Geoffrey L. Keating

The applicant, who was catastrophically impaired after being struck by a vehicle as a pedestrian, sought attendant care benefits of $6,000 per month.

The adjudicator determined the applicant was entitled to attendant care benefits at a rate of $1,529.96 per month, finding that she required assistance with routine personal care and complex hygiene but did not require around-the-clock supervisory care.

However, the adjudicator held that the benefits were not payable because the applicant had not actually incurred the expenses, and the insurer had not unreasonably withheld or delayed payment to justify deeming the expenses incurred.

Claims for an award and interest were dismissed.

The applicant sought retroactive housekeeping benefits following a motor vehicle accident.

The respondent argued the application was barred by res judicata and the two-year limitation period, as a previous Tribunal decision denying these benefits had been quashed by the Divisional Court on consent, but the consent order only explicitly remitted the issue of attendant care benefits.

The Tribunal found that because the prior decision was quashed in its entirety, there was no final decision on housekeeping benefits, meaning res judicata did not apply.

The Tribunal also found the limitation period was met because the original claim was filed within two years of the denial and preserved despite the quashing.

The preliminary issues were dismissed, and the matter was allowed to proceed to a hearing, with the issue of costs added.

The applicant insurer sought repayment of $16,400 in Income Replacement Benefits (IRB) paid to the respondent after she had returned to work.

The respondent argued the repayment notices were deficient under s. 52(2) of the Schedule.

The Tribunal found the notices were compliant given the information available to the insurer at the time, as the respondent had delayed providing her return-to-work dates and pay stubs.

The Tribunal ordered the respondent to repay the $16,400 overpayment plus interest.

The moving party, Aviva General Insurance Company, sought leave to appeal a Divisional Court decision that found Carrie-Anne Davis suffered an "accident" under the Statutory Accident Benefits Schedule (SABS) after slipping on ice near her car.

The Court of Appeal clarified that the `Sault Dock` framework for leave to appeal remains unchanged, despite recent comments in `West Whitby`.

The Court denied leave, finding the dispute largely fact-specific and that Aviva had not presented an arguable case to change the settled SABS "accident" test.

The applicant sought statutory accident benefits following a 2010 motor vehicle accident.

The insurer raised a preliminary issue that the applicant was statute-barred from proceeding with her application for income replacement and housekeeping benefits due to the expiry of the two-year limitation period under s. 56 of the Schedule.

The Tribunal found that the initial January 2011 letter was a valid denial for both benefits.

However, because the insurer subsequently reinstated the income replacement benefit in February 2011, the limitation period for that benefit was restarted and a subsequent termination without a dispute resolution form did not trigger a new limitation period.

The applicant was therefore barred from proceeding with the housekeeping benefit claim, but permitted to proceed with the income replacement benefit claim.

The appellant slipped and fell on black ice while holding her key fob and reaching to unlock her car door.

She applied for accident benefits, which the insurer initially paid but later disputed by raising a preliminary issue that the incident was not an 'accident' under s. 3(1) of the SABS.

The Licence Appeal Tribunal found the incident was not an accident.

On appeal, the Divisional Court held that the LAT did not err in allowing the preliminary issue to be raised late, but erred in law in its causation analysis.

The court found the appellant was engaged in the ordinary use of her vehicle and the ice was not an intervening cause, concluding the incident met the definition of an accident.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's denial of two physiotherapy treatment plans and a portion of a psychological treatment plan.

The respondent argued the applicant was barred from proceeding with one physiotherapy claim due to non-attendance at an insurer's examination, but the Tribunal found no prejudice as the applicant attended a subsequent examination.

On the merits, the Tribunal dismissed the application, finding the physiotherapy plans were not proven reasonable and necessary given the lack of objective medical evidence and an unopposed independent medical examination.

The Tribunal also upheld the respondent's reduced hourly rate for the psychological services provided by an unregulated social worker.

The appellant insurer appealed a preliminary issue decision of the Licence Appeal Tribunal (LAT) regarding whether the respondent's slip and fall incident constituted an 'accident' under the Statutory Accident Benefits Schedule.

The LAT intervened to raise a preliminary issue regarding the Divisional Court's jurisdiction to hear an appeal from an interlocutory decision.

The Divisional Court dismissed the appeal for want of jurisdiction, confirming that appeals lie only from final decisions of the LAT to prevent fragmentation and delay.

The court also declined the parties' joint request to convert the appeal into an application for judicial review.

The applicant sought reconsideration of a preliminary issue decision that found his claims for attendant care benefits were statute-barred under s. 56 of the Schedule.

The applicant argued he was denied procedural fairness because his former counsel abandoned him right before the hearing and failed to file submissions.

The Tribunal granted the reconsideration, finding that the applicant was unable to participate through no fault of his own.

Furthermore, the Tribunal found it was an error of law to statute-bar the claims, as the pre-emptive denial of benefits before the applicant's condition deteriorated engaged the doctrine of discoverability as set out in Tomec.

The preliminary decision was set aside, and the applicant was permitted to proceed with his claim at a substantive hearing.

The applicant sought attendant care benefits following two motor vehicle accidents.

The insurer denied the claims, and the applicant filed appeals with the Tribunal three and five years later, respectively.

The insurer raised a preliminary issue that the claims were barred by the two-year limitation period under s. 56 of the Schedule.

The applicant's counsel withdrew before submissions were due, and the applicant failed to file any materials.

The Tribunal found the claims were limitation-barred and declined to extend the limitation period under s. 7 of the Licence Appeal Tribunal Act, as the applicant provided no evidence or submissions to support an extension.

The applicant was injured in a rear-end motor vehicle accident and sought statutory accident benefits.

The respondent insurer limited the applicant to the $3,500 Minor Injury Guideline (MIG) funding limit.

The Tribunal found that the applicant suffered accident-related psychological injuries, including depression and anxiety, which removed him from the MIG.

The Tribunal ordered the respondent to pay for a psychological assessment and a psychological treatment plan, plus interest on the incurred assessment, but denied the remaining disputed treatment plans as the applicant failed to prove they were reasonable and necessary.

The applicant sought an income replacement benefit (IRB) and medical benefits for chiropractic services following a motor vehicle accident.

The insurer denied the IRB on the basis that the applicant was not substantially unable to perform his essential work tasks and had not declared income.

The insurer also determined the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found the applicant failed to prove entitlement to an IRB, as he provided no medical evidence of inability to work and no financial documentation of pre-accident income.

The Tribunal also held the applicant's injuries were predominantly minor and that he failed to prove the disputed treatment plans were reasonable and necessary.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including an income replacement benefit (IRB), medical benefits for chiropractic services, and various expenses.

The insurer denied the claims.

The Tribunal found the applicant failed to provide sufficient medical and financial evidence to prove a substantial inability to perform the essential tasks of her employment for the IRB.

The Tribunal also found the applicant failed to prove the medical benefits and expenses were reasonable and necessary, noting a lack of supporting medical documentation and failure to rebut the insurer's examination report.

The application was dismissed.

The applicant sought reconsideration of a Tribunal decision denying entitlement to certain chiropractic services and a psychiatric assessment following a motor vehicle accident.

The Tribunal had denied the chiropractic services because the applicant failed to attend a reasonably requested insurer's examination, triggering a statutory bar to proceeding.

The psychiatric assessment was denied because the expense was incurred before the treatment plan was submitted, contrary to the Statutory Accident Benefits Schedule.

On reconsideration, the adjudicator found no significant errors of law or fact in the original decision that would have led to a different result.

The request for reconsideration was dismissed.

The respondent insurer requested a reconsideration of a Tribunal decision which found that the applicant's injuries fell outside the Minor Injury Guideline (MIG) and that six disputed treatment plans were reasonable and necessary.

The respondent argued the Tribunal made significant errors of law by failing to consider whether the injuries were 'predominately' minor, by ruling in the applicant's favour without submissions on the reasonable and necessary test, and by failing to cite the respondent's case law.

The Vice Chair dismissed the request, finding that the Tribunal had properly weighed the medical evidence, correctly concluded the applicant sustained a mild traumatic brain injury that was not predominately minor, and was not required to explicitly cite every piece of case law considered.

The applicant sought income replacement benefits (IRBs) following a motor vehicle accident, claiming she suffered a substantial inability to perform the essential tasks of her pre-accident employment as an early childhood educator due to psychological and physical impairments.

The insurer denied the claim based on multiple insurer's examinations.

The Tribunal found that the applicant failed to meet her burden of proof, noting that her own treating psychiatrist's records indicated her depression and post-concussion syndrome had largely resolved.

The appeal for IRBs and interest was dismissed.

The applicant sought a medical and rehabilitation benefit of $2,661.57 for physiotherapy following a motor vehicle accident, along with interest and an award for unreasonable delay.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to provide any medical evidence or argument to prove the treatment was reasonable and necessary.

The insurer's examination concluded the treatment was not required, and the applicant's criticisms of the insurer's claims adjustment process did not substitute for positive medical evidence.

Consequently, the claims for interest and an award were also dismissed.

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

The respondent denied several treatment plans and income replacement benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant sustained a mild traumatic brain injury and psychological impairments, removing him from the MIG.

The Tribunal approved all six disputed treatment plans as reasonable and necessary.

Furthermore, the Tribunal awarded income replacement benefits, finding the applicant was substantially unable to perform the essential tasks of his employment as a produce clerk.

The applicant's claim for a special award for unreasonable delay was dismissed due to his own delays in providing documentation.

The applicant sought a medical benefit of $2,000 for an attendant care assessment following a motor vehicle accident.

The insurer denied the treatment plan on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the insurer's denial notice was deficient under section 38(8) of the Schedule because it misstated the insurer's examination report and failed to reassess the treatment plan after the applicant was removed from the MIG.

Consequently, under section 38(11), the insurer was liable to pay for the disputed benefit.

The Tribunal ordered the insurer to pay the $2,000 benefit plus interest.

Aviva applied to the Licence Appeal Tribunal for repayment of $6,059.23 in income replacement benefits (IRBs) paid to the respondent, arguing the amount was paid in error due to a miscalculation of his pre-accident self-employment income.

The respondent disputed the recalculation and sought ongoing IRBs.

The Tribunal found that the respondent correctly designated his gross employment income from his last fiscal year prior to the accident under section 4(2)3 of the Schedule, and that corporate losses should not be deducted from his personal income.

The Tribunal dismissed Aviva's claim for repayment and ordered Aviva to pay the respondent IRBs of $400.00 per week from October 18, 2013 to date, plus interest.

The respondent's request for costs was dismissed.