Gordon W. Harris

The applicant sought statutory accident benefits after slipping and falling on an icy parking lot while exiting her vehicle at a dealership.

The respondent insurer denied the claim, arguing the incident did not meet the definition of an 'accident' under s. 3(1) of the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal applied the purpose and causation test, finding that while the purpose test was met, the causation test was not.

The Tribunal concluded that the icy parking lot was an intervening cause and the dominant feature of the injuries, breaking the chain of causation from the use or operation of the vehicle.

The application was dismissed.

The plaintiffs brought a motion for the pre-trial determination of a question of law regarding whether the defendant tort insurer was entitled to deduct long-term disability settlement funds received by the plaintiff from a separate action against her disability carrier.

The court applied the 'silo' approach and found that the settlement was for an income replacement claim.

The court held that the defendant is entitled to deduct the settlement amount from the tort damages for income loss pursuant to s. 267.8(1) of the Insurance Act.

The applicant requested a reconsideration of a Tribunal decision which found she was not involved in an accident.

The applicant argued the Tribunal violated procedural fairness by allowing a preliminary issue hearing and erred in law by improperly applying the causation test.

The adjudicator dismissed the request, finding no exceptional circumstances to permit new arguments regarding procedural fairness and concluding that the original decision correctly applied binding jurisprudence on causation.

The applicant was catastrophically impaired in a motor vehicle accident and sought income replacement benefits (IRB).

The parties disputed the quantum of the IRB, specifically whether collateral benefits (STD, LTD, CPP-D) should be deducted on a gross or net basis, and the calculation of post-65 IRB.

The Tribunal held that deductions for collateral benefits under s. 4 of the Schedule are based on gross income, not net.

The Tribunal ordered the applicant to repay $4,872.90 in overpaid IRB.

Furthermore, the Tribunal found that the applicant's post-65 IRB should be calculated based on the base amount of $400 per week before the ramp-down formula in s. 8(1) is applied, resulting in $122.00 per week, rejecting the insurer's argument that it should be reduced to zero.

The applicant sought reconsideration of a Licence Appeal Tribunal decision denying him a non-earner benefit following a motor vehicle accident.

The applicant argued the Tribunal failed to apply the Heath factors to assess his inability to carry on a normal life.

The Vice-Chair dismissed the request, finding the Tribunal made no material error of law or fact, as the evidence supported the conclusion that the applicant had largely returned to his pre-accident activities and function, rendering the Heath analysis unnecessary.

The applicant sought attendant care benefits following a motor vehicle accident.

The respondent paid a portion of the claimed expenses but denied the remainder, arguing they were not incurred.

The Tribunal preferred the respondent's occupational therapy assessments, finding the applicant's condition had improved and she did not require the level of care claimed, particularly for night-time emergencies.

The Tribunal concluded the applicant was not entitled to any attendant care benefits beyond what the respondent had already paid, as the additional expenses did not meet the definition of an 'incurred expense' under section 3(7)(e) of the Schedule and could not be deemed incurred.

The applicant sought statutory accident benefits after slipping and falling on black ice in a parking lot while reaching to unlock her vehicle.

The respondent brought a motion for a preliminary issue hearing to determine whether the incident constituted an 'accident' under s. 3(1) of the Statutory Accident Benefits Schedule.

The Tribunal applied the two-part purpose and causation test.

While the purpose test was conceded, the Tribunal found the incident failed the causation test.

The ice on the ground was an independent intervening event and the dominant feature of the incident, breaking the chain of causation from the use or operation of the vehicle.

The application was dismissed.

The defendant brought a motion to transfer the action from Kitchener to London, Ontario, arguing it was in the interests of justice.

The plaintiff opposed the transfer.

The court considered the factors under Rule 13.1.02(2)(b) of the Rules of Civil Procedure.

While the location of the collision, damages, and subject matter favored London, and the convenience of parties and witnesses also leaned towards London, the court found that significant backlogs in criminal cases and judicial complement issues in London would severely delay a civil jury trial.

Upholding the plaintiff's prima facie right to choose venue, the court concluded that the defendant failed to demonstrate that a transfer was desirable in the interests of justice, particularly concerning the timely and expeditious determination of the proceeding.

The motion was dismissed.

The plaintiffs brought a motion for leave to appeal an interlocutory order of Taylor J. The Divisional Court dismissed the motion, clarifying that the interlocutory decision does not preclude any party from seeking relief on any issues in the case pursuant to Rules 20 and 21.

No costs were awarded.

The respondent insurer brought a motion to determine as a preliminary issue whether the applicant's slip and fall constituted an 'accident' under s. 3(1) of the Statutory Accident Benefits Schedule.

The applicant slipped on ice in a parking lot while walking toward her vehicle and unlocking it with a key fob.

Applying the Greenhalgh framework, the Tribunal found that while the incident arose from the ordinary use of a vehicle, the use or operation of the vehicle did not directly cause the impairment.

The Tribunal concluded that the ice was the dominant feature and direct cause of the injuries, making the vehicle's involvement merely ancillary.

The incident was deemed not an accident, and the application for accident benefits was dismissed.

The applicants sought reconsideration of a decision finding they were not entitled to accident benefits.

They witnessed a close relative being struck by a vehicle and claimed nervous shock, arguing they were 'involved in an accident' under section 3(1) of the Statutory Accident Benefits Schedule.

The adjudicator dismissed the request, affirming that nervous shock claims are limited to the named insured and their family members under definition (a)(ii) of 'insured person', and the applicants did not fall into these categories.

The applicant requested a reconsideration of a preliminary issue decision which found her application for an income replacement benefit premature due to her failure to submit a Disability Certificate (OCF-3).

The applicant argued that the adjudicator made material errors of fact and law regarding the delivery of the OCF-3 to the insurer.

The Tribunal dismissed the request, finding that the applicant was merely attempting to relitigate the matter and reweigh the evidence, and failed to identify any material error that would have changed the outcome.

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

The parties resolved the substantive claims for medical and rehabilitation benefits up to the policy limits at a case conference.

The remaining issue was whether the applicant was entitled to an award under s. 10 of O. Reg. 664 for unreasonably withheld or delayed payments.

The Tribunal found that the respondent unreasonably denied an orthopaedic assessment under s. 25 of the Schedule by incorrectly characterizing it as a duplication of an insurer's examination under s. 44.

The Tribunal awarded the applicant a 5% award ($42.43) based on the remaining policy limits.

The applicants claimed statutory accident benefits for psychological injuries sustained after witnessing a vehicle strike their relative.

They did not have their own auto insurance policy and claimed under the policy of the driver who struck their relative.

The Licence Appeal Tribunal found that the applicants were not 'involved' in the accident as defined by section 3 of the Statutory Accident Benefits Schedule, as they were merely bystanders who witnessed the accident and its aftermath.

Furthermore, they were not entitled to make a 'nervous shock' claim under the driver's policy because they were not named insureds or relatives of the named insured.

The applications were dismissed.

The applicant sought accident benefits following a motor vehicle accident, disputing the insurer's determination that her injuries fell within the Minor Injury Guideline (MIG).

The applicant claimed entitlement to income replacement benefits (IRBs), various medical and rehabilitation benefits, and examination costs.

The Licence Appeal Tribunal found that the applicant failed to prove her injuries, including alleged chronic pain and psychological impairments, warranted removal from the MIG.

As the MIG limits were exhausted, the disputed medical benefits were not payable.

The claim for IRBs was dismissed because the applicant failed to submit the required application form in a timely manner.

The application was dismissed in its entirety.

The applicant, an incarcerated veteran with severe pre-existing spinal stenosis, sought statutory accident benefits following two prisoner transfers in unpadded, unrestrained vehicles.

The respondent insurer denied the claims, arguing the events were not 'incidents' and the dominant feature of the impairment was the applicant's pre-existing condition, not the use or operation of an automobile.

The Tribunal found that the events were 'incidents' under a purposive interpretation of the Schedule, noting the applicant was shackled and unable to brace himself.

Applying the Greenhalgh test, the Tribunal concluded the use and operation of the vehicles were the dominant feature and a direct cause of the exacerbation of the applicant's pain.

The preliminary issue was resolved in the applicant's favour, allowing the substantive claims to proceed.

The respondent insurer brought a preliminary issue motion to stay the applicant's claim for an income replacement benefit (IRB) on the basis that it was premature.

The insurer argued the applicant failed to submit a Disability Certificate (OCF-3) prior to applying to the Licence Appeal Tribunal.

The applicant contended the OCF-3 was faxed to the insurer in December 2017 or included in a bundle of clinical notes in November 2019.

The Tribunal found that the applicant did not properly submit the OCF-3 until May 2020, after the Tribunal application was commenced.

As there was no valid application for the benefit and no denial at the time of filing, there was no dispute over entitlement.

The claim for an IRB was dismissed as premature.

Following a motion for the production of documents in a motor vehicle accident case that resulted in divided success, the court received written submissions on costs.

The defendant sought costs on a substantial indemnity basis, while the plaintiffs submitted there should be no costs in accordance with the court's preliminary view.

The court found the defendant's position unreasonable, noting it was not significantly more successful than the plaintiffs and there was no conduct justifying an enhanced scale.

The court ordered no costs for the motion.

The defendant in a motor vehicle accident action brought a motion for production of the plaintiff's long-term disability file, statutory accident benefits file, and employment file.

The court ordered production of the long-term disability file and employment file, finding them relevant to the plaintiff's claims for income loss and physical disability, subject to redactions for personal information in the employment file.

The request for the statutory accident benefits file was dismissed, as the plaintiff had already produced the portions in their possession, and the defendant was directed to bring a Rule 30.10 motion against the independent adjuster for any remaining documents.

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

After the respondent eventually agreed to fund the disputed benefits, the sole remaining issue was whether the applicant was entitled to a special award under section 10 of O. Reg. 664 for unreasonable delay.

The Tribunal found that the respondent unreasonably delayed payment by improperly claiming that section 25 assessments were duplications of section 44 assessments and by failing to reconsider earlier denials after removing the applicant from the Minor Injury Guideline.

A nominal special award of $400 was ordered.