Jennifer Lynn Beresford

The applicant sought funding for a treatment plan for chiropractic treatment, massage therapy, and assistive devices following a motor vehicle accident.

The insurer denied the treatment plan on the basis that the applicant was subject to the Minor Injury Guideline (MIG) at the time the plan was submitted.

The Tribunal found that under section 38(5) of the Statutory Accident Benefits Schedule, the insurer was entitled to refuse the treatment plan because it was submitted while the applicant was receiving goods and services under the MIG.

Consequently, section 38(6) prevented the Tribunal from reviewing the denial.

The application was dismissed.

The applicant requested a reconsideration of a Tribunal decision that denied her claim for income replacement benefits, the cost of an accounting report, an award, and costs following a motor vehicle accident.

The applicant argued the Tribunal made significant errors of fact and law by failing to appreciate her psychological impairments and by not assigning appropriate weight to her evidence.

The adjudicator dismissed the request, finding that the Tribunal had carefully weighed the totality of the evidence, including the psychological impairments, and provided sound reasons for its conclusions.

The adjudicator held that the reconsideration process is not an opportunity to re-weigh evidence or give an unsuccessful party a second chance to have their case heard.

The applicant brought a motion to extend the time for her to appeal an order of Speyer J. dated June 8, 2018.

The motion judge found that the order of Speyer J. was not an appeal from a prior order but rather a motion heard by a single judge of the Divisional Court.

Consequently, any appeal of Speyer J.'s order would lie to a panel of the Divisional Court, not to the Court of Appeal for Ontario.

The motion judge therefore lacked jurisdiction to grant an extension of time for appeal and dismissed the motion without costs.

The respondent insurer requested a reconsideration of a Licence Appeal Tribunal decision regarding the applicant's entitlement to income replacement benefits and interest following a motor vehicle accident.

The Vice-Chair found that the original adjudicator violated Rule 18.2 by issuing an unclear order regarding the timeframe for income replacement benefits and by making an error of law in determining that interest on medical benefits was payable from the date the treatment plan was submitted rather than when the expense was incurred.

The request for reconsideration was granted in part, and the decision was referred back to the original adjudicator for amendment.

The applicant sought income replacement benefits (IRBs) and the cost of examinations following a minor rear-end motor vehicle accident.

The respondent insurer terminated IRBs after the applicant returned to work, arguing that her subsequent periods off work were due to pre-existing conditions, a shortage of work, and a subsequent work-related injury.

The Tribunal applied the "but for" test for causation and found that the applicant's ongoing impairments were not caused by the accident.

The Tribunal noted significant credibility issues, as the applicant provided inaccurate histories to her medical assessors regarding her prior neck pain and subsequent workplace injury.

The Tribunal preferred the evidence of the respondent's experts and concluded the applicant did not meet the tests for substantial inability or complete inability to work.

The claims for IRBs, an accounting report, a special award, and costs were dismissed, though the applicant was awarded $200 for a disability certificate.

The parties cross-appealed an Arbitrator's decision awarding the insured person all claimed accident benefits, interest, expenses, and a special award.

The Director's Delegate found that the Arbitrator correctly ordered payment of medical benefits and income replacement benefits (IRBs) where the insurer completely failed to respond to the claims, pursuant to the plain meaning of the Statutory Accident Benefits Schedule.

However, the Arbitrator erred in ordering payment where the insurer's response was merely deemed improper, and in failing to calculate the net amount of IRBs payable after deducting post-accident income.

The Delegate also found that while a special award was justified due to the insurer's unreasonable delay, the Arbitrator erred by failing to fix the amount of the award with precision.

Several issues, including the quantum of IRBs and the special award, were remitted for re-hearing.

Following an arbitration hearing where the insurer was substantially successful, the insurer sought its expenses.

The arbitrator found that the applicant's claims for income replacement and medical benefits were vexatious and improper, and that the applicant had unduly prolonged the proceedings by failing to produce documents.

The applicant was ordered to pay the insurer's expenses and disbursements for the hearing, excluding the pre-hearing conference, fixed at $23,055.31.

Each party was ordered to bear their own expenses for the expense hearing.

The applicant was injured in two motor vehicle accidents and applied for statutory accident benefits.

The insurer placed her in the Minor Injury Guideline (MIG) and denied various medical benefits, income replacement benefits (IRBs), and non-earner benefits (NEBs).

The arbitrator found that the insurer consistently failed to comply with the notice requirements under the Statutory Accident Benefits Schedule.

As a result, the insurer was prohibited from taking the position that the MIG applied and was ordered to pay the claimed medical benefits, IRBs, and NEBs.

The arbitrator also found that the insurer unreasonably withheld or delayed payments and ordered a special award of 50 per cent of the amounts owed, plus interest.

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

The insurer initially paid some benefits but later terminated them, arguing the applicant suffered only minor injuries and was capable of working.

The arbitrator found that the applicant was entitled to IRBs for a limited period from August 2013 to October 2013, as he had returned to work thereafter and failed to prove a complete inability to engage in employment.

The claims for further medical benefits were dismissed because the insurer had already paid the $50,000 policy limit after conceding the applicant's pre-existing condition removed him from the Minor Injury Guideline.

Interest was awarded on benefits that the insurer had delayed paying.

The applicant sought statutory accident benefits, including caregiver benefits, attendant care benefits, and the cost of a psychological assessment, following a motor vehicle accident.

The arbitrator dismissed all claims, finding the applicant lacked credibility due to pervasive inconsistencies in his evidence regarding his employment status, living arrangements, and caregiving responsibilities.

The arbitrator concluded the applicant's self-reports to assessors were unreliable, undermining the medical reports supporting his claims.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming his injuries fell outside the Minor Injury Guidelines (MIG) due to chronic pain and psychological impairments.

The arbitrator found the applicant lacked credibility, having provided inconsistent and inaccurate information to various medical assessors, including failing to disclose a subsequent eye surgery.

The arbitrator concluded the applicant did not prove his injuries fell outside the MIG.

Consequently, the claims for multidisciplinary treatment plans and a psychological assessment were dismissed.

The applicant was also ordered to repay an erroneous payment of $135.60 to the insurer.