Gary Mazin

The applicant, who was catastrophically impaired following a 2011 motor vehicle accident, sought resolution of a dispute over statutory accident benefits.

The Tribunal found the applicant was entitled to reimbursement for medical records requested by the respondent, as well as the cost of float therapy, preferring the evidence of the treating psychologists over the respondent's paper review.

Regarding attendant care benefits, the Tribunal awarded $975.24 per month, finding that while the applicant required assistance with feeding, hygiene, and basic supervision, his claims for skilled supervisory care to address depression and suicidal ideation were better addressed through psychological treatment.

The Tribunal declined to deem the attendant care expenses incurred or to order a special award, finding the insurer had not acted unreasonably in relying on its assessments.

The applicant sought a non-earner benefit and a medical benefit for occupational therapy following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application.

The adjudicator found the applicant failed to prove a complete inability to carry on a normal life, noting she had resumed many pre-accident activities such as driving long distances and attending exercise classes.

The adjudicator also denied the occupational therapy treatment plan, finding it was submitted specifically for whiplash-associated disorder, whereas the applicant's evidence supporting the need for therapy related entirely to cognitive deficits from a concussion.

Claims for interest and a special award were consequently dismissed.

The appellant was catastrophically injured in a motor vehicle accident and sought attendant care benefits and a special award from his insurer.

At first instance, the Licence Appeal Tribunal awarded attendant care benefits up to $6,000 per month and a special award.

On reconsideration, the LAT varied the decision, finding the initial adjudicator erred by not applying the mandatory maximum hourly rates for attendant care and by misapplying the test for a special award.

The appellant appealed to the Divisional Court.

The court dismissed the appeal, holding that the reconsideration adjudicator made no errors of law in applying the statutory hourly rate caps or in setting aside the special award based on the established legal test.

Aviva sought costs for its motion to be added as a statutory third party.

The plaintiff and one defendant claimed they never opposed the motion, but the case conference endorsement explicitly stated they did, leading Aviva to prepare for an opposed motion.

The court found it was reasonable for Aviva to rely on the endorsement and awarded Aviva $5,000 in costs on a partial indemnity scale, payable equally by the plaintiff and the responding defendant.

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

The applicant argued he was denied procedural fairness when his expert was prevented from expanding on answers during cross-examination and re-examination, and that the adjudicator misunderstood the expert's evidence regarding cauda equina-like syndrome.

The Vice Chair dismissed the request, finding that limiting re-examination correctly prevented the applicant from splitting his case.

Furthermore, while the adjudicator acknowledged a minor factual error regarding the AMA Guides, it was not material, as the expert's diagnosis was suspect due to his unawareness of the applicant's pre-existing severe degenerative disc disease.

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

The insurer partially approved a treatment plan for a home accessibility assessment, capping it at $2,000 pursuant to s. 25(5)(a) of the Schedule.

The applicant argued the cap only applied to medical assessments.

The Tribunal held that the $2,000 limit applies to any assessment, including home accessibility assessments, as the report involved an appraisal of the applicant's health status.

The Tribunal also awarded the applicant $200 under s. 10 of Regulation 664 due to the insurer's unreasonable delay in paying for occupational therapy cognitive training sessions.

The applicant, a pedestrian struck by a vehicle, sought statutory accident benefits including attendant care, a social work assessment, and catastrophic impairment assessments.

The respondent denied the attendant care benefits on the basis that the services were not incurred and the invoices lacked sufficient information.

The Tribunal found that the applicant had incurred the attendant care services and was entitled to the statutory maximum of $3,000 per month, despite some inaccuracies in the service providers' invoicing.

The Tribunal also awarded a portion of the social work assessment costs but denied the catastrophic impairment assessments as premature.

The applicant's claim for a special award under Regulation 664 was dismissed, as the respondent's conduct in investigating the discrepancies did not rise to the level of bad faith.

The applicant sought a determination that he sustained a catastrophic impairment as a result of a motor vehicle accident, along with entitlement to attendant care and various medical and rehabilitation benefits.

The Licence Appeal Tribunal found that the applicant failed to prove a catastrophic impairment under Criterion 7, as his whole person impairment rating fell below the 55% threshold.

Consequently, the claim for attendant care benefits beyond the 104-week mark was denied.

However, the Tribunal ruled that the cost of a multidisciplinary catastrophic impairment assessment does not count towards the non-catastrophic medical and rehabilitation limits.

The Tribunal partially granted the claims for physiotherapy, chiropractic treatment, and specific assessment costs, while denying claims for an iPad, rehabilitation therapy, and an award for unreasonably withheld benefits.

The insurer requested a reconsideration of a Tribunal decision that awarded the insured up to $6,000 per month in attendant care benefits and a 25% special award under section 10 of O. Reg. 664.

The reconsideration adjudicator granted the request, finding that the first-instance Tribunal erred in law by failing to calculate the attendant care benefits using the mandatory hourly rates prescribed by the Guideline.

The adjudicator recalculated the incurred attendant care based on a ratio derived from the occupational therapist's recommendations.

Furthermore, the adjudicator set aside the 25% special award, concluding that the insurer's conduct in relying on its own experts' reports to partially approve benefits was not excessive, imprudent, or inflexible, and did not meet the threshold for an unreasonable withholding or delay of benefits.

The applicant sought a determination that he sustained a catastrophic impairment following a motor vehicle accident, which would entitle him to enhanced statutory accident benefits.

The central dispute involved whether the applicant's lower extremity symptoms were caused by accident-related damage to the cauda equina or by pre-existing degenerative disc disease.

The Tribunal preferred the respondent's medical evidence, finding that the applicant suffered an L1 fracture and that his ongoing symptoms were degenerative rather than accident-related.

As the applicant's Whole Person Impairment score did not reach the 55% threshold without the cauda equina impairment rating, the motion was dismissed.

The applicant sought a determination that he sustained a catastrophic impairment following a motor vehicle accident, which would entitle him to enhanced statutory accident benefits.

The dispute centered on whether his lower extremity symptoms were caused by accident-related damage to the cauda equina or pre-existing degenerative disc disease.

The tribunal accepted the respondent's medical evidence that the symptoms were degenerative and that treating physicians had ruled out cauda equina involvement.

Consequently, the applicant's Whole Person Impairment score did not meet the 55% threshold, and the application was dismissed.

The applicant, who sustained a catastrophic impairment in a 2011 motor vehicle accident, sought attendant care and housekeeping benefits.

The Tribunal held that the 2014 amendments to the Statutory Accident Benefits Schedule applied, limiting attendant care benefits to the non-professional provider's economic loss.

The Tribunal found the provider's economic loss was limited to his lost wages of $2,100 per month, rejecting claims for lost opportunities and fringe benefits due to lack of evidence.

The Tribunal deemed professional attendant care expenses incurred under s. 3(8) because the insurer unreasonably delayed payment.

The applicant was also awarded housekeeping benefits and a 50% special award under O. Reg. 664 due to the insurer's repeated and unreasonable delays in paying benefits.

The applicant sought payment for a capacity assessment and the legal costs of a court application for guardianship following a motor vehicle accident.

The Licence Application Tribunal dismissed the application, finding that the capacity assessment was incurred before the treatment plan was submitted and did not meet the emergency exception under s. 38(2)(b) of the Schedule.

Furthermore, the Tribunal held that the legal costs for a guardianship application are not covered as medical or rehabilitation benefits under the Schedule.

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, who was catastrophically impaired in a motor vehicle accident, sought attendant care benefits of $6,000 per month.

The respondent conceded entitlement but disputed the quantum and whether past services provided by the applicant's sister were 'incurred' under the Schedule.

The Tribunal found the applicant required 24-hour basic supervisory care due to unpredictable cognitive and visual episodes, entitling her to $6,000 per month for most of the claimed period.

The Tribunal also found the sister provided services in a professional capacity, satisfying the incurred test.

The claim for a special award was dismissed as the insurer's delay was reasonable given accounting and documentation issues.

The plaintiff's wife died of metastatic breast cancer after suffering a fall that caused fractures.

The plaintiff claimed accidental death benefits under an employer-provided group insurance policy, which was denied by the insurer because the death was caused by illness, not an accident.

The plaintiff sued the employer, Chrysler, alleging negligent misrepresentation regarding the policy terms, negligent selection of the insurer, and negligent infliction of mental distress.

Chrysler moved for summary judgment.

The court granted the motion and dismissed the action, finding no genuine issue for trial as the employer's benefit summaries contained clear disclaimers directing employees to the actual policy wording, and the employer's conduct was not flagrant, outrageous, or malicious.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that awarded $3,047.27 in monthly attendant care benefits following a motor vehicle accident.

The applicant argued the Tribunal breached the rules of natural justice and procedural fairness by awarding an amount not specifically argued by either party.

The adjudicator dismissed the request, finding the Tribunal acted within its jurisdiction under the Insurance Act and based its quantum determination on a detailed analysis of the evidence and both parties' submissions.

The applicant failed to meet the high onus required to justify a reconsideration.

An appeal concerning reasonable apprehension of bias and adjudicative independence in administrative tribunal decision-making.

The applicant sought a determination that her motor vehicle accident injuries met the statutory threshold for catastrophic impairment under the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal adjudicator initially determined the threshold was not met.

An anonymous letter subsequently revealed that the executive chair of the tribunal cluster had reviewed and altered the adjudicator's draft decision before release.

The Divisional Court found a reasonable apprehension of lack of adjudicative independence due to the imposed consultation process lacking procedural safeguards.

The Court of Appeal upheld this finding, emphasizing that consultation cannot be imposed by a superior level of authority without the adjudicator's consent and that robust procedural protections are required to safeguard independence.

The applicant, who was catastrophically impaired following a motorcycle accident, sought attendant care benefits of $6,000 per month for 24-7 supervision, along with medical benefits for physiotherapy and chiropractic treatment.

The Tribunal found that the applicant did not require 24-7 supervision, noting improvements in his condition and inconsistencies in the evidence regarding his need for constant care due to substance abuse and suicidal ideation.

The Tribunal awarded attendant care benefits of $3,047.29 per month.

The Tribunal also partially approved a physiotherapy treatment plan to help manage chronic pain, but denied a second treatment plan for chiropractic and physiotherapy services as excessive and duplicative.

Claims for interest and a special award were dismissed.

The plaintiff brought an action for damages arising from a motor vehicle accident.

Following a jury verdict awarding net general damages of $11,181.03, the court considered whether the plaintiff's injuries met the statutory threshold under the Insurance Act.

The court found that the plaintiff, whose primary role was a homemaker, sustained permanent and serious impairments to important physical and psychological functions, including PTSD and depression.

The court ruled that the injuries met the threshold and dismissed the defendant's motion.