Janet S. Young

The applicant sought an income replacement benefit (IRB) for the period of September 15, 2016 to March 1, 2017, following a motor vehicle accident.

The applicant had returned to modified duties as a delivery driver but was subsequently terminated for reasons unrelated to his injuries.

The Tribunal found that the applicant failed to provide objective medical evidence demonstrating a substantial inability to perform the essential tasks of his pre-accident employment during the disputed period.

The application for IRB, interest, a special award, and costs was dismissed.

The applicant sought production of all surveillance evidence from the respondent insurer, regardless of whether the insurer intended to rely on it at the hearing.

The adjudicator found that surveillance evidence is relevant to the catastrophic impairment determination.

However, litigation privilege arose on September 4, 2014, when the applicant filed a prior related application for a non-earner benefit.

Applying the Supreme Court's decision in Blank, the adjudicator held that the litigation privilege from the 2014 application continued for the current application because both proceedings shared a common factual issue regarding the applicant's level of impairment.

The respondent was ordered to disclose and produce surveillance conducted prior to September 4, 2014, but surveillance conducted after that date was protected by litigation privilege and did not need to be produced unless the respondent intended to rely on it.

The applicant sought a catastrophic impairment determination under the mental and behavioural disorder criteria following a motor vehicle accident.

The insurer requested a neuropsychological and psychological insurer examination (IE), which the applicant refused to attend, citing severe psychological distress from previous IEs.

The Tribunal held that the applicant is precluded from proceeding with his appeal on the catastrophic determination until the insurer completes the requested IE.

The Tribunal found the IE was reasonably necessary to assess the new catastrophic impairment claim, but imposed conditions on how the IE must be conducted to protect the applicant's psychological well-being.

The applicant sought a determination of catastrophic impairment following a motor vehicle accident.

The respondent insurer requested in-person section 44 assessments to evaluate the claim, which the applicant refused to attend.

The respondent raised a preliminary issue regarding the applicant's failure to attend.

The Tribunal found that the requested assessments were reasonably necessary as catastrophic impairment was a new issue not addressed by previous assessments.

Consequently, the Tribunal ordered the applicant to attend the assessments and procedurally dismissed the application to dispute catastrophic impairment pursuant to section 55(1)2 of the Schedule.

Following an arbitration hearing where the applicant achieved mixed success, including an award for ongoing income replacement benefits, the applicant sought expenses.

The arbitrator considered the criteria under section 12 of Regulation 664 and awarded the applicant partial indemnity costs.

The applicant was awarded $8,459.47 in fees plus HST, and $17,191.54 in disbursements, for a total of $26,750.74.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including a non-earner benefit, medical cannabis, and osteopathy treatments (including a treadmill and vaporizer).

The Licence Appeal Tribunal denied the non-earner benefit, finding the applicant was still able to perform many self-care and daily living activities.

However, the Tribunal granted the medical benefits for medical cannabis and osteopathy, finding them reasonable and necessary given the applicant's ongoing pain and the recommendations of his treating practitioners.

Interest on overdue payments was also awarded.

The applicant sought a determination that her accident-related impairments met the definition of a catastrophic impairment under the Statutory Accident Benefits Schedule.

The Tribunal found that the applicant sustained a marked impairment in the areas of activities of daily living, concentration, persistence and pace, and adaptation due to a mental or behavioural disorder.

The Tribunal preferred the evidence of the applicant's experts, noting the applicant's pre-existing vulnerabilities and significant post-accident functional decompensation.

As the applicant met the catastrophic threshold under section 3(2)(f), the Tribunal did not need to determine whether she met the 55% whole person impairment threshold under section 3(2)(e).

The applicant was injured in a motor vehicle accident and sought payment for assessments in preparation for a Catastrophic Impairment Assessment.

The insurer partially approved the Treatment Plan but denied payment for a physiatry assessment, file review, Whole Person Impairment Analysis, x-rays, and the completion of an OCF-19.

The Tribunal found the physiatry assessment and OCF-19 completion were reasonable and necessary, ordering payment with interest.

However, the Tribunal denied payment for the file review and WPI Analysis as duplicitous, and denied the x-rays because the applicant failed to prove OHIP coverage was not reasonably available.

The Applicant was injured in a motor vehicle accident and sought statutory accident benefits from the Insurer, including income replacement benefits, attendant care benefits, and payment for various medical treatments and assessments.

The Arbitrator found that the Applicant suffered from chronic pain and functional limitations, exacerbated by his functional illiteracy, which rendered him substantially unable to perform his pre-accident employment and completely unable to engage in any suitable employment post-104 weeks.

The income replacement benefit claim was granted.

The claim for attendant care benefits was dismissed, as the Applicant's family and friends did not suffer an economic loss, and the evidence did not support the need for 24/7 supervision.

Claims for medical treatments and assessments were partially granted based on reasonableness and necessity.

The applicant, who was deemed catastrophically impaired following a motor vehicle accident, sought payment for various denied and partially approved treatment plans, as well as attendant care benefits.

The Licence Appeal Tribunal dismissed the claims for the medical benefits and treatment plans, finding the applicant failed to provide sufficient evidence that they were reasonable and necessary.

Regarding attendant care benefits, the Tribunal found the applicant was not entitled to additional amounts for the period prior to February 2016.

However, the Tribunal determined that the applicant had incurred attendant care expenses from February 2016 onwards and awarded partial attendant care benefits based on a detailed assessment of the required levels of care and the applicable hourly rate guidelines.

The applicant sought expenses following an arbitration hearing where she was successful on issues of catastrophic impairment and income replacement benefits, but unsuccessful on medical benefits and a special award.

The arbitrator applied Rule 75.2 of the Dispute Resolution Practice Code and reduced the applicant's claimed expenses by 40 percent due to divided success.

The arbitrator also disallowed certain disbursements, including duplicate claims for catastrophic assessment reports under both the Schedule and the DRPC, and the cost of a chiropractor's report whose treatment plans were found unreasonable.

The insurer was ordered to pay the applicant $55,572.80 in expenses, inclusive of disbursements and HST.

The appellant appealed an Arbitrator's decision denying his request for interest and a special award following a settlement for attendant care and housekeeping benefits.

The Director's Delegate upheld the Arbitrator's finding that the appellant was required to provide proof of ongoing incurred expenses before the insurer was obligated to pay the settled benefits, and that the insurer's request for such proof did not warrant a special award.

However, the Delegate found the Arbitrator erred in denying interest on the delayed payments, ruling that interest is mandatory and compensatory under the Statutory Accident Benefits Schedule even when an insurer legitimately requests further information.

The appeal was allowed in part to award interest.

The defendant, Nicole Vandelden, brought a motion for summary judgment to dismiss the plaintiff's action arising from a motor vehicle incident.

The plaintiff opposed, arguing that credibility issues required a trial.

The court reviewed extensive evidence, including conflicting accounts from the parties and multiple witnesses, as well as police notes and surveillance video.

Despite the general principle that credibility should be assessed at trial, the court found that the independent witness's evidence was unassailable and unchallenged, making it an exceptional case where the paper record was sufficient to reach a fair and proportionate conclusion.

The defendant's motion for summary judgment was granted, and the action was dismissed.

The applicant, a two-year-old child, was injured in a collision with a Polaris ATV operated by a seven-year-old on vacant land.

The applicant sought statutory accident benefits.

The preliminary issue was whether the uninsured ATV was an 'automobile' under the Schedule, making the incident an 'accident'.

The arbitrator found that the ATV was an off-road vehicle required to be insured under the Off-Road Vehicles Act because the owner of the ATV was not an 'occupier' of the land where the collision occurred.

Therefore, the ATV met the statutory definition of an automobile, and the applicant was involved in an accident within the meaning of the Schedule.

The parties settled the applicant's claim for statutory accident benefits prior to the arbitration hearing, leaving only the issue of expenses to be determined.

The applicant sought $25,228.49 in fees and disbursements.

The arbitrator found that the applicant was entitled to expenses, but reduced the claimed amounts, noting that the matter was not complex and that certain disbursements for web-based document services were not recoverable.

The arbitrator fixed the applicant's expenses at $12,250.00, inclusive of fees, disbursements, and taxes.

The applicant was injured in a motor vehicle accident and applied for arbitration of her claims for statutory accident benefits.

The parties settled the claims on the eve of the hearing, with the insurer agreeing to pay the applicant's arbitration expenses.

The parties could not agree on the amount, leading to this hearing.

The arbitrator reduced the claimed legal fees, finding 50 hours reasonable instead of the claimed 62.625 hours, and deducted a small amount for parking and mileage from the disbursements.

The applicant was awarded $18,385.66 in fees and disbursements.

Following a partial settlement of the applicant's claims for statutory accident benefits, the parties could not agree on the quantum of expenses payable by the insurer.

The arbitrator assessed the applicant's legal fees and disbursements, reducing the claimed hours and applying a 40% reduction to account for work related to unsettled issues.

The arbitrator awarded $14,140.18 in expenses but allowed the insurer to set off $1,000 previously ordered against the applicant for a late disclosure adjournment, resulting in a net award of $13,140.18.

The insurer appealed a pre-hearing arbitrator's decision refusing its request for an order compelling the insured to attend further insurer examinations (IEs) and precluding the introduction of IE reports and surveillance evidence.

The Director's Delegate dismissed the appeal, finding that while the arbitrator erred in stating that the sole right an insurer has to conduct IEs is to adjust the file, the arbitrator made a factual finding that there was no evidence the request reflected any further need based on adjusting the file.

The Delegate also noted procedural deficiencies in the insurer's notices, which were sent under the wrong regulation.

The Delegate declined to interfere with the evidentiary rulings, noting that the hearing arbitrator is not bound by the pre-hearing arbitrator's decisions.

The applicants sought expenses following the resolution of an interim benefits motion regarding a motor vehicle accident claim.

The parties had agreed on interim benefits but could not agree on expenses.

The arbitrator reviewed the applicants' Bill of Costs, allowing 30 hours of counsel time at $150 per hour after deducting duplicative and premature claims.

Disbursements for reports were allowed up to the maximum under the Expense Regulation, and photocopying was permitted, while parking was disallowed.

The applicants were jointly awarded $19,846.22 in expenses, inclusive of HST.

The appellant was injured in a rear-end motor vehicle collision.

At trial, the jury found neither the appellant nor the respondent negligent, accepting evidence that an unknown driver cut in front of them and caused the sudden braking.

The appellant's action was dismissed.

On appeal, the appellant argued the unknown driver evidence should have been excluded because it was not pleaded.

The Court of Appeal dismissed the appeal, noting the evidence was known to the appellant and admitted without objection at trial.

The court also upheld the jury's assessment of damages as defensible based on the evidence of soft tissue injuries.