Geoffrey L. Keating

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.

The applicant was injured in a motor vehicle accident while on maternity leave and applied for an income replacement benefit.

The respondent conceded entitlement but argued it could deduct 70% of the applicant's Employment Insurance maternity benefits and employer top-up.

The Tribunal held that EI maternity benefits and employer top-ups fall within the definition of gross employment income and are therefore deductible from the income replacement benefit.

The Tribunal declined to make a special award but ordered the respondent to pay $1,000 in costs because it unreasonably maintained that entitlement was in dispute until the morning of the hearing.

The applicant was injured in a motor vehicle accident while on maternity leave and applied for an income replacement benefit.

The respondent conceded entitlement but argued it could deduct the applicant's Employment Insurance (EI) maternity benefits and employer top-up from the benefit amount.

The Tribunal held that EI maternity benefits and employer top-ups fall within the definition of 'gross employment income' under the Statutory Accident Benefits Schedule and are therefore deductible.

The Tribunal declined to order a special award but ordered the respondent to pay $1,000 in costs due to its unreasonable and vexatious conduct in maintaining a dispute over entitlement until the morning of the hearing.

The applicant was injured in a motor vehicle accident and applied for income replacement benefits (IRB).

The parties agreed the applicant was entitled to IRB but disagreed on the quantum, specifically whether short term and long term disability benefits should be deducted from the IRB on a gross or net-of-tax basis.

The Licence Appeal Tribunal held that the definition of 'other income replacement assistance' under the Statutory Accident Benefits Schedule refers to the gross amount of disability benefits.

The Tribunal found that calculating deductions based on net income could lead to double recovery and was contrary to the legislative intent.

The applicant's claim for higher IRB amounts based on net deductions was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits from the insurer, including attendant care benefits, medical benefits for an eye exam, and replacement costs for damaged clothing and prescription sunglasses.

The insurer denied the benefits.

The arbitrator found the applicant was entitled to attendant care benefits at the rate determined by the initial assessment, as the service provider had sustained an economic loss.

The arbitrator also awarded the costs of the eye exam and prescription sunglasses, but denied the clothing claims due to a lack of receipts.

Furthermore, the arbitrator ordered the insurer to pay a special award of 50% of the owing benefits, finding that the insurer had unreasonably withheld payment contrary to the Schedule and ignored evidence of the service provider's economic loss.

The applicant was injured in a 2011 motor vehicle accident and sought payment for a $2,362.00 physical therapy treatment plan, a special award, and interest.

The insurer denied the treatment plan based on an independent physiotherapy assessment concluding the applicant had reached maximum therapeutic benefit.

The arbitrator found the treatment plan was reasonable and necessary, noting the applicant's complex pre-accident medical history and chronic pain, which required a longer course of treatment.

The arbitrator relied on credible testimony from the applicant, his mother, and treating practitioners showing functional deterioration when treatment ceased.

The claim for a special award was dismissed as the insurer relied on an expert opinion and did not act imprudently or inflexibly.

Interest was awarded on the overdue benefits.

The applicant, a tow truck driver, was injured in a rear-end motor vehicle accident and sought income replacement benefits (IRBs).

The insurer terminated the IRBs after eight months, arguing that the applicant's ongoing pain was due to pre-existing degenerative disc disease rather than the accident.

The Tribunal found the applicant credible and preferred the evidence of his treating specialists over the insurer's expert, concluding that the accident aggravated his underlying condition and caused chronic pain and radiculopathy.

The Tribunal held that the applicant was substantially unable to perform the heavy physical duties of his pre-accident employment and was therefore entitled to ongoing IRBs.

The plaintiffs' claim for personal injuries, stemming from a 2003 motor vehicle accident, was dismissed by the Superior Court of Justice.

The action, commenced in 2007, had a long history of delays, including the plaintiffs' repeated failure to attend court conferences, non-compliance with court orders, and requests for adjournments of peremptory trial dates without sufficient medical evidence.

Despite being granted numerous indulgences and warnings, the plaintiffs failed to proceed with the trial on the final peremptory date.

The court emphasized the need to control its procedure and ensure fairness to all litigants, noting that access to justice is not without limits and cannot be abused by disregarding court rulings.

The respondent insurer requested a reconsideration of a Tribunal decision, arguing the adjudicator acted outside their jurisdiction by making a finding on whether the applicant's injuries fell within the Minor Injury Guideline (MIG).

The insurer submitted that the MIG was not an issue in dispute, as the applicant had already been removed from the guideline.

The Executive Chair agreed, finding that the MIG issue was not listed in the application, response, or case conference order.

The reconsideration was granted, and the adjudicator's findings regarding the MIG were cancelled.

The applicant sought statutory accident benefits for chiropractic and physiotherapy treatments following a motor vehicle accident.

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

The adjudicator found that the applicant's bilateral carpal tunnel syndrome and right-sided sciatica were neurological injuries caused by the accident, taking her outside the MIG.

However, the adjudicator dismissed the claims for medical benefits, finding that the proposed musculoskeletal treatments were not reasonable and necessary for her neurological conditions.

Claims for a special award and costs were also dismissed.

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

A preliminary issue hearing was held to determine whether the applicant was a party under disability pursuant to Rule 10 of the Dispute Resolution Practice Code, given her history of bipolar affective disorder and hospital admissions.

The arbitrator found that the medical evidence, including a recent letter from her treating psychiatrist, did not rebut the presumption of capacity.

The arbitrator concluded that the applicant had the capacity to instruct her representative and proceed with the dispute resolution process.

The applicant sought expenses following an arbitration where she had mixed success in claiming statutory accident benefits.

The insurer argued that it enjoyed a greater degree of success and that the applicant unnecessarily prolonged the proceeding by calling six expert witnesses and being tardy in providing medical and financial records.

The arbitrator found that while the applicant's success was mixed, she was forced to proceed with the arbitration to obtain any benefits, as the insurer refused to acknowledge liability until the eve of the hearing.

The arbitrator awarded the applicant her reasonable expenses, with some reductions for unnecessary testimony and excessive preparation time, totaling $20,637.64 inclusive of fees and disbursements.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits from her insurer, including income replacement, attendant care, housekeeping, and medical/rehabilitation benefits.

The insurer denied several of the claims, leading to an arbitration hearing.

The arbitrator found that the applicant was substantially unable to perform the essential tasks of her pre-accident employment as a self-employed landscaper for the first 104 weeks, but did not meet the test for post-104 week income replacement benefits as she was capable of retraining for a sedentary occupation.

The arbitrator also awarded attendant care and housekeeping benefits for the first year post-accident, as well as certain medical benefits and examination costs.

The applicant's claim for a special award was dismissed, as the insurer's withholding of benefits was not unreasonable given the delayed provision of medical and financial information.

The insurer brought a motion to dismiss the applicant's claims for statutory accident benefits.

The applicant, who resided in the U.K. and was self-represented, failed to comply with production requests over a seven-month period and indicated she had no plans to attend the scheduled arbitration hearing in Toronto.

The arbitrator found that the applicant was not taking the arbitration process seriously and that the proceeding had become vexatious.

The application for arbitration was dismissed pursuant to Rule 68 of the Dispute Resolution Practice Code, with no order as to expenses.

The applicant sought a medical benefit of $1,482.00 for a physiotherapy treatment plan following a motor vehicle accident.

The respondent denied the plan based on an insurer examination which concluded the treatment was not reasonable and necessary.

The adjudicator found that the applicant's back and neck injuries were pre-existing and not accident-related.

Furthermore, the proposed treatment was substantially similar to previous physiotherapy that had worsened the applicant's condition.

The application was dismissed and no interest was payable.

The defendant insurer brought a motion relating to a defence medical examination conducted under s. 105 of the Courts of Justice Act.

After the examination, the examining physician disclosed that her fellowship in physical medicine and rehabilitation had been withdrawn before she issued a report.

The court held that because the examination had been conducted by a licensed physician, the examiner was required under rule 33.06 of the Rules of Civil Procedure to prepare and deliver a written report, which the defendant was then required to serve on the plaintiff.

The defendant’s request was treated as a request for a further medical examination under s. 105(4), which was permitted only after service of the first report.

The court also directed that the subsequent physiatry examination be conducted in Windsor for the plaintiff’s convenience.