Julianne Brimfield

The respondent insurer sought reconsideration of a preliminary issue decision which found that the applicant was a dependent of his mother and therefore an insured under her policy.

The Tribunal dismissed the request for reconsideration, holding that under Rule 18.1 of the Licence Appeal Tribunal Rules, reconsideration is only available for decisions that finally dispose of an appeal.

Because the preliminary issue decision allowed the applicant's claim to proceed, it was not a final disposition, and the request was premature.

The applicant sought medical and rehabilitation benefits following a motor vehicle accident.

The insurer 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 pre-existing degenerative disc disease, chronic pain, and psychological injuries.

The Tribunal found the applicant failed to prove that his pre-existing condition precluded recovery within the MIG, or that he suffered from accident-related chronic pain or psychological injuries.

As the MIG limits were exhausted, the application for further benefits, interest, and a special award was dismissed.

The applicant was injured in a motor vehicle accident and sought various medical benefits and costs of examinations from the respondent insurer.

The insurer denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant failed to meet the burden of proving that his physical or psychological impairments warranted removal from the MIG.

The Tribunal also dismissed the claims for the costs of examinations, finding them not reasonable and necessary, and denied the claim for a section 10 award.

The applicant sought entitlement to an income replacement benefit and a medical benefit for chiropractic treatment following a motor vehicle accident.

The adjudicator found the applicant was not entitled to the income replacement benefit because he failed to attend properly scheduled insurer's examinations and did not provide a reasonable explanation for his non-attendance.

The claim for chiropractic treatment was also dismissed, as the adjudicator preferred the respondent's expert reports over the applicant's family physician notes, concluding the treatment was not reasonable and necessary.

Claims for interest and an award were consequently dismissed.

The claimant, an Ontario resident, was catastrophically injured in a motor vehicle accident in Nunavut while driving a Nunavut-plated vehicle insured by the appellant.

The respondent, the claimant's Ontario insurer, paid Ontario statutory accident benefits and sought reimbursement from the appellant under the priority provisions of the Ontario Insurance Act.

The arbitrator and appeal judge ruled in favour of the respondent.

The Court of Appeal allowed the appeal, holding that the appellant was not an 'Ontario insurer' for the purposes of the priority dispute and that the Ontario Insurance Act could not be applied extraterritorially to a Nunavut policy for an accident occurring in Nunavut.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's determination that his injuries fell within the Minor Injury Guideline (MIG).

The applicant claimed exceptions to the MIG based on a pre-existing condition, psychological conditions, and chronic pain, and sought $2,230.64 for a chiropractic treatment plan.

The adjudicator found that the applicant's injuries were minor and that his ongoing pain was likely aggravated by his work as a driver rather than caused by the accident.

The applicant failed to provide objective medical evidence to support any of the claimed exceptions.

The application was dismissed, including claims for the treatment plan, interest, and a special award under Regulation 664.

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

The respondent denied the treatment plans and the applicant filed an appeal with the Licence Appeal Tribunal.

The respondent raised a preliminary issue that the application was statute-barred because it was filed after 5:00 p.m. on the final day of the two-year limitation period, making it deemed received on the next business day.

The adjudicator found that while the Tribunal has jurisdiction under s. 7 of the Licence Appeal Tribunal Act to extend the limitation period, it would not exercise that discretion.

Applying the four-factor test, the adjudicator found no bona fide intent to appeal within the period and no merit to the appeal, as the applicant's injuries were predominantly minor and subject to the Minor Injury Guideline.

The application was dismissed as statute-barred.

The respondent applied for statutory accident benefits after falling and fracturing her knee while attempting to enter a vehicle.

The applicant, the Motor Vehicle Accident Claims Fund, disputed that the incident met the definition of an 'accident' under section 3(1) of the Statutory Accident Benefits Schedule, arguing the fall was caused by the respondent's pre-existing medical conditions and not the use or operation of an automobile.

The Tribunal found that the incident met both the purpose and causation tests, as the respondent fell while getting into the vehicle when the driver accidentally shifted gears, causing the car to move forward.

The Tribunal concluded the respondent was involved in an accident and is entitled to claim accident benefits.

The appellant, an out-of-province insurer, appealed an arbitrator's decision finding that the priority provisions in s. 268 of the Insurance Act applied to it for a motor vehicle accident that occurred in Ontario.

The appellant argued that applying the Ontario legislation would have an extra-jurisdictional effect.

The Superior Court of Justice dismissed the appeal, applying the reasonableness standard of review.

The court held that because the accident occurred in Ontario and the appellant had signed a Power of Attorney and Undertaking (PAU), it was bound by the priority provisions of the Insurance Act.

The appellant sought to appeal a decision of a Director's Delegate that dismissed her application to vary or revoke an earlier arbitration order regarding statutory accident benefits.

The Director's Delegate held that under the Dispute Resolution Practice Code, there is no jurisdiction for one Director's Delegate to hear an appeal of another Director's Delegate's decision.

In the alternative, the appeal would be dismissed on the merits as the appellant failed to demonstrate any error of law.

The appeal was dismissed.

The appellant, seriously injured in a motor vehicle accident, sued her insurer for bad faith in handling her statutory accident benefits (SABs) claim, seeking punitive and exemplary damages.

The insurer had failed for approximately three years to advise the appellant or her parents that her injuries qualified as a catastrophic impairment or to inform them of available benefits.

The motion judge struck the statement of claim, finding that the Licence Appeal Tribunal (LAT) had exclusive jurisdiction under section 280 of the Insurance Act.

The Court of Appeal upheld this decision, holding that the dispute resolution provisions of the Insurance Act apply broadly to disputes concerning SABs entitlement and administration, regardless of whether the claim is characterized as one for bad faith.

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

The respondent insurer denied the claims on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG), subjecting her to a $3,500 treatment limit.

The applicant argued she should be exempted from the MIG due to pre-existing conditions and a psychological impairment.

The Tribunal found that the applicant failed to provide compelling evidence of a pre-existing condition that would prevent maximal medical recovery within the MIG.

Furthermore, the Tribunal rejected the claim of psychological impairment due to unexplained discrepancies in the applicant's self-reporting to different medical experts.

The Tribunal concluded the injuries were predominantly minor, the $3,500 cap applied, and no further benefits or interest were payable.

Northbridge General Insurance Corporation appealed an arbitrator's decision that designated it as the priority insurer for accident benefits following a motor vehicle accident.

Northbridge contended that Co-Operators General Insurance Company failed to provide proper notice under section 3(1) of Ontario Regulation 283/95, thereby precluding Co-Operators from asserting Northbridge's priority.

The Superior Court of Justice applied a reasonableness standard of review to the arbitrator's decision, consistent with The Dominion of Canada General Insurance Company v. Unifund Assurance Company.

The court upheld the arbitrator's finding that Co-Operators' initial failure to notify Northbridge directly under section 3(1) was not fatal, as Intact Insurance Company subsequently provided notice to Northbridge under section 10(1) of the Regulation.

The court emphasized the practical realities of priority investigations and the public policy of ensuring timely benefit payments.

The appeal was dismissed, and Northbridge was ordered to pay costs to both respondents.

The appellant, Travelers Insurance Company, appealed an arbitrator's decision that it was the priority insurer for statutory accident benefits following an accident in Nunavut.

The arbitrator found Travelers liable because it was an Ontario insurer, had filed a Power of Attorney and Undertaking (PAU) in Ontario, and was the insurer of the car involved.

Travelers argued the arbitrator erred by applying Ontario law to a Nunavut policy without first determining if the policy provided Ontario benefits coverage.

The court upheld the arbitrator's decision, finding that the standard of review was reasonableness and that Travelers, as an Ontario-licensed insurer and PAU signatory, was bound by Ontario's priority laws, precluding it from denying coverage based on the accident's location.

The plaintiff sued her insurer for bad faith, negligence, and fraud in the administration of her statutory accident benefits claim following a motor vehicle accident.

The defendant insurer brought a Rule 21 motion to strike the statement of claim, arguing the Licence Appeal Tribunal (LAT) had exclusive jurisdiction under section 280 of the Insurance Act.

The court agreed, finding that the essential character of the dispute concerned the denial of accident benefits, which falls within the exclusive jurisdiction of the LAT regardless of how the claim is legally characterized.

The statement of claim was struck without leave to amend.

Two consolidated appeals concerning the standard of review applicable to insurance arbitral decisions resolving priority disputes under the Statutory Accident Benefits Schedule (SABS).

The first appeal involved a claimant listed as an excluded driver on his parents' policy who was injured as a passenger in another vehicle.

The second involved a claimant similarly listed as an excluded driver who was injured while driving an uninsured motorcycle.

The central issue was whether excluded drivers could qualify as "insured persons" under the SABS definition and thus trigger priority coverage under their parents' policies.

The Court of Appeal held that the appropriate standard of review for such arbitral decisions is reasonableness, not correctness, and that arbitrators' interpretations of the SABS and insurance policies within their specialized expertise warrant deference.

The Applicant sought income replacement benefits, medical benefits, and the cost of assessments following a motor vehicle accident.

The Respondent denied the benefits, arguing the Applicant did not suffer a substantial inability to perform the essential tasks of her employment and that her injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found no procedural errors in the Respondent's denial of benefits.

Relying on video surveillance that contradicted the Applicant's self-reported limitations, the Tribunal found the Applicant's evidence unreliable and concluded she was not eligible for income replacement benefits.

Furthermore, the Applicant failed to meet her burden of proving her injuries fell outside the MIG.

As the Applicant had already received the maximum $3,500 in medical benefits under the MIG, the claims for additional treatment and assessments were dismissed.

The applicant sought accident benefits following a motor vehicle accident, claiming entitlement to medical benefits and income replacement benefits.

The insurer denied the claims, arguing the applicant was self-employed with no net profits and that her injuries did not warrant further treatment.

The arbitrator found the applicant lacked credibility and accepted the insurer's expert evidence that her physical injuries had plateaued and her psychological issues were unrelated to the accident.

The arbitrator also determined the applicant was self-employed and had no profits, resulting in an income replacement benefit calculation of zero.

The application was dismissed, and the insurer was awarded its expenses.