Jonathon Neil Kahane-Rapport

The applicant, who was struck by a school bus as a pedestrian in 2006 at age six, sought statutory accident benefits including psychological and occupational therapy assessments over 15 years later.

The respondent denied the benefits.

The Licence Appeal Tribunal found that the applicant was not barred from proceeding to a hearing, but dismissed the claims for benefits.

The Tribunal concluded that the proposed treatment plans were not reasonable and necessary, as there was no medical evidence linking the applicant's current psychological and physical issues to the 2006 accident.

Claims for interest and an award for unreasonable delay were also dismissed.

The applicant sought a special award under s. 10 of O. Reg. 664, alleging the respondent insurer unreasonably delayed payment of attendant care and housekeeping benefits.

The Tribunal found that the delay was the result of an inadvertent clerical error by an adjuster covering the file, and that the respondent immediately paid the outstanding amounts with interest upon being notified.

The Tribunal concluded the insurer's conduct was not excessive, imprudent, or stubborn, and dismissed the application for an award.

The applicant sought entitlement to statutory accident benefits for chiropractic and physiotherapy treatment plans following a 2018 motor vehicle accident.

The adjudicator found that the claim for the first treatment plan had already been resolved by agreement between the parties.

For the remaining treatment plans, the adjudicator preferred the evidence of the respondent's insurer's examination assessors, who concluded that the applicant had fully recovered from minor soft tissue injuries and did not require further facility-based treatment.

The application was dismissed, and claims for interest and a special award were denied.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming the unapproved portions of several treatment plans for psychological and occupational therapy services.

The respondent had partially approved the plans but denied the higher hourly rate proposed for a psychotherapist and the costs for brokerage services.

The Tribunal found that the applicant failed to demonstrate why the psychotherapist should be paid at a rate equivalent to a psychologist, exceeding the Professional Services Guideline.

Furthermore, the applicant provided no evidence to justify the brokerage services, which are excluded under the Guideline.

The application was dismissed, and claims for interest and an award were denied.

The applicant sought statutory accident benefits following a motor vehicle accident, including chiropractic services, psychological services, and medication expenses.

The Licence Appeal Tribunal dismissed the application, finding that the proposed chiropractic and psychological treatments were not reasonable and necessary based on the respondent's expert medical assessments, which showed no objective physical impairments and a deterioration in mood despite prior psychological treatment.

The medication expense had already been reimbursed.

Claims for interest and a special award were also dismissed.

The applicant sought payment for various prescription medications following a 2014 motor vehicle accident.

The respondent insurer had paid 50% of the claimed amounts and denied the remainder.

The Tribunal found that the applicant failed to establish on a balance of probabilities that the disputed medications, including those for pain and substance dependence, were reasonable and necessary as a result of the accident.

The application for accident benefits and interest was dismissed.

This endorsement addresses the issue of costs following a jury trial where The Co-operators General Insurance Company was wholly successful in two consolidated claims against Bagwandat (Ron) Doobay.

The jury found Mr. Doobay not catastrophically impaired, not entitled to income replacement benefits, and awarded Co-operators $60,000 for repayment of benefits and punitive damages.

The court awarded Co-operators substantial indemnity costs from the date of their offer to settle and partial indemnity costs prior to that, totaling $135,400.00.

The court rejected Mr. Doobay's argument of impecuniosity, noting his prior assets and the existence of an adverse costs insurance policy.

It also ruled that costs previously awarded in arbitration could not be claimed in these court proceedings.

The applicant sought statutory accident benefits for chiropractic and physiotherapy treatment plans following a 2019 motor vehicle accident.

The respondent insurer denied the plans based on an insurer's examination which concluded the applicant sustained only soft tissue injuries and did not require further facility-based treatment.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to provide sufficient medical evidence, such as clinical notes or progress reports, to demonstrate that the proposed treatments were reasonable and necessary.

The respondent insurer brought a preliminary motion to dismiss the applicant's claims for attendant care and housekeeping benefits, arguing they were statute-barred because the applicant failed to dispute a 2012 denial within two years.

The applicant was deemed catastrophically impaired in 2015.

Applying the discoverability rule and the Court of Appeal's decision in Tomec, the Tribunal found that the limitation period did not commence until the applicant was denied benefits based on his catastrophic designation, which occurred in 2017.

Therefore, the application was not statute-barred and the motion was dismissed.

The applicant requested a reconsideration of a case conference order requiring him to produce a list of relevant, non-privileged documents from his accident benefits file.

The applicant argued this breached procedural fairness and was overly burdensome given the 13-year-old file.

The Vice Chair dismissed the request, finding the applicant misunderstood the order, which did not require producing the entire file or privileged documents, and that the order was within the adjudicator's discretion to ensure procedural fairness for both parties.

The appellant was injured in a motor vehicle accident and received income replacement benefits, which were later terminated by the insurer via an OCF-9 notice.

The appellant applied for mediation more than two years after receiving the notice, and the insurer argued the application was statute-barred.

The arbitrator agreed.

On appeal, the Director's Delegate found the arbitrator erred in law by considering extrinsic evidence rather than assessing the validity of the OCF-9 on its face.

However, upon reviewing the OCF-9, the Delegate concluded the notice was valid and sufficient to trigger the limitation period, as the disputed steps outlined in the form were permissive rather than mandatory.

The appeal was dismissed.

The applicant, who sustained a catastrophic impairment in a motorcycle accident, sought payment for case management services provided by registered social workers at an hourly rate of $150.00.

The respondent insurer reduced the rate to $89.07 per hour, the maximum rate for unregulated providers under the Professional Services Guideline.

The Licence Appeal Tribunal held that the social workers fell within the definition of 'qualified case manager' under section 17(3) of the Statutory Accident Benefits Schedule and were therefore subject to the maximum hourly rate of $89.07 set out in the Guideline.

The applicant's claim for an award under section 10 of Regulation 664 was also dismissed.

The plaintiff insurer brought a motion to enforce a settlement reached during a Financial Services Commission of Ontario arbitration regarding statutory accident benefits.

The defendant insured had rescinded the settlement within two days, relying on the cooling-off period set out in section 9.1 of Ontario Regulation 664 and explicitly included in the settlement release drafted by the plaintiff.

The court dismissed the motion, finding that because the cooling-off clause was attached to and formed part of the signed settlement documentation, the defendant was entitled to rely on it to rescind the agreement.

The Applicant was injured in a motor vehicle accident and received Income Replacement Benefits (IRBs) until they were terminated by the Insurer.

The Applicant applied for arbitration six years after the termination, arguing the termination notice (OCF-9) was invalid because it directed her to contact an 'adjustor' while her file was handled by a 'claims representative'.

The Arbitrator found the notice was clear, unequivocal, and complied with the requirements set out in Smith v. Co-operators.

The Applicant's failure to dispute the termination within the two-year limitation period was not excused by the job title of the Insurer's employee.

The Applicant was held to be statute-barred from claiming IRBs, and the Insurer was awarded its expenses.

The applicant, a pedestrian struck by a vehicle, applied to the Licence Appeal Tribunal for non-earner benefits and funding for various treatment plans.

The insurer denied the claims, arguing the applicant did not meet the test for non-earner benefits and that his injuries fell within the Minor Injury Guideline (MIG), for which the $3,500 limit had been exhausted.

The Tribunal found that the applicant failed to prove on a balance of probabilities that he suffered a complete inability to carry on a normal life, noting surveillance evidence and his ability to engage in many daily activities and work casually.

Furthermore, the Tribunal held that the applicant failed to provide medical evidence establishing a causal link between his back and shoulder issues and the accident to rebut the insurer's medical examination, thereby failing to prove his injuries fell outside the MIG.

The application was dismissed.

Following a ten-day jury trial where the plaintiff was awarded $18,076, the parties made submissions on costs.

The defendants had made a pre-trial offer to settle of $25,000, which the plaintiff did not beat, engaging Rule 49.10.

The court declined to deny the plaintiff costs under the simplified procedure or small claims rules, finding the ordinary procedure was reasonable.

Applying the principle of proportionality, the court awarded the plaintiff $34,000 for pre-offer costs and the defendants $62,000 for post-offer trial costs, resulting in a net costs award of $28,000 payable by the plaintiff to the defendants.

The appellants' parked motor vehicle was destroyed by a fire allegedly caused by a transmission fluid leak.

The motion judge granted summary judgment dismissing the action as statute-barred by the two-year limitation period in s. 206(1) of the Highway Traffic Act, relying on the binding precedent of Karakas v. General Motors of Canada Ltd. The Court of Appeal dismissed the appeal, holding that while there was arguable merit to the appellants' claim that Karakas was at odds with Supreme Court of Canada jurisprudence, the court was not asked to overrule Karakas and the present case could not be distinguished from it.

The appellants appealed a motion judge's decision, arguing that the binding precedent of Karakas was at odds with the Supreme Court's decision in Heredi v. Fensom and attempting to distinguish their case.

The Court of Appeal dismissed the appeal, agreeing with the motion judge that the case could not be distinguished from Karakas and that the automobile was not merely ancillary to the damage caused.

The appellant appealed an order dismissing his action for failing to complete defence medical examinations.

The Court of Appeal found that while the appellant had been dilatory and uncooperative, dismissing the action is a measure of last resort.

The court allowed the appeal in part, setting aside the dismissal, ordering the appellant to pay $1,287.50 for a missed appointment, and requiring him to complete the examinations on the first available date, failing which the action would be dismissed.