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Applicant found catastrophically impaired under Criterion 8 due to marked impairments in three functional domains.
The applicant sought a determination that he sustained a catastrophic impairment under Criterion 8 (mental or behavioural disorder) following a 2017 motor vehicle accident.
The Tribunal evaluated the four domains of function under the AMA Guides.
Preferring the evidence of the applicant's experts, the Tribunal found the applicant sustained marked impairments in Activities of Daily Living, Concentration, Persistence and Pace, and Adaptation.
As the applicant demonstrated marked impairment in three domains, he met the test for catastrophic impairment.
The claim for a section 10 award was dismissed as no specific benefits were ordered payable.
The court dismissed the motion to strike pleadings for late disclosure but awarded costs.
The court dismissed the applicant's motion to strike the respondent's pleadings and for other relief, finding such an order would be disproportionate given the circumstances.
While there was imperfect and late compliance with court orders, new counsel had recently produced substantial disclosure, and most outstanding disclosure was sufficiently explained.
The court ordered costs of $3,000 payable by the respondent to the applicant and made procedural orders to streamline the matter toward resolution or trial.
A plaintiff's settlement of their statutory accident benefits claim precludes an independent action for punitive damages against the initial insurer.
TD General Insurance Company (TD) brought a motion for summary judgment to dismiss claims for punitive and aggravated damages by the plaintiffs, Mergim Imeri et al.
The claims arose from TD's initial handling of statutory accident benefits (SABS) following a motor vehicle accident, before Aviva Canada Inc. was determined to be the appropriate insurer.
TD argued that the plaintiffs failed to mediate these damages as a precondition and that their settlement of the SABS claim with Aviva precluded an independent action against TD.
The court dismissed the mediation argument due to TD's failure to plead it as a condition precedent in a timely manner.
However, the court granted summary judgment on the second ground, holding that the plaintiffs' settlement of their SABS claim with Aviva, which included a full and final release, resolved the underlying entitlement to benefits.
Since the claim for punitive and aggravated damages against TD flowed directly from the alleged wrongful denial of benefits, and that underlying issue was settled, there was no longer a basis for the claim against TD.
The claim against TD was dismissed.
The court ordered primary residence with the mother and split decision-making, gradually increasing the father's parenting time.
This trial decision addresses parenting and child support for a four-year-old child born from a brief, high-conflict relationship.
The Mother sought primary decision-making and residence, while the Father sought equal shared parenting and a parallel parenting regime.
The court dismissed the Father's allegations of sexual assault against the Mother due to insufficient evidence.
The court determined that the child's primary residence would remain with the Mother, citing the child's stable environment and the impracticality of the Father's proposed school arrangements.
Decision-making was split, with the Mother having final say on health and education, and the Father on extracurricular activities, both requiring consultation.
The Father's parenting time was gradually increased, and child support was ordered based on the Father's income and imputed income for the Mother.
Default judgment granted for negligent unauthorized injection causing serious knee infection.
On a default judgment motion in a negligence action, the court found that an unauthorized knee injection administered by a practitioner who held himself out as a medical doctor caused a septic knee infection, surgery, prolonged impairment, and ongoing functional limitations.
The court accepted expert orthopedic evidence establishing causation, breach of the standard of care, lack of informed consent, and the impropriety of intra-articular vitamin B12 injections.
Damages were awarded for pain and suffering, Family Law Act claims, past and future medical care, prejudgment interest, and costs.
Punitive damages were also awarded because the defendant deliberately misrepresented his qualifications and knowingly engaged in prohibited and unauthorized conduct in reckless disregard of the consequences.
A provincial court judge loses jurisdiction to complete a Provincial Offences Act trial upon appointment to the Superior Court.
A provincial court judge presiding over a lengthy trial involving charges under the Occupational Health and Safety Act arising from a stage collapse at a Radiohead concert in Toronto was appointed to the Superior Court of Justice mid-trial.
The Crown argued the judge retained jurisdiction to complete the trial under the Provincial Offences Act, while the defence argued the appointment resulted in loss of jurisdiction.
The court found that the judge had lost jurisdiction to continue the trial, as the Provincial Offences Act lacks a provision comparable to section 669.3 of the Criminal Code permitting continuing jurisdiction upon appointment to another court.
A new trial was ordered.
The court dismissed the defendants' section 11(b) Charter applications, finding the 44-month delay justified by the case's complexity and transitional exceptional circumstances.
Defendants charged with offences under the Occupational Health and Safety Act brought applications alleging violations of their Charter right to trial within a reasonable time under section 11(b).
The court applied the new framework established in R. v. Jordan, determining that while the net delay of approximately 44 months exceeded the 18-month presumptive ceiling for Ontario Court of Justice trials, the Crown established exceptional circumstances justifying the delay.
The court found the case was particularly complex due to the nature of the evidence and issues involved, and that the transitional exceptional circumstance applied to cases in the system when Jordan was released.
The applications were dismissed.
Engineers who investigated a fatal stage collapse are qualified to give expert evidence.
This is a trial decision on a voir dire regarding the admissibility of expert evidence in a prosecution under the Occupational Health and Safety Act arising from a stage collapse at a concert venue that resulted in a fatality.
The defendant Live Nation Canada Inc. challenged the qualification of two Ministry of Labour engineers to provide expert opinion evidence on the cause of the stage collapse.
The court found that both experts met the threshold requirement to testify, applying the test established in White Burgess v. Abbott and Haliburton Co. The court rejected arguments that the experts' involvement in the investigation, their employment relationship with the Ministry of Labour, and their participation in interviews with defendants undermined their independence and impartiality.
Slip-and-fall claim failed because breach and mechanism of fall were not proven.
The plaintiff sought damages after a fall from an apartment building fire escape, alleging breach of the Occupiers’ Liability Act and the Fire Code due to accumulated snow and ice.
The court held that fire escapes must be kept safe for emergency use and that the occupier’s duty was not negated merely because tenants used the area for smoking, but found the defendants had a reasonable winter maintenance system in place.
The plaintiff failed to prove on a balance of probabilities that ice on the fire escape caused the fall, particularly given credibility problems, inconsistent accounts of the accident, and photographic and witness evidence inconsistent with the alleged icy condition.
The action was dismissed.
The court nevertheless assessed hypothetical damages totalling substantial non-pecuniary, loss of competitive advantage, future care, and OHIP subrogated amounts.
Late expert report and speculative demonstrative video excluded during personal injury trial.
During a personal injury trial arising from a fall from an apartment building fire escape, the plaintiff sought to have a neuro‑psychiatrist provide an opinion on the mechanism of the head injury and introduce an animated demonstrative video illustrating a coup‑contrecoup brain injury.
The court ruled that the late‑served expert report failed to comply with Rule 53.03 of the Rules of Civil Procedure and would prejudice the defence if admitted during trial.
The court also held that, although the witness was qualified in neuro‑psychiatry, he was not properly qualified to opine on the mechanism of the accident, which was a liability issue better addressed by engineering experts.
The proposed demonstrative video was excluded because it was hypothetical and not grounded in evidence adduced at trial.
The expert was limited to giving evidence within the scope of his earlier reports concerning the plaintiff’s neuro‑psychiatric injuries.
Interest on accident benefits runs from first overdue date despite insurer’s earlier payments.
Following a jury verdict in a statutory accident benefits action, the court determined post‑trial issues concerning transportation expense deductibles, interest on overdue benefits, and costs.
The insurer argued that the statutory 50‑kilometre deductible applied to transportation expenses and sought to call additional evidence, but the court refused and held the deductible did not apply because the insurer had waived it and the insured was unable to drive during the relevant period.
On the issue of interest under the Statutory Accident Benefits Schedule, the court applied appellate authority holding that interest on overdue benefits runs from the date the benefit first became overdue, even if the insurer did not know the correct amount at the time.
The court also considered competing offers to settle and concluded that the plaintiff was the successful party overall.
Costs were awarded to the plaintiff on a partial indemnity basis.
Municipality found grossly negligent for icy sidewalk; plaintiff's severe injury provided reasonable excuse for late notice.
The appellant suffered a fractured ankle after slipping on an icy municipal sidewalk.
He failed to give the required 10-day notice to the municipality under the Municipal Act, 2001, only providing notice months later after consulting a lawyer.
The trial judge dismissed the action, finding no reasonable excuse for the late notice and no gross negligence by the municipality.
The Court of Appeal reversed, holding that the appellant's severe injury, medication, and resulting depression constituted a reasonable excuse for the delay.
Furthermore, the municipality's failure to salt the sidewalks for nearly 34 hours after becoming aware of dangerous conditions amounted to gross negligence.
Insurer's appeal of non-earner benefits dismissed; arbitrator's credibility findings and weighing of evidence entitled to deference.
The insurer appealed an arbitrator's decision awarding the insured non-earner benefits, prescription costs, and the cost of a medical report following a motor vehicle accident.
The insurer argued the arbitrator erred by relying on the evidence of the insured's husband, who had previously assisted the insured in providing inaccurate histories to medical assessors.
The Director's Delegate dismissed the appeal, finding that the arbitrator's credibility assessments and weighing of the evidence were fact-driven determinations entitled to deference.
The arbitrator had a sufficient evidentiary basis, including evidence from the treating psychologist and the insurer's own examining psychiatrist, to conclude that the accident significantly exacerbated the insured's pre-existing depression and prevented her from engaging in substantially all of her pre-accident activities.
Insurer's appeal of a $50,000 special award dismissed; egregious adjusting practices justified the maximum penalty.
The insurer appealed an arbitrator's decision granting a $50,000 special award to the respondent for unreasonably withholding accident benefits following the death of a pedestrian.
The insurer argued the arbitrator erred in law by imposing the award and in calculating its quantum, contending the evidence of an 'accident' was equivocal.
The Director's Delegate dismissed the appeal, finding the special award was justified not by the ultimate evidence, but by the insurer's egregious adjusting practices, including failing to investigate, ignoring evidence, and allowing tort considerations to influence the first-party claim.
The quantum of the award was upheld as rationally related to the misconduct and necessary for deterrence.
Insurer ordered to produce adjuster log notes up to the date of the last mediation application.
The applicant sought production of the insurer's adjuster log notes beyond the date of the first Application for Mediation.
The insurer argued that notes created after the first mediation application were protected by litigation privilege and irrelevant.
The Arbitrator ordered production of the log notes up to the date of the last Application for Mediation, finding that the notes were potentially relevant to the applicant's claim for a special award and that the insurer failed to establish litigation privilege over notes relating to issues that were not yet the subject of a mediation application.
Special awards under s. 282(10) of the Insurance Act must be expressed as a specific lump sum, not a percentage.
Liberty Mutual appealed an arbitration order requiring it to pay a special award under s. 282(10) of the Insurance Act for unreasonably withholding or delaying the payment of statutory accident benefits.
The Arbitrator had ordered a special award expressed as a percentage of the benefits owing.
On appeal, the Director of Arbitrations held that the percentage approach was inappropriate and that special awards must be expressed as a specific lump sum amount.
The Director also found the order was too vague to be enforceable.
Liberty Mutual's argument that the use of full-time government employees as arbitrators raised a reasonable apprehension of institutional bias was dismissed.
The appeal was allowed in part, the special award paragraph was rescinded, and the Director remained seized to determine the appropriate lump sum amount.
Arbitrator erred by deciding a new issue raised during final submissions without giving the insurer an opportunity to respond.
The insured was involved in a motor vehicle accident and received weekly income benefits.
A dispute arose regarding her entitlement to benefits beyond the 156-week mark and whether she had been overpaid due to the receipt of collateral benefits.
At arbitration, the insured argued for the first time during final submissions that her collateral benefits were not deductible.
The Arbitrator agreed and ordered the insurer to pay additional benefits.
On appeal, the Director of Arbitrations held that the Arbitrator erred in deciding the deductibility issue without giving the insurer an adequate opportunity to respond, as it was raised too late and constituted a denial of fairness.
The insurer's appeal was allowed, and the insured's appeal regarding interest was dismissed.
Claim for post-156 week income benefits dismissed due to surveillance evidence contradicting claimed disability.
The applicant was injured in a motor vehicle accident and received statutory accident benefits.
The insurer terminated weekly income benefits after 156 weeks.
The applicant sought ongoing benefits, claiming she was continuously prevented from working as a dressmaker due to chronic pain and fibromyalgia.
The arbitrator dismissed the claim for ongoing benefits, relying heavily on surveillance evidence that contradicted the applicant's reported functional limitations.
However, the arbitrator found that collateral benefits received by the applicant from private disability policies were not deductible from her pre-156 week income benefits, ordering the insurer to pay the shortfall with interest.
Insurer's request for an orthopaedic examination denied as not reasonably necessary given prior specialist assessments.
The applicant was injured in a motor vehicle accident and applied for statutory accident benefits.
The insurer terminated income replacement benefits and, over four years later, requested that the applicant undergo a medical examination by an orthopaedic surgeon under section 42 of the Statutory Accident Benefits Schedule.
The applicant refused, arguing the examination was not reasonably necessary.
The arbitrator found that the insurer had already conducted multiple assessments by other specialists, including a neurosurgeon and an occupational medicine physician, none of whom recommended an orthopaedic evaluation.
The insurer failed to establish that the proposed examination was reasonably necessary or that its previous assessments were not meaningful evaluations of the applicant's physical condition.
The insurer's request was denied, and the applicant was awarded the expenses of the preliminary issue hearing.
Motion by intervenor to admit affidavit evidence regarding institutional bias in arbitration system granted.
The Ministry of Finance, acting as an intervenor, brought a motion to introduce new evidence in the form of an affidavit from a former Director of Arbitrations.
The underlying appeal involved a challenge by the insurer to the dispute resolution system based on alleged institutional bias.
The insurer and another intervenor objected to portions of the affidavit referring to historical reports and special award statistics.
The Director of Arbitrations allowed the motion, finding the historical context relevant to the institutional bias issue and noting that the insurer had the opportunity to cross-examine the affiant.
The affidavit was admitted in its entirety.