Gregory Paul Specht

The applicant was struck by an unidentified driver as a pedestrian and failed to notify the respondent of his intention to claim accident benefits within the prescribed time.

The respondent argued the claim was statute-barred.

The Tribunal found that the applicant, an unsophisticated person with no knowledge of automobile insurance, provided a reasonable explanation for the delay.

The Tribunal concluded that the hardship to the applicant outweighed any prejudice to the respondent, allowing the applicant to proceed to a substantive issues hearing.

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

The respondent denied several treatment plans.

The Tribunal found that the applicant was barred from proceeding to a hearing for two chiropractic treatment plans and a chronic pain assessment because he failed to dispute the valid denials within the two-year limitation period, and declined to extend the limitation period under s. 7 of the LAT Act.

The Tribunal also found that the psychological assessment, psychological services, and driving evaluation were not payable under s. 38(11) of the Schedule, as the applicant failed to identify how the denials were deficient.

The application was dismissed.

The applicant requested reconsideration of a preliminary issue decision that barred his application for accident benefits based on res judicata.

The Vice-Chair granted the reconsideration, finding the original adjudicator erred by failing to address the applicant's argument that res judicata should be waived based on fairness.

Rehearing the preliminary issue, the Vice-Chair determined that res judicata did not apply because the applicability of the Minor Injury Guideline (MIG) was no longer an issue and the new treatment plans required adjudication.

The preliminary issue decision was cancelled, and the matter was ordered to proceed to a written hearing on the remaining preliminary and substantive issues.

The bankrupt applied for an absolute discharge from bankruptcy following a motor vehicle accident in which he was an uninsured driver.

The Motor Vehicle Accident Claims Fund, which paid a $130,000 judgment against the bankrupt, opposed the discharge, arguing the bankrupt should be required to repay the debt.

The court found this was essentially a single-creditor bankruptcy filed to avoid the judgment debt.

While the bankrupt had cooperated with the trustee and his circumstances had improved, the court determined that the integrity of the bankruptcy process required some repayment.

The court granted a conditional discharge requiring repayment of 25% of the debt.

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

In a prior decision, the Tribunal determined that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant filed a new application seeking payment for additional treatment plans, arguing he should be removed from the MIG.

The respondent raised a preliminary issue that the application was barred by res judicata.

The Tribunal found that the issue of the MIG had already been decided in a final decision between the same parties.

The Tribunal rejected the applicant's argument that new treatment plans constituted fresh evidence warranting a waiver of res judicata.

The application was dismissed.

The respondent insurer requested a reconsideration of a Tribunal decision that found the applicant entitled to a chronic pain assessment.

The insurer argued the Tribunal erred in law by applying a heightened standard of proof to the availability of OHIP coverage under s. 47(2) of the Schedule, and erred in fact by failing to address a pre-accident OHIP-funded consultation report.

The Tribunal dismissed the request, finding that the phrase 'compelling evidence' did not impose a higher standard but reflected the quality of evidence needed to show the specific post-accident assessment was reasonably available.

The Tribunal also found no error of fact, as the pre-accident report did not establish that a comparable assessment for accident-related injuries was currently available through OHIP.

The applicant requested a reconsideration of a previous Tribunal decision which found that his injuries did not remove him from the Minor Injury Guideline (MIG) and denied his claims for treatment plans and interest.

The applicant argued that the Tribunal breached procedural fairness by excluding a psychological assessment report and erred in law and fact in its interpretation of the MIG, the Schedule, and the evidence regarding his psychological impairments and chronic pain.

The Tribunal dismissed the request, finding that the applicant was attempting to re-litigate his position and raise new arguments not presented at the initial hearing, and that he failed to establish any errors of law or fact or a breach of procedural fairness.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the insurer's denial of several treatment plans.

The Tribunal found the applicant was not entitled to an attendant care assessment because it was incurred before the treatment plan was submitted, contrary to section 38(2) of the Schedule.

The Tribunal partially approved a physiotherapy treatment plan for hourly services but denied per-procedure items that lacked evidence of compliance with the Professional Services Guideline.

The unapproved balance for chiropractic services was similarly denied.

However, the Tribunal granted entitlement to a chronic pain assessment, finding it reasonable and necessary given the applicant's persistent symptoms and functional limitations, and awarded interest on overdue payments.

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

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant failed to provide sufficient objective medical evidence to prove that his physical or psychological impairments warranted removal from the MIG.

As the $3,500 MIG limit had been exhausted, the claims for a physiotherapy treatment plan and a psychological assessment were dismissed, along with claims for interest and an award.

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

The respondent denied several treatment plans for physiotherapy on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.

The applicant argued that the MIG no longer applied because the treatment plans were submitted outside the 12-week timeframe, and alternatively, that he should be removed from the MIG due to chronic pain and psychological impairments.

The Tribunal found that the applicant failed to establish accident-related impairments warranting removal from the MIG.

The Tribunal also rejected the applicant's argument that the respondent's initial non-compliant notices rendered the treatment plans payable, as the respondent subsequently provided a compliant notice and no services were incurred during the period of non-compliance.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident and applied to the Tribunal after the insurer denied benefits.

The insurer raised a preliminary issue that the application was statute-barred because it was filed beyond the two-year limitation period.

The Tribunal found that the insurer issued a valid denial for the non-earner benefits, triggering the limitation period, which expired before the application was filed.

The Tribunal declined to extend the limitation period as the applicant provided no submissions.

The claim for non-earner benefits was dismissed as statute-barred, but the applicant was permitted to proceed with the remaining claims, including a disputed treatment plan.

The applicant was involved in a motor vehicle accident and submitted an Application for Accident Benefits (OCF-1) over two years after receiving the forms from the insurer.

The insurer denied the application as being outside the 30-day statutory deadline.

The Licence Appeal Tribunal held a preliminary issue hearing to determine if the applicant was statute-barred from proceeding.

The Tribunal found that the applicant failed to provide a credible or reasonable explanation for the delay, rejecting arguments related to the COVID-19 pandemic, a misunderstanding of available benefits, and a delayed fibromyalgia diagnosis.

The application was dismissed as statute-barred.

The applicant, who was a minor at the time of the motor vehicle accident, sought a non-earner benefit and medical/rehabilitation benefits.

The insurer denied the benefits, and the applicant filed an application with the Licence Appeal Tribunal more than two years after the denials.

The applicant argued that the limitation period for the non-earner benefit should only commence upon turning 18, relying on the rule of discoverability.

The Tribunal held that the limitation period is triggered by the insurer's refusal to pay, regardless of the applicant's age.

The Tribunal declined to extend the limitation period under section 7 of the Licence Appeal Tribunal Act, finding no bona fide intention to appeal within the time limit, an excessive and unexplained delay, prejudice to the respondent, and a lack of merit.

The application was dismissed as statute-barred.

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits from the respondent insurer.

The insurer denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.

The applicant argued she should be removed from the MIG due to pre-existing injuries and psychological impairments.

The Tribunal found insufficient evidence of pre-existing conditions preventing recovery or clinically significant psychological impairments, preferring the respondent's psychological assessment over the applicant's.

The Tribunal concluded the applicant's injuries were predominantly minor, and since the MIG limits were exhausted, the claims for treatment plans and interest were dismissed.

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

The insurer determined the injuries fell within the Minor Injury Guideline (MIG) and denied funding for two physiotherapy treatment plans.

The applicant argued he sustained a concussion and chronic pain, removing him from the MIG.

The Tribunal found the medical evidence, including hospital records and employment records, did not support a non-minor injury diagnosis.

The applicant was held to the MIG limit, which was already exhausted, and his claims for the treatment plans, an award, and costs were dismissed.

The plaintiff in a motor vehicle accident personal injury action moved to strike the defendants' jury notice due to the suspension of civil jury trials during the COVID-19 pandemic.

The defendants cross-moved to adjourn the trial to conduct defence medical examinations and obtain expert reports.

The court granted the plaintiff's motion and struck the jury notice, finding that the plaintiff would suffer non-compensable prejudice from trial delay due to statutory deductibles and income loss limits under the Insurance Act.

The court dismissed the defendants' cross-motion, holding that their lack of trial readiness was due to their own failure to diligently seek medical examinations and expert reports.

The statutory third party, Allstate Insurance, brought a motion for security for costs against the plaintiff, who had moved to Angola after commencing a motor vehicle accident claim.

The court found that the plaintiff was ordinarily resident outside Ontario and failed to establish impecuniosity, as the only evidence provided was a law clerk's affidavit.

The court ordered the plaintiff to post $10,000 as security for costs.

The applicant sought statutory accident benefits following a motor vehicle accident, including non-earner benefits, attendant care benefits, and various treatment plans.

The Tribunal found that the insurer failed to properly deny the non-earner benefits and a psychological assessment treatment plan in accordance with the Statutory Accident Benefits Schedule, entitling the applicant to those benefits for the period of the insurer's non-compliance.

However, the applicant failed to prove a complete inability to carry on a normal life for the ongoing period.

The Tribunal also awarded a 25% penalty under O. Reg. 664 due to the insurer's unreasonable delay in adjusting the claim, particularly given the applicant's known vulnerability due to pre-existing schizophrenia.

The applicant sought statutory accident benefits for physiotherapy and a chronic pain assessment following a motor vehicle accident.

The insurer denied the treatment plans, citing a gap in treatment and an insurer's examination concluding the shoulder injury was not causally linked to the accident.

The Licence Appeal Tribunal found the treatment plans were reasonable and necessary, noting the applicant's ongoing pain and the lack of explanation from the insurer's assessor regarding causation.

The Tribunal ordered the insurer to pay for the physiotherapy and chronic pain assessment with interest, but denied the applicant's request for a bad faith award.