James M. Brown

The applicant was injured in a motor vehicle accident and sought payment for a psychological services treatment plan proposed by a social worker.

The insurer partially approved the plan at an hourly rate of $100, denying the higher requested rate and additional planning fees.

The Licence Appeal Tribunal dismissed the application, finding the $100 hourly rate reasonable as it fell between the Guideline rates for psychologists and psychometrists, and the applicant failed to establish that the higher rate or the planning and documentation fees were reasonable and necessary.

The applicant sought income replacement benefits following a motor vehicle accident.

The matter proceeded to a written hearing, but the self-represented applicant failed to file any submissions or evidence despite receiving proper notice.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to meet his evidentiary burden to establish entitlement to the claimed benefits.

The appellant insurer appealed a Licence Appeal Tribunal decision which held that Employment Insurance (EI) sickness benefits were not deductible from the respondent's Income Replacement Benefits (IRBs) under the Statutory Accident Benefits Schedule.

The Divisional Court allowed the appeal, finding the adjudicator erred in law by creating an ambiguity where none existed and by distinguishing sickness benefits from other EI benefits.

The Court held that all EI benefits, including sickness benefits, fall within the definition of gross employment income and must be deducted from IRBs at the rate of 70 per cent.

The appellant insurer appealed a License Appeal Tribunal decision reinstating the respondent's Income Replacement Benefits.

The benefits had been suspended after the respondent failed to provide requested medical records.

The Tribunal found the respondent had a 'reasonable explanation' for the delay under s. 33(8)(b) of the Statutory Accident Benefits Schedule.

The Divisional Court dismissed the appeal, holding that the Adjudicator applied the correct legal test for 'reasonable explanation' by considering both objective and subjective factors, and provided adequate reasons for the decision.

The respondent insurer filed a request for reconsideration of a decision finding that the applicant was entitled to payment of an income replacement benefit that was improperly deducted due to her receipt of Employment Insurance sickness benefits.

The insurer argued the Tribunal erred in law by determining that EI sickness benefits were not deductible as gross employment income under s. 7(3) of the Statutory Accident Benefits Schedule.

The Tribunal dismissed the request, finding no error of law in its original interpretation that a genuine conflict exists in the Schedule and that EI sickness benefits fall within the temporary disability benefit exclusion under s. 47(3)(f)(i).

The applicant sought medical and rehabilitation benefits following a motor vehicle accident.

The respondent 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 her pre-existing conditions, including chronic pelvic pain and a history of surgeries, prevented her from achieving maximal recovery within the MIG, and that she developed chronic pain from the accident.

The Tribunal found the applicant failed to provide compelling medical evidence that her pre-existing conditions prevented maximal recovery from her accident-related soft tissue injuries.

The Tribunal also found insufficient evidence that the applicant suffered chronic pain as a result of the accident.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought an income replacement benefit (IRB).

The insurer deducted the applicant's Employment Insurance (EI) sickness benefits from the IRB, arguing they constituted 'gross employment income' under the Statutory Accident Benefits Schedule.

The Tribunal found that the Schedule contains conflicting provisions regarding EI benefits but concluded that EI sickness benefits, unlike other EI benefits, are received in respect of an impairment and are specifically excluded from deduction under section 47(3).

The Tribunal ordered the insurer to pay the improperly deducted amount of $5,901.00 plus interest.

The applicant was injured in a motor vehicle accident and initially received a non-earner benefit (NEB) before it was terminated by the insurer in 2016.

The applicant's condition later deteriorated, leading to a catastrophic impairment designation and a new application for NEB in 2018.

The insurer argued the claim was statute-barred under s. 56 of the Statutory Accident Benefits Schedule as the two-year limitation period from the 2016 denial had expired.

The Tribunal applied the discoverability doctrine from Tomec, finding the applicant's cause of action for the new NEB claim only accrued when her psychological condition deteriorated in 2018.

The Tribunal held the claim was not statute-barred and, alternatively, would have granted an extension under s. 7 of the Licence Appeal Tribunal Act.

The applicant sought Income Replacement Benefits (IRBs) following a motor vehicle accident.

The respondent insurer claimed a deduction for post-accident payments the applicant received from her mother's business, where she had been employed prior to the accident.

The applicant argued the payments were a gift, as she was not actively working.

The Tribunal found that the payments constituted employment income, noting they were paid in the same manner as pre-accident wages, with standard tax deductions, and reported as income to the CRA.

The Tribunal concluded the applicant failed to provide contemporaneous evidence to rebut the presumption of employment income and establish the legal elements of a gift.

The respondent was entitled to deduct the income, reducing the IRB payable to nil.

The applicant was injured in a motor vehicle accident and sought the cost of various catastrophic impairment assessments.

The respondent insurer partially denied the treatment plan, arguing the assessments were not reasonable and necessary.

Following a written hearing, the adjudicator found that only the Functional Review Evaluation was reasonable and necessary to procure accurate digital measurements under the AMA Guides.

The remaining assessments, including the AMPS, collateral interview, file review, and consensus opinion, were deemed duplicative or not essential.

The applicant was awarded the cost of the Functional Review Evaluation plus interest.

The insurer sought reconsideration of a Licence Appeal Tribunal decision that found the applicant entitled to payment for Lidocaine intravenous injections and a dietician assessment following a motor vehicle accident.

The insurer argued the Tribunal made significant errors of law and fact by misapprehending the 'reasonable and necessary' standard and improperly shifting the burden of proof.

The Vice-Chair dismissed the reconsideration request, finding that the original adjudicator properly considered the evidence, applied the correct legal standards, and made reasonable factual findings based on the medical evidence presented.

The applicant sought non-earner benefits following a motor vehicle accident.

The insurer suspended benefits after the applicant refused to provide clinical notes and records, a prior accident benefits file, and a CPP disability file requested under s. 33 of the Statutory Accident Benefits Schedule.

The Tribunal found that the clinical notes and the medical/rehabilitation portions of the prior files were reasonably required to assess causation, given the applicant's pre-existing injuries from a prior accident.

However, because the insurer's initial notices failed to inform the applicant of the saving provision under s. 33(8), the insurer remained liable to pay benefits until a compliant notice was issued on October 19, 2018.

The insurer is not liable to pay benefits after that date until the applicant provides the required information.

The respondent insurer requested a reconsideration of a LAT decision which found that post-accident payments made to the applicant by her mother's corporation were gifts and not deductible from her Income Replacement Benefit (IRB).

The Vice-Chair granted the reconsideration, finding that the original adjudicator's written reasons were inadequate and constituted a denial of natural justice.

The adjudicator failed to address major points in issue, incorrectly summarized the parties' positions, and did not set out a reasoning process.

The decision was cancelled and the matter was referred back to the original adjudicator for a written rehearing based on the existing evidentiary record.

The applicant sought income replacement benefits following a 2002 motor vehicle accident, which the respondent denied in 2011.

The applicant commenced an application at the Tribunal five years after the two-year limitation period expired.

The Tribunal found the respondent's denial was valid and clear, triggering the limitation period.

Applying the four-factor test for extending time under section 7 of the LAT Act, the Tribunal declined to extend the limitation period due to the significant five-year delay and resulting prejudice to the respondent.

The application was dismissed as statute-barred.

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs).

The respondent insurer claimed deductions under s. 7(3) of the Schedule for post-accident payments the applicant received from her employer, a restaurant owned by her mother.

The Tribunal found that the payments were a gift intended to help the applicant financially, not employment income or a temporary disability benefit.

The applicant met the legal test for a gift, as there was an intention to give without expectation of remuneration, acceptance, and transfer.

The Tribunal ordered the respondent to pay the IRBs without deductions, plus interest.

The applicant was injured in a motor vehicle accident and sought income replacement and medical benefits from her insurer.

The insurer denied the benefits, arguing that the applicant's ongoing impairments were caused by a subsequent slip and fall incident rather than the motor vehicle accident.

The arbitrator found the applicant credible and concluded that the motor vehicle accident rendered an asymptomatic condition symptomatic, making her vulnerable to subsequent flare-ups.

The arbitrator awarded income replacement benefits from March 2014 onwards and approved several treatment plans, but denied a special award, finding the insurer had not acted unreasonably given the complex medical evidence.

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

The insurer denied the claims on the basis that the injuries fell within the Minor Injury Guideline and requested the applicant attend several insurer examinations.

The applicant failed to attend the examinations, arguing the notices did not provide sufficient medical reasons.

The Tribunal found the notices were sufficient and that the applicant failed to comply with section 44 of the Statutory Accident Benefits Schedule.

Consequently, the application was dismissed pursuant to section 55.

The plaintiff municipality sought leave to amend its statement of claim to add its consulting engineer, WSP, as a defendant in an action concerning defective bridge rehabilitation work.

WSP opposed the motion, arguing the claim was statute-barred by the two-year limitation period.

The court applied the discoverability principle, finding that the plaintiff reasonably relied on WSP's professional advice that the defects were caused by poor workmanship rather than WSP's specified concrete mixture.

The limitation period did not begin to run until the plaintiff obtained independent expert reports revealing WSP's potential negligence.

The motion to add WSP as a defendant and extend the time to set the matter down for trial was granted.

The appellants (Mastron entities) appealed a motion judge's order that refused to dismiss third and fourth party claims and granted leave nunc pro tunc to Genivar to issue its fourth party claim.

The motion judge held that an order by Hackland J. dated December 10, 2013 was intended to continue the proceedings under the ordinary track rather than under the Construction Lien Act.

The appellants argued the motion judge erred in granting leave nunc pro tunc because the two-year limitation period for commencement of the fourth party claim had expired.

The Court of Appeal dismissed the appeal, finding that the motion judge correctly interpreted Hackland J.'s order as continuing the action on the ordinary track, since the third party claim included claims for breach of contract and negligence in addition to contribution and indemnity, which could only proceed under the ordinary track.

The defendant WSP Canada Inc. brought a motion for leave to appeal to the Divisional Court from a decision compelling the production of an internal Risk Management Report (RMR).

WSP claimed common law privilege over the RMR, arguing that the motion judge erred in applying the dominant purpose test for litigation privilege and that his decision conflicted with other authorities.

The court dismissed the motion for leave to appeal, finding no conflicting decisions on common law privilege principles and no good reason to doubt the correctness of the original decision.

The court affirmed that the RMR was not prepared for the dominant purpose of litigation and therefore was not protected by litigation privilege, correctly applying the Slavutych test.