Dr. Gallimore

The appellant, who was injured in a motor vehicle accident, appealed and sought judicial review of a Licence Appeal Tribunal decision denying her catastrophic impairment benefits.

The Divisional Court found that while there was no breach of procedural fairness, the Adjudicator's findings regarding the appellant's whole person impairment under Criterion 6 of the AMA Guides were unreasonable.

Specifically, the Adjudicator unreasonably dismissed evidence of double vision, peripheral neuropathy, and medication side effects.

The court quashed the decision and remitted the matter to the LAT for a new hearing before a different adjudicator.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision which found she was not catastrophically impaired and denied her claims for attendant care, treatment plans, housekeeping, and costs.

The applicant argued the Tribunal breached procedural fairness and made errors of fact and law in assessing various Whole Person Impairment (WPI) ratings, including those for upper extremity, mental status, diplopia, medications, and social functioning.

The Adjudicator dismissed the request, finding no material breach of procedural fairness as the applicant had ample opportunity to present her case during the 11-day hearing.

Furthermore, the Adjudicator concluded that no errors of fact or law were made that would have resulted in a different outcome.

The applicant sought medical benefits for three physiotherapy treatment plans following a motor vehicle accident.

The respondent denied the plans, arguing the applicant could perform self-directed exercises.

The Tribunal found that the applicant suffered from chronic pain as a result of the accident, relying on the consensus of treating doctors and independent assessors.

The Tribunal concluded that the first and third treatment plans were reasonable and necessary to reduce pain and increase functionality, but denied the second plan as a duplication.

The Tribunal also admitted late-served surveillance evidence but gave it no weight, as it did not contradict the applicant's reported deterioration without treatment.

The applicant was injured in a motor vehicle accident and sought medical and rehabilitation benefits, which the respondent insurer denied.

The applicant applied to the Licence Appeal Tribunal to dispute the denial of treatment plans for a chronic pain assessment, psychological assessment and services, and chiropractic services.

The adjudicator found that the applicant established he suffered from chronic pain syndrome as a result of a coccyx fracture, making the chronic pain assessment reasonable and necessary.

However, the applicant failed to prove on a balance of probabilities that he sustained accident-related psychological injuries or required further chiropractic treatment.

The application was allowed in part, with the respondent ordered to pay for the chronic pain assessment with interest.

The applicant insurer sought judicial review of a decision by the Director's Delegate, which allowed the insured's appeal from an arbitrator's denial of statutory accident benefits.

The Director's Delegate found that the arbitrator erred in law by failing to provide adequate reasons for denying income replacement and medical benefits.

Applying the Vavilov framework, the Divisional Court held that the standard of review was reasonableness.

The Court concluded that the Director's Delegate reasonably found the arbitrator's reasons inadequate, as they failed to address the principal evidence or explain the reasoning process.

The application for judicial review was dismissed.

The insurer appealed an arbitrator's decision finding the respondent catastrophically impaired following a motor vehicle accident.

The insurer argued the arbitrator erred in law by allowing the respondent to file expert reports after the hearing commenced and by misapplying the AMA Guides in assessing whole person impairment and mental/behavioral disorders.

The Director's Delegate dismissed the appeal, finding no error of law in the arbitrator's procedural rulings under Rule 39 of the Dispute Resolution Practice Code, as the insurer had first filed late reports.

The Delegate also upheld the arbitrator's substantive findings, concluding they were based on reasonable assessments of expert credibility and evidence.

The appellant appealed an Arbitrator's decision dismissing her claims for post-104 week income replacement benefits and a medical benefit for a physiotherapy treatment plan.

The Director's Delegate found that the Arbitrator failed to provide adequate reasons for his decision, which constituted a breach of natural justice and procedural fairness.

The Arbitrator ignored, failed to summarize, analyze, or consider important evidence that was not supportive of the insurer's position, and misinterpreted other evidence.

The appeal was allowed, the decision rescinded, and the matter returned to arbitration for a fresh hearing before a different arbitrator.

The appellant appealed an arbitrator's decision dismissing her claims for post-104 week income replacement benefits and a medical benefit for a physiotherapy treatment plan.

The Director's Delegate allowed the appeal, finding that the arbitrator failed to provide adequate reasons for his decision and failed to fairly consider the evidence from both parties.

The arbitrator ignored or misinterpreted significant evidence from several experts, including those retained by the insurer, whose opinions supported the appellant's claims.

The matter was returned to arbitration for a fresh hearing before a different arbitrator.

The Applicant was injured in a motor vehicle accident and sought statutory accident benefits, including an Income Replacement Benefit (IRB) beyond the 104-week mark and a Medical Treatment Plan.

The Insurer denied the benefits.

The Arbitrator found that the Applicant did not meet the "complete inability" test required for post-104 week IRBs, noting her history of working in a sedentary position and the availability of suitable alternative employment that would provide a higher income than her pre-accident earnings.

The Arbitrator also dismissed the claim for the Medical Treatment Plan, finding that the Applicant failed to prove it was reasonable and necessary, and did not contradict the Insurer's medical evidence that she had reached maximum therapeutic benefit.

The application was dismissed.

The applicant sought statutory accident benefits, including non-earner, attendant care, and housekeeping benefits, following a motor vehicle accident.

The insurer denied the claims, arguing the applicant's impairments pre-dated the accident and that she misrepresented her medical history.

The arbitrator dismissed the application, finding the applicant and her husband lacked credibility.

The evidence demonstrated the applicant had a significant pre-existing history of chronic pain and degenerative arthritis for which she was already receiving a disability pension, and she failed to disclose this history to post-accident assessors.

The applicant, who was confined to a wheelchair following a motor vehicle accident, sought interim attendant care, caregiving, and housekeeping benefits after the insurer terminated them at the 104-week mark.

The insurer relied on a surveillance video and medical assessments suggesting the applicant was malingering.

The arbitrator found the surveillance video to be of questionable probative value and tainted the insurer's medical evidence.

Applying the prima facie and urgency/necessity tests, the arbitrator granted the interim benefits, noting the extraordinary hardship on the applicant's family who were providing his care.