Imtiaz Hosein

The applicant sought an award under section 10 of Regulation 664, arguing the respondent insurer unreasonably delayed approving his catastrophic impairment designation until a case conference.

The Tribunal dismissed the claim for an award, finding the insurer's initial reliance on its own assessments was not imprudent or stubborn, and the Schedule does not require medical reasons for approving a designation.

However, the Tribunal awarded the applicant $500 in costs because the respondent misrepresented at the case conference that the reasons for the reversal would be found in the adjuster's log notes.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that awarded a 15% special award under section 10 of O. Reg. 664 but failed to address the mandatory interest on that award.

The adjudicator found that the failure to specify that interest was payable on the lump sum award was an error of law, as section 10 interest is mandatory and distinct from the discretionary lump sum component.

The decision was varied to include entitlement to interest in accordance with Reg. 664, but the adjudicator declined to quantify the exact amount owing due to insufficient information.

The applicant requested reconsideration of a Licence Appeal Tribunal decision regarding statutory accident benefits.

The applicant argued the Tribunal erred by failing to award interest for the pre-application period under s. 51(3) of the Schedule and by failing to award interest on the s. 10 special award itself.

The Vice-Chair dismissed the first ground, finding no evidence that the benefits were incurred and therefore overdue.

However, the Vice-Chair granted the second ground, holding that s. 10 of O. Reg. 664 mandates the inclusion of interest on the award amount.

The original decision was varied to include interest payable under s. 10.

The applicant requested reconsideration of a decision denying her claim for catastrophic impairment and various medical benefits following a motor vehicle accident.

She also filed a Notice of Constitutional Question, arguing the Tribunal's assessment of her psychiatric impairments violated s. 15(1) of the Charter.

The Vice-Chair granted the reconsideration in part, finding the Tribunal erred in denying six treatment plans based on the 260-week limit, as the respondent had previously admitted the policy allowed for 10 years of benefits.

A written rehearing was ordered for those six plans.

The reconsideration was otherwise dismissed, as the Tribunal made no error in its causation analysis for catastrophic impairment or its strict application of s. 38(2) for living accommodations.

The Charter challenge was also dismissed, as the Tribunal's causation analysis did not constitute adverse-effect discrimination against individuals with mental disabilities.

The applicant applied to the Licence Appeal Tribunal seeking a determination that the respondent's counsel was in a conflict of interest for requesting an examination under oath regarding accident benefits after previously conducting one for a priority dispute.

The applicant did not dispute any specific entitlement to accident benefits.

The Tribunal held that under s. 280(1) of the Insurance Act, its jurisdiction is limited to disputes regarding entitlement to or the amount of statutory accident benefits.

Because the conflict of interest was raised as a standalone issue without an underlying benefits dispute, the Tribunal found it lacked jurisdiction and dismissed the application.

The applicant sought a determination that she sustained a catastrophic impairment following a motor vehicle accident.

Her initial application was dismissed by the Tribunal and upheld on judicial review.

She filed a new application, and the respondent raised the preliminary issue of res judicata.

The applicant also raised a constitutional challenge, arguing the Tribunal's practice of holding written preliminary issue hearings violated section 7 of the Charter.

The Tribunal dismissed the constitutional challenge, finding the practice direction was a non-binding guideline and the applicant had consented to the written format.

The Tribunal further held that the application was barred by res judicata, as the issues had been previously decided on their merits and the applicant failed to demonstrate a material change in circumstances that would conclusively impeach the original decision.

The applicant sought a determination that she sustained a catastrophic impairment following a motor vehicle accident, after a previous Tribunal decision found she did not meet the criteria.

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

The applicant also raised a constitutional challenge, arguing the Tribunal's practice of holding preliminary issue hearings in writing violated her section 7 Charter rights.

The Tribunal dismissed the constitutional challenge, finding the practice direction was a non-binding guideline and the applicant had consented to the written format.

The Tribunal further held that the application was barred by res judicata, as the same question had been decided in a final decision between the same parties, and the applicant failed to demonstrate a material change in circumstances that would conclusively impeach the original result.

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

The respondent insurer raised a preliminary issue that the applicant was statute-barred from proceeding to a hearing because she failed to attend scheduled insurer's examinations.

The applicant argued the notices of examination were non-compliant and the insurer failed to prove it arranged the examinations at its expense.

The Tribunal found the notices were compliant with section 44 of the Schedule and the applicant failed to provide a reasonable explanation for her non-attendance.

The application was dismissed as statute-barred under section 55(1)2, and the applicant's request for costs was denied.

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 sought statutory accident benefits, claiming a catastrophic impairment under Criterion 4 due to a traumatic brain injury sustained in a 2018 motor vehicle accident.

The respondent argued the application was barred by res judicata, as a prior 2023 Licence Appeal Tribunal decision had already determined the applicant did not sustain a neurological injury.

The Tribunal agreed, finding that the same question had been decided, the prior decision was final, and the parties were the same.

The Tribunal declined to exercise its discretion to waive res judicata, noting the applicant had the opportunity to present evidence of a brain injury at the first hearing but failed to do so.

The application was dismissed, with no costs awarded to either party.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied an adjournment request and dismissed her application for catastrophic impairment benefits.

The applicant argued that the denial of the adjournment was a material breach of procedural fairness, as her newly retained counsel had identified a potential conflict of interest with her litigation guardian on the eve of the hearing, alongside ongoing capacity concerns.

Applying the Divisional Court's reasoning in Riddell regarding the need for flexibility in complex catastrophic impairment cases, the Tribunal found that the combination of the potential conflict, capacity issues, and recently retained counsel constituted compelling circumstances.

The Tribunal concluded that denying the short adjournment was a material breach of procedural fairness, cancelled the initial decision, and ordered a rehearing before a new adjudicator.

The applicant requested reconsideration of a decision that denied an oral adjournment request and dismissed her application for catastrophic impairment determination.

The applicant argued that her newly retained counsel had identified a potential conflict of interest with her litigation guardian on the eve of the hearing, alongside concerns about her capacity.

The Tribunal found that denying the adjournment in these complex circumstances constituted a material breach of procedural fairness.

The reconsideration request was granted, the initial decision was cancelled, and a rehearing was directed.

The applicant sought statutory accident benefits following a 2016 motor vehicle accident, claiming catastrophic impairment under criterion 8 due to mental and behavioural disorders.

The Tribunal found the applicant was not catastrophically impaired, as she failed to establish that her psychological impairments would not have occurred 'but for' the accident, noting a significant time gap and high level of functioning in the intervening years.

The Tribunal granted entitlement to several treatment plans for occupational therapy, assistive devices, and assessments incurred prior to the 260-week mark, but denied plans submitted after that period and denied the claim for living accommodations due to non-compliance with section 38(2) of the Schedule.

The claim for a special award was also dismissed.

The applicant commenced a second application to the Licence Appeal Tribunal (LAT) seeking over $100 million in damages against her insurer, adjusters, and health professionals for alleged tortious conduct related to her statutory accident benefits (SABS) claim.

The LAT declined to process the application, finding it lacked jurisdiction to award damages or make orders against non-insurer parties.

The applicant sought judicial review and appealed to the Divisional Court.

The Court dismissed the proceedings under Rule 2.1.01 of the Rules of Civil Procedure, holding that the LAT is a statutory body without jurisdiction to award general or non-compensatory damages, and that the proceedings constituted an abuse of process and an impermissible collateral attack on a prior final LAT decision regarding her SABS.

The applicant/appellant commenced a second application to the Licence Appeal Tribunal (LAT) seeking damages and declaratory relief against her insurer and various non-insurer parties for alleged tortious conduct related to her statutory accident benefits (SABS) claims.

The LAT dismissed the application for lack of jurisdiction, noting it had no authority to award damages or make orders against non-insurers.

The applicant/appellant appealed to the Divisional Court.

The Court issued a notice under Rule 2.1.01 of the Rules of Civil Procedure and subsequently dismissed the proceedings as frivolous, vexatious, and an abuse of process, finding that the LAT lacks statutory jurisdiction to grant the requested relief and that the proceedings were an impermissible collateral attack on a prior final LAT decision.

The applicant, who sustained a catastrophic brain injury in a 1997 motor vehicle accident, applied for retroactive attendant care benefits (ACBs) in 2021.

The respondent insurer denied the retroactive claim.

The Tribunal found that the applicant was entitled to retroactive ACBs for the period after his discharge from the hospital, as well as for two weekends spent at home during his hospital stay, because the services were reasonably necessary and quantifiable.

The Tribunal also held that interest on the overdue benefits began to accrue 10 business days after the 2021 application was submitted.

Finally, the Tribunal granted a special award of $42,000 under s. 10 of Regulation 664, finding that the respondent unreasonably withheld benefits by failing to adequately inform the applicant of his potential entitlement to ACBs shortly after the accident.

The applicant and respondent both requested reconsideration of a Tribunal decision that dismissed the application for failing to file submissions.

The parties argued that they had reached a settlement pending court approval and had informed the Tribunal via email, believing no decision would be made.

The Vice-Chair found that there was a misunderstanding of fact based on the email correspondence.

The reconsideration was granted on consent, the previous decision was cancelled, and the file was closed without prejudice pending the outcome of the court approval process.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that dismissed her application without a hearing.

The applicant had sought damages for torts, including intimidation, against the insurer and other named respondents.

The Vice-Chair dismissed the reconsideration request, finding no error of law or fact in the initial determination that the Tribunal lacks jurisdiction to award common law damages or punitive damages.

The Tribunal reaffirmed that its remedial powers are limited to those granted by statute, such as deeming benefits incurred or making special awards, and do not extend to tort damages.

The applicant sought judicial review of a Licence Appeal Tribunal (LAT) decision dismissing her claims for statutory accident benefits, including income replacement benefits, catastrophic impairment designation, and attendant care benefits.

The Divisional Court dismissed the application, finding that the LAT's decisions regarding the 104-week deadline for income replacement benefits, the assessment of catastrophic impairment criteria, and the reduction of attendant care benefits were reasonable.

The court also rejected the applicant's claims of procedural fairness violations, concluding that the LAT appropriately controlled its own process.

The applicant requested a reconsideration of the Tribunal's decision not to process her application.

The application sought damages from an insurer and several non-insurer respondents for alleged breaches of the duty of good faith and civil conspiracy.

The Tribunal dismissed the reconsideration request, finding no error of law or fact.

The Tribunal held that its jurisdiction under section 280 of the Insurance Act is limited to disputes over statutory accident benefits and amounts, and it does not have the authority to award punitive or other damages against insurers or non-insurers.