Jason H. Goodman

The applicant and the respondent insurer, Aviva, both requested reconsideration of a Licence Appeal Tribunal decision regarding statutory accident benefits.

The applicant alleged procedural fairness breaches and errors of law regarding the denial of attendant care benefits and the reliance on an untested expert report.

The Tribunal dismissed the applicant's request, finding no procedural unfairness as the applicant had not properly summonsed the expert, and no error in the adjudicator's requirement for detailed invoices to prove expenses were incurred.

Aviva's request for reconsideration was granted in part to correct a mathematical error in the calculation of a bad faith award, reducing the quantum to $7,263.45.

The applicant's request for costs was denied.

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

The respondent denied several treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant sustained a meniscal tear in his left knee as a result of the accident, removing him from the MIG.

The Tribunal approved four of the five disputed treatment plans for injections, chiropractic, and massage therapy, finding them reasonable and necessary for pain relief.

One chiropractic treatment plan was denied because the applicant failed to establish its reasonableness and necessity, relying solely on an argument that the respondent's denial letter was invalid.

The applicant was awarded interest on the approved plans but denied an award for unreasonable delay.

The applicant sought statutory accident benefits following a 2017 motor vehicle accident.

The respondent denied treatment plans for a neuro-optometric assessment, prolotherapy, and psychological services.

The Tribunal found the neuro-optometric assessment was not reasonable and necessary, as the supporting medical reports were either not contemporaneous or did not recommend further assessments.

The Tribunal approved the prolotherapy plan, preferring the in-person assessment of the applicant's physiatrist over the respondent's remote assessment.

The claim for the balance of psychological services was dismissed, as the applicant failed to justify the need for an updated assessment or the higher hourly rate for a psychotherapist.

The applicant sought judicial review of a Licence Appeal Tribunal (LAT) decision refusing to extend the limitation period for her claim for non-earner benefits.

The LAT Act limits appeals to questions of law, but the applicant sought judicial review on issues of mixed fact and law regarding her mental capacity.

Applying the framework from Yatar, the Divisional Court declined to hear the application, finding no exceptional circumstances to justify judicial review where the legislature intended to limit recourse to the courts.

The applicant requested a reconsideration of a previous Licence Appeal Tribunal decision that partially granted attendant care and chiropractic benefits but dismissed other claims.

The applicant argued the adjudicator violated procedural fairness and made errors of law and fact by improperly weighing medical evidence and failing to provide sufficient reasons.

The Vice-Chair dismissed the request, finding no violation of procedural fairness or errors of law or fact, noting that the applicant was attempting to re-litigate issues already decided.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that partially granted attendant care and chiropractic benefits but dismissed the remaining claims.

The applicant argued the adjudicator violated procedural fairness and made errors of law and fact by improperly weighing medical evidence and failing to provide sufficient reasons.

The Vice-Chair dismissed the request, finding that the original decision fully considered the evidence, provided adequate reasons, and contained no errors of law or fact.

The reconsideration request was deemed an attempt to re-litigate the issues.

The applicant was injured in a motor vehicle accident and deemed catastrophically impaired.

They sought various statutory accident benefits, including attendant care benefits, medical and rehabilitation expenses, and an award for unreasonable delay.

The Licence Appeal Tribunal found the applicant entitled to a reduced amount of attendant care benefits, case management services, and chiropractic treatment, as the insurer had previously approved or partially approved these amounts.

The remaining claims for assessments, assistive devices, and other treatments were dismissed for lack of medical evidence proving they were reasonable and necessary.

The Tribunal declined to make an award under section 10 of Regulation 664, finding the insurer did not unreasonably withhold or delay payments.

The applicant requested a reconsideration of a decision denying entitlement to a physiotherapy treatment plan.

The applicant argued the adjudicator erred in law by interpreting section 38(11) of the Statutory Accident Benefits Schedule to require that goods and services be incurred before an insurer is obligated to pay for them following a failure to provide timely notice under section 38(8).

The adjudicator dismissed the request, finding no error of law.

The adjudicator confirmed that section 38(11)(2) serves to compel timely responses from insurers but still requires the insured to actually incur the goods and services described in the treatment plan.

The applicant sought to dispute the respondent's denial of non-earner benefits (NEBs) approximately three years after the expiry of the two-year limitation period under s. 56 of the Statutory Accident Benefits Schedule.

The applicant argued that the limitation period should be extended under s. 7 of the Licence Appeal Tribunal Act due to her mental incapacity during the appeal period.

The Tribunal found that the respondent's denial was clear and unequivocal.

Applying the Manuel factors, the Tribunal concluded that the applicant failed to establish a bona fide intention to appeal within the limitation period, as no medical practitioner had recommended a capacity assessment at the time.

Given the significant delay and resulting prejudice to the respondent, the Tribunal held that the justice of the case did not warrant an extension of time.

The application was dismissed as statute-barred.

The applicant, a driver who was assaulted by his passengers after exiting his vehicle, sought reconsideration of a decision finding that the incident was not an 'accident' under the Statutory Accident Benefits Schedule.

The applicant argued the adjudicator erred in fact regarding the number of passengers and erred in law in applying the causation test.

The adjudicator dismissed the request for reconsideration, finding no factual error and confirming that the correct legal test from Chisholm was applied, which established that the assault was an intervening act and the direct cause of the injuries, not the use or operation of the automobile.

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

The respondent initially denied funding for physiotherapy and chiropractic treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

Prior to the hearing, the respondent conceded the injuries were not subject to the MIG.

The Tribunal found the applicant was entitled to a November 2016 physiotherapy plan as it was reasonable and necessary, but denied the October 2016 physiotherapy plan and May 2016 chiropractic plan.

Claims for an award and interest were also dismissed.

The applicant, a driver, was assaulted by his passengers after exiting his vehicle to retrieve his phone, which had been thrown out the window.

He applied for statutory accident benefits, claiming the incident was an "accident" under the Schedule.

The Tribunal found that while the "purpose test" was met, the "causation test" was not.

The assault occurred outside the vehicle after its use had ended, constituting an intervening act that broke the chain of causation.

The vehicle was not the dominant feature of the incident.

The application was dismissed.

The respondent's request for costs based on the applicant's prior adjournment requests was also dismissed, as the representative's actions were not unreasonable.

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits (IRBs) and the cost of a neuropsychological assessment.

The respondent insurer had terminated IRBs, alleging the applicant failed to provide requested income information, refused to answer questions at an examination under oath (EUO), and made a material misrepresentation about his employment status.

The Tribunal found that the applicant suffered a substantial inability to engage in the essential tasks of his pre-accident employment as a web designer due to post-traumatic headaches and ocular motor dysfunction.

However, the Tribunal also held that the respondent was entitled to withhold IRBs from June 15, 2016, onwards because the applicant failed to provide reasonably requested income information and refused to answer relevant questions at his EUO without a reasonable excuse.

The respondent's claim for repayment based on material misrepresentation was dismissed.

The Tribunal approved the treatment plan for the neuropsychological assessment and awarded interest on a limited period of overdue IRBs, but denied a special award.

The defendant moved to dismiss the plaintiff's 15-year-old personal injury action for delay and breach of court orders, primarily stemming from the plaintiff's failure to complete defence medical examinations.

The plaintiff, who had been self-represented for a significant period, refused to be examined by male doctors due to severe anxiety and later had conflicts with female examining doctors.

The court found the delay was inordinate but excusable given the circumstances, and that the defendant suffered no actual prejudice.

The motion to dismiss was denied, but the court ordered the plaintiff to attend a defence medical examination with a female specialist under strict conditions, including audio recording, warning that failure to comply would result in dismissal.

The defendant moved to dismiss the plaintiff's 15-year-old personal injury action for delay and breach of court orders, primarily due to the plaintiff's failure to complete defence medical examinations.

The plaintiff, who had been self-represented for a significant period, refused to be examined by male doctors due to severe anxiety stemming from a past assault, and later had confrontational interactions with female examiners.

The Master found the delay was inordinate but excusable under the circumstances, and that the defendant suffered no actual prejudice.

The motion to dismiss was denied, but the Master imposed strict terms for a final defence medical examination, including that it be conducted by a female specialist and be audio recorded.

The insurer, having successfully defended an appeal regarding whether the insured was injured in an accident, sought its expenses for the appeal proceeding.

The Director's Delegate found that the insurer was entirely successful and that the appeal had little chance of success.

The insurer was awarded its legal fees and disbursements fixed at $1,894.92.

The appellant appealed an arbitrator's preliminary issue finding that she was not injured in an accident pursuant to section 2 of the Statutory Accident Benefits Schedule.

The arbitrator had accepted the respondent's accident reconstruction expert evidence that the damage to the vehicles was inconsistent with the appellant's description of the collision, and found the appellant's testimony not credible.

On appeal, the Director's Delegate found no error requiring a rehearing, concluding that the arbitrator was entitled to weigh the evidence and determine that the appellant had not met her burden of proof to establish that an incident occurred.

The appellants appealed an order dismissing their action against the respondent employer.

The Court of Appeal allowed the appeal, finding that the appellants' claim was a separate and independent tort of negligent misrepresentation regarding the process to be followed in pursuing a claim, rather than a claim arising in respect of a worker's injury.

The order dismissing the action was set aside.