172 total
Reconsideration partially granted to correct error on benefit time limits; Charter challenge regarding psychiatric impairment assessment dismissed.
The applicant requested reconsideration of a decision denying her claim for catastrophic impairment and various medical benefits following a motor vehicle accident.
She also filed a Notice of Constitutional Question, arguing the Tribunal's assessment of her psychiatric impairments violated s. 15(1) of the Charter.
The Vice-Chair granted the reconsideration in part, finding the Tribunal erred in denying six treatment plans based on the 260-week limit, as the respondent had previously admitted the policy allowed for 10 years of benefits.
A written rehearing was ordered for those six plans.
The reconsideration was otherwise dismissed, as the Tribunal made no error in its causation analysis for catastrophic impairment or its strict application of s. 38(2) for living accommodations.
The Charter challenge was also dismissed, as the Tribunal's causation analysis did not constitute adverse-effect discrimination against individuals with mental disabilities.
Tribunal awards IRBs finding no wilful misrepresentation of cash employment, but denies unsupported treatment plans.
The applicant sought statutory accident benefits following a motor vehicle accident.
The respondent denied income replacement benefits (IRBs), alleging the applicant wilfully misrepresented his pre-accident employment and income.
The Tribunal found no wilful misrepresentation, noting the applicant's language difficulties and reliance on his employer's cash payment and tax remittance practices.
The Tribunal awarded IRBs based on the applicant's CRA Notice of Assessment and medical evidence showing a substantial inability to perform his pre-accident heavy labour tasks.
Claims for a vision assessment and a recliner chair were dismissed for lack of contemporaneous medical evidence.
A claim for a special award was also dismissed.
Applicant denied catastrophic impairment designation due to lack of causation but awarded pre-260-week treatment plans.
The applicant sought statutory accident benefits following a 2016 motor vehicle accident, claiming catastrophic impairment under criterion 8 due to mental and behavioural disorders.
The Tribunal found the applicant was not catastrophically impaired, as she failed to establish that her psychological impairments would not have occurred 'but for' the accident, noting a significant time gap and high level of functioning in the intervening years.
The Tribunal granted entitlement to several treatment plans for occupational therapy, assistive devices, and assessments incurred prior to the 260-week mark, but denied plans submitted after that period and denied the claim for living accommodations due to non-compliance with section 38(2) of the Schedule.
The claim for a special award was also dismissed.
Motion to strike jury notice dismissed because corrective instructions cured defence counsel's improper closing arguments.
The court dismissed a motion to strike the jury notice following closing arguments in a negligence trial arising from a motor vehicle accident.
The plaintiffs objected to 19 statements made by defence counsel in his closing address, alleging they were inflammatory, invited improper reasoning, misstated the law, and appealed to emotion.
The court found some statements objectionable but determined that corrective jury instructions were sufficient to remedy any prejudice, making discharge of the jury unnecessary.
The jury subsequently found the defendants liable in negligence, apportioning liability at 93% to one defendant and 7% to the other.
A driver owes an established duty of care to other road users, even when another driver unlawfully attempts to pass them.
Three consolidated civil actions arose from a motor vehicle accident on April 22, 2016, near Stouffville, Ontario, involving three vehicles.
The defendant Rae argued he owed no duty of care to the plaintiffs.
The court ruled on the duty of care issue at the close of the plaintiffs' case, finding that Rae owed a duty of care to all plaintiffs as a driver to other users of the roadway.
The court applied established jurisprudence recognizing the duty of care owed by drivers to other road users and rejected Rae's arguments based on the distinction between nonfeasance and misfeasance, finding that driving is a heavily regulated activity and that the duty of care exists regardless of whether specific statutory obligations apply to the particular conduct alleged.
Appeal dismissed as an abuse of process; LAT lacks jurisdiction to award tort damages against non-insurers.
The applicant/appellant commenced a second application to the Licence Appeal Tribunal (LAT) seeking damages and declaratory relief against her insurer and various non-insurer parties for alleged tortious conduct related to her statutory accident benefits (SABS) claims.
The LAT dismissed the application for lack of jurisdiction, noting it had no authority to award damages or make orders against non-insurers.
The applicant/appellant appealed to the Divisional Court.
The Court issued a notice under Rule 2.1.01 of the Rules of Civil Procedure and subsequently dismissed the proceedings as frivolous, vexatious, and an abuse of process, finding that the LAT lacks statutory jurisdiction to grant the requested relief and that the proceedings were an impermissible collateral attack on a prior final LAT decision.
Reconsideration dismissed; Tribunal lacks jurisdiction to award common law damages for torts in accident benefits disputes.
The applicant requested a reconsideration of a Licence Appeal Tribunal decision that dismissed her application without a hearing.
The applicant had sought damages for torts, including intimidation, against the insurer and other named respondents.
The Vice-Chair dismissed the reconsideration request, finding no error of law or fact in the initial determination that the Tribunal lacks jurisdiction to award common law damages or punitive damages.
The Tribunal reaffirmed that its remedial powers are limited to those granted by statute, such as deeming benefits incurred or making special awards, and do not extend to tort damages.
Application not barred; insurer's notices of examination failed to provide required medical and other reasons.
The respondent insurer raised a preliminary issue, arguing the application should be barred under s. 55 of the Schedule because the applicant failed to attend scheduled occupational therapy and neurology insurer's examinations.
The Tribunal found that the respondent's notices of assessment failed to provide the mandatory medical and other reasons for the examinations, as required by s. 44(5)(a) of the Schedule.
Because the notices were non-compliant, the applicant was not obligated to attend the examinations and is not barred from proceeding to a hearing.
The court dismissed the defendant's motion to compel defence medicals and serve late expert reports due to an unreasonable explanation for delay.
The court considered a motion by the defendant to compel the plaintiff to attend two defence medicals and to permit late service of expert reports in a motor vehicle accident case.
The court found the defendant's explanation for delay unreasonable and dismissed the motion, except for allowing late service of a neurology report, as the plaintiff did not oppose that part.
The court emphasized the importance of timely expert report exchange and the consequences of litigation strategy that delays compliance with the rules.
Accident benefits largely denied and $3,000 repayment ordered due to wilful misrepresentation and surveillance evidence.
The applicant sought various statutory accident benefits following a motor vehicle accident.
The Tribunal found the applicant was barred from claiming a non-earner benefit because she ought reasonably to have known her vehicle was uninsured at the time of the accident.
Claims for attendant care benefits and most treatment plans were denied, as medical and surveillance evidence demonstrated her injuries had healed and her presentation was exaggerated.
The Tribunal ordered the applicant to repay $3,000 in attendant care benefits, finding she wilfully misrepresented the extent of services received from personal support workers.
The applicant was awarded $80 for the outstanding balance of an assistive devices treatment plan.
Accident benefits claim dismissed; surveillance evidence and symptom magnification undermined applicant's self-reported inability to work.
The applicant sought statutory accident benefits, including income replacement benefits (IRBs) and funding for seven physiotherapy treatment plans, following a motor vehicle accident.
The Licence Appeal Tribunal dismissed the application in its entirety.
The adjudicator found the applicant's self-reporting to medical assessors unreliable due to symptom magnification and surveillance evidence showing the applicant working long hours at a restaurant.
Consequently, the applicant failed to prove a substantial inability to perform the essential tasks of his employment for pre-104 week IRBs, or a complete inability to engage in any employment for post-104 week IRBs.
The physiotherapy plans were deemed not reasonable and necessary, as the applicant contemporaneously reported to his family doctor that the treatments were ineffective.
Reconsideration granted and new hearing ordered based on new medical evidence of applicant's incapacity.
The applicant requested a reconsideration of a Licence Appeal Tribunal decision that dismissed her application for catastrophic impairment benefits.
The original application was dismissed after the applicant's counsel, following instructions from the applicant, refused to proceed with the hearing due to concerns about her capacity.
On reconsideration, the applicant introduced a new psychological report opining that she lacked the capacity to instruct counsel during the hearing.
The Tribunal found this report constituted new evidence that could not have been obtained previously and would likely have affected the result.
The reconsideration was granted, the original decision was cancelled, and a new hearing was ordered.
The applicant's requests for costs and a caution against respondent's counsel were denied.
Reconsideration granted and new hearing ordered due to Tribunal's error in applying the causation test.
The applicant requested a reconsideration of a previous Tribunal decision which found he was not involved in an 'accident' under the Statutory Accident Benefits Schedule.
The applicant argued the Tribunal erred in law by focusing on inconsistencies in his testimony regarding his injuries and seatbelt use, rather than applying the proper causation test.
The Vice-Chair agreed, finding the Tribunal erred in its treatment of the causation test from Greenhalgh, and that this error likely affected the outcome.
The reconsideration was granted, the previous decision cancelled, and a new hearing ordered.
Applicant designated catastrophically impaired due to accident-related psychological impairments and awarded ongoing income replacement benefits.
The applicant was injured in a motor vehicle accident and sought a determination of catastrophic impairment based on mental or behavioural impairments, as well as ongoing income replacement benefits and medical/rehabilitation benefits.
The Tribunal found that the applicant sustained a catastrophic impairment under Criterion 8, as the accident exacerbated her pre-existing mental health issues, resulting in marked impairments in activities of daily living, concentration, persistence and pace, and adaptation.
The Tribunal also found the applicant entitled to a post-104-week income replacement benefit, concluding she suffered a complete inability to engage in suitable employment due to her psychological impairments.
Claims for social rehabilitation counselling and a separate file review fee for a catastrophic assessment were dismissed as not reasonable and necessary.
Reconsideration granted and new hearing ordered due to error of law in applying accident causation test.
The applicant requested a reconsideration of a Licence Appeal Tribunal decision which found he was not involved in an 'accident' under the Statutory Accident Benefits Schedule and ordered him to repay medical and rehabilitation benefits.
The Vice-Chair granted the reconsideration, finding that the original adjudicator erred in law by focusing on the consistency of the applicant's testimony and seatbelt use rather than properly applying the causation test from Greenhalgh.
The original decision was cancelled and a new hearing in writing was ordered.
Tribunal partially approves $19,097 CAT assessment plan, awarding $9,266 for reasonable and necessary components.
The applicant sought statutory accident benefits following a 2019 motor vehicle accident, specifically a $19,097.00 treatment plan for a catastrophic impairment (CAT) assessment and an award for unreasonable delay.
The Tribunal found the applicant was entitled to $9,266.00 for the CAT assessment, approving the physiatry, psychiatry, and occupational therapy components, but denying duplicative or premature elements like the intake assessment and OCF-19 completion.
The Tribunal admitted several late or disputed medical reports, finding them relevant and not prejudicial.
The claim for a special award was dismissed as the insurer's denial was not unreasonable, though interest was awarded on the overdue assessment costs.
Application for accident benefits dismissed after applicant refused to present evidence and raised meritless procedural motions.
The applicant sought statutory accident benefits, claiming a catastrophic impairment.
On the second day of the hearing, the applicant refused to present evidence or make submissions on the substantive issues, instead raising numerous procedural motions including requests for an adjournment, a stay of proceedings, and the adjudicator's recusal.
The adjudicator dismissed the procedural motions, finding no compelling circumstances for an adjournment and no reasonable apprehension of bias.
Because the applicant failed to meet her evidentiary burden on the substantive issues, the application was dismissed in its entirety.
Bicycle crash caused by evasive action to avoid unidentified vehicle qualifies as an accident under Schedule.
The applicant was injured while riding her bicycle when she veered off the road to avoid an oncoming, unidentified vehicle driving erratically.
The respondent denied her claim for statutory accident benefits, arguing the incident did not meet the definition of an 'accident' under the Schedule because no vehicle was involved.
The Tribunal found the applicant credible and concluded that a vehicle was involved, satisfying both the purpose and causation tests.
The Tribunal determined the applicant's impairments fell outside the Minor Injury Guideline and ordered the respondent to pay the disputed medical and examination expenses up to the Guideline limits.
The Tribunal dismissed the claim for a special award but ordered the respondent to pay $500 in costs for unreasonable conduct during the proceeding.
Insurer awarded repayment of $24,687.79 in accident benefits after proving the reported collision was staged.
The applicant insurer sought repayment of $24,687.79 in medical rehabilitation benefits paid to the respondent, alleging that the reported motor vehicle accident never occurred and the claim was based on material misrepresentations.
The respondent did not participate in the written hearing.
Relying on an engineering expert report which concluded the vehicles never touched and the collision monitor recorded no impact, the adjudicator found that the accident did not occur.
The tribunal ordered the respondent to repay the benefits in full, plus interest, pursuant to section 52 of the Statutory Accident Benefits Schedule.
Applicant removed from Minor Injury Guideline due to psychological impairments; treatment plans and laptop approved.
The insurer denied benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).
The Tribunal found that the applicant suffered from psychological impairments, including Major Depressive Disorder, which warranted her removal from the MIG.
The Tribunal ordered the insurer to pay for a psychological assessment, psychological treatment, and a laptop required to access virtual therapy during the COVID-19 pandemic, along with interest on overdue payments.
The applicant's claim for a special award under Regulation 664 was dismissed, as the insurer's denial was not found to be unreasonable.