Benefits Schedule limits the benefit for purchasing a new home to the cost of renovations that would have been required for the existing home.

The claim for the additional amount was dismissed.