Dr. Lawrence Tuff

The applicant sought a determination of catastrophic impairment and entitlement to attendant care benefits and hearing aids following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant was statute-barred from claiming attendant care benefits because she failed to dispute the insurer's denial within the two-year limitation period, and the justice of the case did not warrant an extension.

On the issue of catastrophic impairment, the Tribunal applied the AMA Guides to assess the applicant's physical and psychological impairments, ultimately finding a combined Whole Person Impairment (WPI) of 56%, which exceeds the 55% threshold under Criterion 7.

The Tribunal denied the claim for hearing aids because the applicant incurred the expense without first submitting a treatment plan, contrary to section 38(2) of the Schedule.

The claim for a special award was also dismissed as the insurer did not unreasonably withhold or delay benefits.

The applicant sought statutory accident benefits following a 2012 motor vehicle accident, claiming she sustained a catastrophic impairment and was entitled to non-earner benefits.

The Tribunal found the applicant did not meet the 55% whole person impairment threshold under Criterion 7, nor did she demonstrate the required marked impairments under Criterion 8.

The Tribunal preferred the evidence of the respondent's assessors, noting the applicant successfully attends university full-time and maintains part-time employment.

The claims for catastrophic impairment and non-earner benefits were dismissed.

The applicant sought various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The respondent insurer denied portions of several treatment plans for physiotherapy, occupational therapy, and psychological services, as well as transportation expenses.

The adjudicator found that the respondent's denial notices were compliant with section 38(8) of the Schedule.

The applicant failed to prove that the disputed physiotherapy, occupational therapy, and transportation expenses were reasonable and necessary.

However, the adjudicator found that the proposed psychological services were reasonable and necessary based on the treating psychologist's evidence of ongoing symptoms.

The claim for an award for unreasonable delay was dismissed.

The applicant was injured in a motor vehicle accident and sought non-earner benefits, medical benefits for physiotherapy, an attendant care assessment, an award, and interest.

The respondent denied the benefits.

The Tribunal found that the applicant did not meet the test for a non-earner benefit, as medical evidence showed he had resumed most pre-accident activities shortly after the accident.

The Tribunal also denied the physiotherapy treatment plan, preferring the respondent's orthopaedic assessment which found no objective evidence of significant impairment.

The attendant care assessment was denied because it was incurred before the treatment plan was submitted, contrary to s. 38(2) of the Schedule.

Claims for an award and interest were consequently dismissed.

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

The respondent insurer denied benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and later moved to bar the application under s. 55(1)2 of the Schedule for failure to attend insurer's examinations.

The Tribunal found the application was not barred because the insurer's notice lacked adequate reasons.

On the merits, the Tribunal concluded the applicant's psychological issues, including severe depression, pre-dated the accident and that the accident itself was a suicide attempt.

Consequently, the applicant failed to prove he sustained a psychological impairment caused by the accident or that a pre-existing condition prevented his recovery under the MIG.

The application for psychological benefits, an award, and interest was dismissed.

The applicant requested a reconsideration of a decision finding he did not sustain a catastrophic impairment following a motor vehicle accident.

He argued the adjudicator breached procedural fairness by failing to address his testimony and the four spheres of Criterion 8, and that new evidence in the form of addendum reports should be considered.

The Vice-Chair dismissed the request, finding the adjudicator's reasons adequately explained the preference for the respondent's medical evidence over the applicant's.

The Vice-Chair also found the addendum reports did not constitute new evidence and would not have changed the outcome.

The respondent's request for costs was denied.

The applicant sought statutory accident benefits following a 2014 motor vehicle accident, claiming catastrophic impairment due to psychological issues.

The Licence Appeal Tribunal found the respondent's expert evidence more reliable than the applicant's expert, concluding the applicant did not sustain a catastrophic impairment.

The Tribunal also denied the disputed treatment plans for occupational therapy and a driving rehabilitation assessment, finding them not reasonable and necessary.

Claims for an award and interest were consequently dismissed.

The applicant sought a determination that she sustained a catastrophic impairment following a motor vehicle accident, claiming entitlement to attendant care, medical, and rehabilitation benefits beyond the $65,000 non-catastrophic limit.

The Tribunal assessed her impairments under criteria 7 (whole person impairment) and 8 (mental or behavioural impairment) of the Statutory Accident Benefits Schedule.

The adjudicator found the applicant's combined whole person impairment was 42%, falling short of the 55% threshold, and that she did not suffer a marked impairment in three or more areas of function.

Consequently, the application for benefits and a section 10 award was dismissed.

The Tribunal also dismissed the applicant's motion for punitive damages for lack of jurisdiction and awarded $2,000 in costs to the respondent due to the applicant bringing frivolous and vexatious motions alleging criminal conduct and contempt.

The applicant sought a determination that he sustained a catastrophic impairment due to a mental or behavioural disorder following a 2006 motor vehicle accident.

The respondent argued that the applicant's impairments were moderate and caused entirely by a previous accident in 2002.

The Licence Appeal Tribunal found that the applicant did not suffer a marked impairment in any of the four areas of function, noting his ability to drive, live independently, and pass a licensing exam.

The Tribunal also concluded that the 2006 accident did not cause the impairments.

The application for catastrophic impairment and an award for delayed payments was dismissed.

The respondent's request for costs was also denied.

The applicant sought payment for a $2,000 chronic pain assessment following a motor vehicle accident.

The respondent denied the claim, arguing the applicant's injuries fell within the Minor Injury Guideline.

The applicant challenged the sufficiency of the respondent's denial notices under s. 38 of the Statutory Accident Benefits Schedule.

The Tribunal found that the respondent's explanations of benefits complied with s. 38.

On the merits, the Tribunal held that the applicant failed to prove the chronic pain assessment was reasonable and necessary, noting evidence of steady improvement, return to pre-accident activities, and failure to pursue approved treatments.

The application was dismissed, with no interest or costs awarded.

The applicant was injured in a motor vehicle accident and sought accident benefits, claiming he sustained a catastrophic impairment.

The insurer denied the claim, arguing that any catastrophic impairment was the result of a stroke the applicant suffered two years after the accident.

The arbitrator found that the applicant's psychological impairments resulting from the accident met the threshold for catastrophic impairment, and that the accident materially contributed to the stroke.

The arbitrator awarded attendant care benefits for incurred professional services but denied them for family-provided care due to a lack of evidence of economic loss.

A special award was granted against the insurer for unreasonably withholding payments.

The applicant sought to proceed to arbitration for income replacement benefits and housekeeping and home maintenance benefits after the two-year limitation period had expired.

She argued the limitation period should be tolled because she lacked capacity to instruct counsel due to severe substance abuse and cognitive impairments.

The arbitrator found the applicant was an unreliable historian and failed to rebut the presumption of capacity, precluding her claim for housekeeping benefits.

However, the arbitrator found the insurer's notices terminating income replacement benefits were confusing and not clear and unequivocal, particularly given the applicant's extremely low cognitive abilities.

Therefore, the limitation period for the income replacement benefits claim did not commence, and the applicant was permitted to proceed to arbitration on that issue.

The plaintiff was involved in a rear-end motor vehicle accident and claimed damages for chronic pain and psychological impairments.

Following a nine-day jury trial, the defendant brought a threshold motion arguing the plaintiff's injuries did not meet the statutory requirement of a permanent serious impairment under the Insurance Act.

The court reviewed extensive medical evidence and found the plaintiff lacked credibility, having concealed her pre-accident medical history and exaggerated her symptoms.

The court concluded the plaintiff failed to establish on a balance of probabilities that her injuries were permanent, noting she had voluntarily stopped treatment and had significant pre-existing conditions.

The defendant's motion was granted and the plaintiff's action was dismissed.

The parents of a profoundly deaf 11-year-old student appealed the school board's placement decision, requesting that the student continue to receive a resource withdrawal teacher fluent in cued speech.

The school board raised a preliminary objection that teacher qualifications were beyond the scope of a placement appeal, which the Tribunal dismissed, finding that placement includes considering the nature of programs and services.

On the merits, after hearing extensive expert and educator testimony regarding the student's dependency on cued speech and need to develop oral, lip-reading, and social skills, the Tribunal declined to order a cueing resource teacher.

Instead, the Tribunal ordered that the student spend 50% of the day in a regular class with a cueing interpreter, and 50% of the day with a qualified teacher of the deaf to develop comprehensive communication and independent work skills.