Joanne Witt

The applicant sought an award under section 10 of Regulation 664, arguing the respondent insurer unreasonably delayed approving his catastrophic impairment designation until a case conference.

The Tribunal dismissed the claim for an award, finding the insurer's initial reliance on its own assessments was not imprudent or stubborn, and the Schedule does not require medical reasons for approving a designation.

However, the Tribunal awarded the applicant $500 in costs because the respondent misrepresented at the case conference that the reasons for the reversal would be found in the adjuster's log notes.

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

The respondent denied the claims and requested the applicant attend insurer's examinations under s. 44 of the Schedule.

The applicant failed to attend the scheduled examinations and provided no reasonable explanation for his non-attendance.

The Tribunal held that the applicant was barred from proceeding with his claims for attendant care benefits and vestibular physiotherapy.

The Tribunal further dismissed the claim for an occupational therapy treatment plan, finding the applicant failed to prove it was reasonable and necessary.

Claims for interest and a special award were also dismissed.

The applicant sought entitlement to statutory accident benefits for psychological and physiotherapy treatment plans, a general practitioner's assessment, and a special award following a 2019 motor vehicle accident.

The Licence Appeal Tribunal found the applicant was partially entitled to one psychological treatment plan, preferring the treating psychiatrist's clinical notes over the respondent's section 44 assessor.

The remaining psychological and physiotherapy plans were denied as the applicant failed to prove they were reasonable and necessary, with the Tribunal finding the applicant had reached maximum medical improvement physically.

The claim for the general practitioner's assessment was barred by issue estoppel from a previous Tribunal decision.

No special award was granted as the insurer's conduct was not unreasonable.

The applicant, a minor injured in a motor vehicle accident, sought payment for two treatment plans for physical medical and oculo-visual services.

The respondent insurer initially provided non-compliant notices of denial under s. 38(8) of the Statutory Accident Benefits Schedule but later provided compliant notices following insurer's examinations.

The Tribunal found that while the initial non-compliance triggered the 'shall pay' provision of s. 38(11)2, the applicant had not incurred any expenses during the relevant period, relying on the Divisional Court's decision in Catic.

The applicant also failed to provide evidence that the treatment plans were reasonable and necessary.

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

The applicant sought statutory accident benefits for oculo-visual treatment and physical therapy following a motor vehicle accident.

The respondent denied the treatment plans.

The applicant argued the denial notices were procedurally defective under s. 38(8) of the Schedule but made no submissions on the substantive reasonableness and necessity of the treatments.

The Tribunal found the respondent's denial notices were compliant with the Schedule, providing clear medical and other reasons.

As the applicant failed to establish the treatments were reasonable and necessary, the claims were dismissed, along with claims for interest and an award.

The applicant sought $3,445.28 for physical therapy services following a motor vehicle accident.

The insurer denied the treatment plan, and the applicant argued the denial letter failed to provide adequate medical reasons under s. 38(8) of the Schedule.

The Tribunal found the insurer's reasons were adequate and specific to the applicant's condition.

Because the applicant provided no evidence or submissions to demonstrate the treatment was reasonable and necessary, the claim was dismissed.

Claims for interest and a special award were also dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit and several treatment plans.

The Tribunal found the respondent's denial of the non-earner benefit lacked medical reasons, rendering it non-compliant with s. 36(4) of the Schedule, and awarded the benefit from January 13, 2022, to September 2, 2023, with interest.

However, the Tribunal found the respondent's denial notices for the treatment plans were compliant with s. 38(8) and that the applicant failed to prove the plans were reasonable and necessary.

The claim for an award under s. 10 of Reg. 664 was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, which the respondent insurer initially denied on the basis that the incident was an assault and not an 'accident'.

After a preliminary decision found the incident was an accident, the matter proceeded to a hearing on substantive benefits.

The Tribunal dismissed the claims for income replacement benefits, transportation expenses, and assistive devices, finding the applicant failed to meet his burden of proof.

However, the Tribunal granted the claim for occupational therapy services because the respondent's denial did not comply with the requirements of s. 38(8) of the Schedule.

The claim for a special award was dismissed, but interest was awarded on any overdue benefits.

The applicant was injured in a motor vehicle accident and sought various statutory accident benefits, including multiple treatment plans for physiotherapy, a TENS unit, a chronic pain program, and various assessments.

The respondent insurer denied the benefits, arguing the physical injuries were minor and the applicant had reached maximum medical recovery.

The Tribunal found that five of the physiotherapy treatment plans were reasonable and necessary, and that one of the respondent's denial notices failed to comply with the medical reasons requirement under s. 38(8) of the Schedule.

However, the Tribunal dismissed the claims for the remaining treatment plans, finding insufficient evidence to support them.

The Tribunal also denied the applicant's request for a special award under s. 10 of Reg. 664, finding no unreasonable withholding or delay by the respondent.

The applicant sought statutory accident benefits following a motor vehicle accident but failed to attend the videoconference hearing or file any evidence.

The respondent moved to dismiss the application as abandoned and sought costs.

The Tribunal denied the motion to dismiss as abandoned, opting to proceed on the merits.

Because the applicant provided no evidence, the Tribunal found he failed to meet his evidentiary burden and dismissed the claims for benefits.

The Tribunal also denied the respondent's request for costs, finding that the applicant's failure to attend did not amount to unreasonable, frivolous, or vexatious conduct warranting a costs award.

The applicant, a taxi driver, sought statutory accident benefits after an unidentified pedestrian shattered his driver's side window, causing glass to enter his eyes.

The respondent insurer denied benefits, arguing the incident was an assault and not an 'accident' under s. 3(1) of the Schedule.

The Tribunal applied the purpose and causation tests, finding that the vehicle was being used for its ordinary purpose and that the vehicle itself was the instrument of injury.

The Tribunal concluded the incident met the definition of an accident and ordered the matter to proceed to a substantive hearing.

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

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued for removal from the MIG based on chronic pain and psychological impairments.

The Tribunal found insufficient medical evidence of functional impairment arising from chronic pain or psychological injuries, preferring the respondent's insurer's examinations over the applicant's medical reports.

The application was dismissed, and the applicant was found not entitled to the disputed treatment plans, interest, or an award.

The defendant brought a motion pursuant to Rule 6.01 of the Rules of Civil Procedure to have two actions arising from the same motor vehicle accident tried together.

The parties in both actions consented to the order.

The court granted the motion, finding that the actions arose out of the same occurrence and that it was in the interests of justice for them to be tried together or one after the other.

The appellant appealed a summary judgment decision that found the respondent not liable in a multi-vehicle motor vehicle accident.

The motion judge had relied on the appellant's evidence, another witness, and the accident report, while rejecting the respondent's own evidence about her position in the queue due to inconsistencies with physical damage.

The Court of Appeal found no palpable and overriding error and dismissed the appeal, awarding costs to the respondents.

A third party brought a motion for summary judgment seeking dismissal of a third party claim arising from a multi-vehicle collision on the Gardiner Expressway.

The moving party relied primarily on an affidavit sworn by counsel that included excerpts from police reports and discovery transcripts, including the moving party’s own discovery evidence.

The court held that such evidence was largely inadmissible under the Rules of Civil Procedure and noted the absence of direct affidavit evidence from the moving party with personal knowledge of the events.

Given conflicting evidence about whether the third party caused the defendant to swerve and lose control, the court concluded that there was a genuine issue requiring a trial.

The motion for summary judgment was therefore dismissed and costs were awarded against the moving party.

The applicant alleged discrimination on the basis of age, race, ethnic origin, and colour after his insurer determined he was 100% at fault for an automobile accident under the Fault Determination Rules, despite a police officer stating he did not cause the accident.

The Tribunal held a summary hearing to determine if the application had a reasonable prospect of success.

The Tribunal dismissed the application, finding that the applicant provided no evidence linking the insurer's fault determination to any prohibited ground under the Human Rights Code.

The applicant sought to amend a pre-hearing report to remove the issues of quantum and repayment of income replacement benefits, arguing they were not part of her original application for arbitration.

The arbitrator dismissed the motion, holding that under section 282(3) of the Insurance Act, the arbitrator must determine all issues in dispute, whether raised by the insured or the insurer.

The issues of quantum and repayment were found to be genuine disputes that naturally flowed from the applicant's claim for entitlement, and their inclusion would prevent multiple proceedings.