Joseph Griffiths

The appellant appealed Tarion's decision to deny her Major Structural Defect (MSD) claim because it was filed outside the seven-year warranty period.

The appellant argued that Tarion should have exercised its discretion under s. 5.10 of the Regulation to extend the timeline due to extraordinary circumstances, including inconsistent information from Tarion, her father's palliative care, and her own severe COVID-19 illness.

The Licence Appeal Tribunal found that Tarion had the discretion to extend the timeline and that the appellant's circumstances warranted such an extension.

The Tribunal ordered Tarion to accept the MSD claim and process it in accordance with the Act.

The applicant, an Ontario resident, was involved in a motor vehicle accident in Quebec and elected to receive statutory accident benefits under the Quebec legislative framework.

A dispute arose regarding his entitlement to a lump sum payment, and he applied to the Licence Appeal Tribunal.

The respondent insurer brought a preliminary issue motion arguing that the Tribunal lacked jurisdiction because the applicant elected Quebec benefits.

The Tribunal held that it has jurisdiction under section 280 of the Insurance Act to resolve disputes regarding entitlement to benefits, and section 59 of the Schedule does not require an insured to pursue dispute resolution in the jurisdiction where the accident occurred.

The respondent's motion was dismissed.

The applicant was injured in a motor vehicle accident and sought a catastrophic impairment designation under the Statutory Accident Benefits Schedule due to a mental or behavioural disorder.

The respondent insurer denied the designation.

The Tribunal found that the applicant suffered a Class 4 (marked) impairment in the domains of activities of daily living and adaptation to work or worklike settings, caused by an accident-related Somatic Symptom Disorder.

The Tribunal concluded the applicant was catastrophically impaired effective October 19, 2016.

The applicant was injured in a motor vehicle accident and sought payment for an occupational therapy treatment plan that the insurer denied.

The adjudicator found that the applicant suffered from chronic pain and psychological impairments as a result of the accident.

The adjudicator concluded that the proposed occupational therapy, which focused on pain management and increasing functional activity, was a reasonable and necessary method of treating the applicant's impairments.

The insurer was ordered to pay the treatment plan amount of $3,358.14 plus interest.

The appellant appealed an arbitrator's order precluding her from proceeding with claims for income replacement benefits (IRBs) due to missing the two-year limitation period and failing to comply with notification obligations.

The Director's Delegate dismissed the appeal, finding that the appellant never met the eligibility criteria for IRBs because she continued working for more than five years after the accident and did not suffer a substantial inability to perform her essential tasks within 104 weeks.

Applying binding Court of Appeal precedent, the Delegate confirmed that an insured must establish eligibility within the first 104 weeks to qualify for benefits beyond that period.

The applicant sought income replacement benefits (IRBs) after being terminated from her employment more than five years following a motor vehicle accident.

The insurer raised a preliminary issue that the claim was statute-barred, having issued a clear denial of IRBs shortly after the accident when the applicant returned to work.

The arbitrator found that the insurer's initial denial was valid and triggered the two-year limitation period, which had long expired.

Furthermore, the arbitrator held that the applicant failed to comply with her statutory obligations to notify the insurer of her change in circumstances and to provide requested information, without a reasonable excuse.

The applicant was therefore precluded from proceeding to arbitration on her IRB claim.

The insurer brought a motion to require the insured to attend an in-home assessment, a psychological assessment, and an orthopaedic assessment pursuant to section 42 of the Statutory Accident Benefits Schedule, and to stay the arbitration pending her attendance.

The insured had previously failed to attend the insurer's scheduled assessments, claiming they conflicted with her own.

The arbitrator found that the insured had conceded the assessments were reasonable and necessary by agreeing to attend them at a pre-hearing, and that allowing her to reverse this position would be procedurally unfair.

The arbitrator ordered the insured to attend the assessments and stayed the arbitration pending her attendance.

The applicant, a condominium resident, filed a human rights application alleging discrimination based on disability because the respondent required him to cart his companion dog on common grounds.

The applicant requested an expedited proceeding, claiming that carting the dog exacerbated his catastrophic injuries.

The respondent opposed the request, arguing the applicant had known of the rule for years and submitted evidence suggesting he could perform physically demanding acts.

The Tribunal dismissed the request to expedite, finding the applicant's submissions too vague and lacking medical evidence to demonstrate truly urgent circumstances.

Following the withdrawal of an arbitration application, the insurer requested an assessment of expenses.

The arbitrator had previously ordered the applicant's representative to personally pay the insurer's expenses because he caused the insurer to incur expenses without reasonable cause.

The arbitrator assessed the insurer's expenses at $3,063.68, finding the claimed hours and hourly rate to be reasonable.

The Applicant sought to withdraw her arbitration application for statutory accident benefits.

The Insurer consented to the withdrawal but sought its expenses, arguing they were unreasonably incurred due to the conduct of the Applicant's representative.

The Arbitrator permitted the withdrawal and awarded expenses to the Insurer.

The Arbitrator found that the Applicant's representative, a paralegal, demonstrated a lack of knowledge of the law and arbitration process, commenced claims that were time-barred or unmediated, and prolonged the proceeding unnecessarily.

Finding his conduct amounted to inexcusable misconduct, the Arbitrator ordered the representative to personally pay the Insurer's expenses pursuant to section 282(11.2) of the Insurance Act.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits, which the insurer terminated.

The applicant sought arbitration.

During the proceedings, the applicant's representative was found to have a conflict of interest and withdrew.

After being given time to find new representation, the applicant and the insurer ultimately signed a consent to dismiss the arbitration without costs.

The arbitrator dismissed the issues in the arbitration hearing based on the consent of the parties.

The applicant was injured in a motor vehicle accident and received income replacement benefits (IRBs) from the insurer, as well as paid sick leave from his employer.

The insurer requested repayment of the IRBs, stating the applicant was not entitled to both.

The applicant applied for mediation more than two years after receiving the insurer's refusal to pay.

The arbitrator held that the insurer's refusal was clear, unequivocal, and met the notice requirements set out in Smith v. Co-operators.

Consequently, the applicant was precluded from proceeding to arbitration due to the expiry of the two-year limitation period.

The insurer appealed an arbitrator's decision awarding the insured expenses for two disputed treatment plans and housekeeping benefits following a motor vehicle accident.

The insurer argued the arbitrator erred in his treatment of the medical assessments and in awarding housekeeping benefits despite finding the insured's expense forms unreliable.

The Director's Delegate dismissed the appeal, finding no reversible error in the arbitrator's weighing of the evidence, including his preference for the treating physiotherapist's plans over the insurer's assessments and his reliance on in-home assessments to determine housekeeping entitlement.

The applicant was injured in a motor vehicle accident as a pedestrian and claimed statutory accident benefits.

The sole issue in dispute was the quantum of attendant care benefits for the period of June to September 2005.

The applicant sought $1,777.56 per month based on an initial assessment, while the insurer relied on subsequent assessments indicating independence in self-care.

The arbitrator found the applicant's evidence regarding specific attendant care needs during the disputed period to be vague and insufficient to support the full amount claimed.

However, relying on an occupational therapy assessment, the arbitrator determined the applicant required assistance with bathing due to shower door limitations and awarded $168.92 per month for the disputed period.

The appellant appealed an arbitrator's decision dismissing her claim for a treatment plan following a motor vehicle accident.

She argued the arbitrator should have given no weight to a Designated Assessment Centre (DAC) report because the assessors were not qualified as experts at the hearing.

The Director's Delegate dismissed the appeal, finding that the appellant failed to challenge the introduction of the DAC report or the assessors' qualifications during the hearing.

The Delegate held that it was too late to raise the issue of expert qualifications for the first time in final written submissions.

The applicant was injured in a rear-end motor vehicle accident and sought statutory accident benefits from her insurer.

The insurer denied four treatment plans for medical benefits and disputed her ongoing entitlement to housekeeping benefits.

The arbitrator found that the first two disputed treatment plans were reasonable and necessary, as they were supported by the treating physiotherapist's assessments, but denied the latter two plans, preferring the opinion of a MedRehab DAC assessor.

The arbitrator also awarded housekeeping benefits for a limited period following the accident, finding that the applicant's need for assistance gradually diminished to zero by September 10, 2003.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits from the insurer.

Disputes arose and the applicant applied for arbitration at the Financial Services Commission of Ontario.

During a hearing to determine a motion, the applicant requested to withdraw his application without costs.

The insurer consented to the request.

The arbitrator granted the request and permitted the applicant to withdraw the application without costs.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including income replacement benefits (IRBs) and medical benefits, which the insurer denied.

The arbitrator found that the applicant suffered a substantial inability to perform the essential tasks of her pre-accident employment as a seamstress, satisfying the pre-104 week IRB test.

Furthermore, due to her chronic pain, psychological condition, and limited education and English proficiency, she met the post-104 week test of a complete inability to engage in any suitable employment.

The arbitrator also awarded the claimed medical benefits, finding them reasonable and necessary for pain management, along with interest on overdue amounts.

The applicant applied for arbitration regarding statutory accident benefits following a motor vehicle accident.

The applicant failed to attend the scheduled hearing and provided no evidence to support her claim.

The arbitrator proceeded in her absence pursuant to the Statutory Powers Procedure Act and dismissed the arbitration without costs.

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

A dispute arose regarding entitlement to further treatment and housekeeping assistance.

At the scheduled arbitration hearing, the insurer sought a ruling on the consequences of the applicant's expert witnesses being unavailable for cross-examination.

The arbitrator found that the hearing could not proceed fairly without the experts or by excluding their evidence, which would likely result in dismissal.

The arbitrator adjourned the hearing and ordered the applicant to pay $300 in costs to the insurer for the unnecessary expense incurred.