11 total
Applicant partially successful in claiming outstanding administrative expenses for treatment plans; award claim dismissed.
The applicant was injured in a motor vehicle accident and sought payment for nine treatment plans (OCF-18s) that were partially denied by the respondent insurer.
The disputed amounts largely related to administrative expenses, such as form completion, brokerage fees, and documentation support.
The Tribunal found that the applicant was entitled to the outstanding balances for several of the treatment plans, as the fees for form completion, brokerage, and documentation were reasonable and necessary.
However, the Tribunal denied claims for transportation and activity expenses where insufficient evidence was provided.
The applicant's claim for an award under Regulation 664 for unreasonable delay or withholding of benefits was dismissed.
The court granted a motion to remove a father-in-law as a party to a matrimonial dispute because the claims against him disclosed no reasonable cause of action.
The applicant, Sahil Kapila, brought a motion to remove his father, Prem Kumar Kapila, as an added respondent in a matrimonial dispute with his former spouse, Rubi Chhina.
Rubi had added Prem, making various claims including domestic violence, trespass, rent/utilities, and trust claims over property and funds.
The court found that Rubi's claims against Prem did not disclose a reasonable cause of action under Rule 7(3) of the Family Law Rules, nor did they meet the threshold for adding a party under the Rules of Civil Procedure.
The court granted the motion to remove Prem as a party, thereby also dismissing Rubi's cross-motion seeking financial disclosure and freezing of Prem's assets.
Reconsideration request dismissed as the claim for a higher attendant care rate was not in dispute.
The applicant requested a reconsideration of a Tribunal decision that awarded attendant care benefits at a rate of $644.63 per month.
The applicant argued the Tribunal made an error of fact by failing to award benefits at a higher rate of $1,919.06 per month based on an updated Form 1.
The Tribunal dismissed the reconsideration request, finding that the claim for the higher rate was not properly before the Tribunal as an issue in dispute.
The applicant had not requested to amend the claim to reflect the increased quantum prior to or during the hearing.
Applicant deemed catastrophically impaired under Criterion 7; awarded attendant care, housekeeping, and occupational therapy benefits.
The applicant was severely injured in a head-on motor vehicle collision and applied for statutory accident benefits.
After exhausting non-catastrophic limits, she sought a determination of catastrophic impairment and entitlement to further attendant care, housekeeping, and medical/rehabilitation benefits.
The Tribunal found the applicant catastrophically impaired under Criterion 7, accepting a combined Whole Person Impairment rating of 59% based on physical and mental/behavioral impairments, including a mild traumatic brain injury.
The Tribunal awarded attendant care and housekeeping benefits for incurred amounts, as well as an occupational therapy treatment plan, but dismissed claims for physiotherapy and a special award.
The applicant was also ordered to repay income replacement benefits received while employed.
Applicant deemed catastrophically impaired due to marked impairment in adaptation following a motor vehicle accident.
The applicant was injured in a motor vehicle accident and sought statutory accident benefits, claiming she sustained a catastrophic impairment due to mental and behavioural disorders.
The Licence Appeal Tribunal found that the applicant sustained a marked impairment (Class 4) in Adaptation, qualifying her for catastrophic impairment status.
The Tribunal awarded attendant care benefits, professional organizing services, and vision therapy, but denied aquatherapy sessions.
The Tribunal also denied the applicant's request for a special award under Regulation 664, finding the insurer's denials were not unreasonable.
Costs awarded for needlessly complicating an uncontested divorce.
This was a costs-only family law decision arising from prolonged delay and deficient materials in obtaining an uncontested divorce after the parties had already settled their divorce action.
The court applied Rule 24 of the Family Law Rules and found that the responding party's conduct had turned a simple divorce into unnecessary motion litigation, justifying a substantial costs award to the moving party.
The court also considered whether counsel should bear costs personally under the Young and Galganov framework, but declined to do so despite serious concern with counsel's conduct.
Costs of $2,750 all-inclusive were ordered payable by the responding party within 30 days.
Partial summary judgement granted dismissing malicious prosecution and defamation claims; remaining claims proceed to trial.
The defendants brought a motion for summary judgement to dismiss the plaintiffs' claims of malicious prosecution, defamation, and fraud/theft relating to a saving circle and employment termination.
The defendants also sought default judgement on their counterclaim for theft.
The plaintiffs brought a cross-motion for summary judgement.
The court granted partial summary judgement dismissing the malicious prosecution and defamation claims, finding no evidence that the police lacked independent discretion in laying charges or that defamatory statements were made to third parties.
The court found genuine issues requiring a trial for the saving circle and employment monies claims due to credibility issues.
The court also set aside the noting of default on the counterclaim to avoid inconsistent findings at trial.
Reconsideration requests dismissed; LTD settlement not deductible from IRBs and no special award granted.
Both the applicant and the respondent insurer requested a reconsideration of a Licence Appeal Tribunal decision regarding the calculation of income replacement benefits (IRBs).
The insurer argued the Tribunal erred by not deducting the applicant's $120,000 long-term disability (LTD) settlement from her IRBs, asserting it resulted in double recovery.
The applicant argued the Tribunal erred by refusing to grant a special award under s. 10 of O. Reg. 664 for unreasonable withholding of benefits.
The Vice-Chair dismissed both requests, finding no significant errors of law or fact.
The LTD settlement was a lump sum covering multiple heads of damages and could not be clearly apportioned as an income continuation benefit, and the insurer's conduct in disputing the claim was not excessive or unreasonable.
The plaintiff's motion to strike a jury notice due to pandemic-related delays was dismissed.
The plaintiff S.M. brought a motion to strike his jury notice, filed in 2014, seeking to proceed with a judge-alone trial in March 2021 due to anticipated delays in jury trials caused by the COVID-19 pandemic.
The primary defendant, Ero Longo, opposed the motion.
The court applied the "justice better served" test, considering factors such as the substantive right to a jury trial, the extent of delay, and the practicalities of trial scheduling.
The court found that a six-month delay to an October 2021 jury trial blitz was not unconscionable, especially given the plaintiff's own delays in the action and the availability of retrofitted court facilities.
The plaintiff failed to demonstrate sufficient prejudice beyond delay or that a judge-alone trial would better serve justice.
The motion was dismissed, the March 2021 trial dates were vacated, and the case was placed on the October 2021 trial blitz for an in-person jury trial.
The issue of striking the jury was left open for future reconsideration if the October trial does not proceed.
Lump sum LTD settlement encompassing extracontractual damages is not deductible from income replacement benefits.
The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs) from the respondent insurer.
The parties disputed the correct calculation of the IRB, specifically whether a $120,000 lump sum settlement the applicant received from her long-term disability (LTD) carrier should be deducted from her IRBs.
The Tribunal found that the LTD settlement encompassed all claims against the LTD carrier, including extracontractual damages, and could not be broken down to satisfy the requirements of the Schedule.
Therefore, the LTD settlement was not deductible from the IRBs.
The Tribunal ordered the respondent to pay IRBs at $400 per week plus interest, denied the respondent's claim for repayment, and declined to make an award for unreasonable withholding of benefits.
Insurer ordered to pay disputed medical benefits and maximum 50% special award for unreasonable delay.
The applicant sought various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule following a motor vehicle accident.
The respondent insurer denied the treatment plans for physiotherapy, assistive devices, psychological treatment, and chiropractic treatment based on its insurer's examinations.
The Licence Appeal Tribunal found the respondent's expert opinions unpersuasive and insufficiently explained, preferring the evidence of the applicant and her treating practitioners.
The Tribunal ordered the respondent to pay all disputed treatment plans and overdue interest.
Furthermore, the Tribunal granted a maximum special award of 50% under Regulation 664, finding that the respondent unreasonably delayed or withheld payments by providing reasons for denial inconsistent with its actual reasons and failing to consider medical records on file.