Kadey B. J. Schultz

The applicant sought statutory accident benefits following a 2018 motor vehicle accident, claiming catastrophic impairment under Criteria 6, 7, and 8 of the Schedule.

The Tribunal gave no weight to the applicant's key expert witness, who failed to attend the hearing for cross-examination, citing procedural fairness.

Relying on surveillance evidence that contradicted the applicant's claims of severe impairment and social isolation, the Tribunal found the applicant did not meet the threshold for catastrophic impairment.

Consequently, claims for medication expenses beyond the non-catastrophic limit, a special award, and interest were dismissed.

The applicant, who sustained catastrophic injuries in a motor vehicle accident, sought $12,887.06 for a home massage chair under the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to provide sufficient medical evidence to demonstrate that the massage chair was reasonable and necessary.

The Tribunal noted that the treatment plan alone, without supporting medical documentation or recommendations from treating practitioners, was insufficient to meet the applicant's burden of proof.

The applicant sought accident benefits following a 2019 motor vehicle accident, claiming catastrophic impairment due to psychological issues.

The adjudicator first held that the applicant was barred from disputing attendant care benefits because he failed to attend scheduled insurer's examinations without a valid reason.

On the catastrophic impairment issue, the adjudicator preferred the respondent's psychiatric assessment, finding that the applicant's marked psychological impairments were attributable to extensive pre-existing conditions, including bereavement following his mother's death, rather than the subject accident.

As the applicant did not meet the catastrophic impairment threshold and his non-catastrophic limits were exhausted, the claims for disputed treatment plans were dismissed.

The self-represented applicant sought statutory accident benefits following a July 2021 motor vehicle accident, including income replacement benefits (IRBs), a physiotherapy treatment plan, and medication expenses.

The Licence Appeal Tribunal dismissed the application.

The Tribunal found the applicant was not entitled to pre-104 week IRBs as he continued to work in various roles after the accident and failed to provide medical evidence of a substantial inability to perform his essential tasks.

Consequently, he did not qualify for post-104 week IRBs.

The Tribunal also denied the physiotherapy treatment plan due to a lack of corroborating medical evidence demonstrating it was reasonable and necessary.

Finally, the Tribunal found the claimed medication expenses had already been paid in full by the respondent.

This costs endorsement addresses the appropriate scale and quantum of costs following the dismissal of the plaintiff Jordan’s claim for fire loss under an insurance policy.

The court rejected the defendants’ request for substantial indemnity costs, finding that the circumstances did not justify such an award.

The court fixed costs at $10,000 for each defendant, inclusive of disbursements, emphasizing proportionality and the absence of scandalous or outrageous conduct.

The applicant sought statutory accident benefits following a 2018 motor vehicle accident.

The issues in dispute included entitlement to interest on previously paid income replacement and attendant care benefits, funding for a new home purchase and modifications, psychological and social rehabilitative services, physical therapies, and an award for unreasonable delay.

The Tribunal found the applicant was not entitled to interest on the IRB and ACB payments, as the respondent had already remitted the appropriate amounts.

The claim for a new home and modifications was dismissed because the applicant failed to prove it was more reasonable to purchase a new home than to renovate his existing one.

The Tribunal approved the psychological services and partially approved the social rehabilitative and physical therapies, finding them reasonable and necessary to address the applicant's accident-related impairments.

The claim for an award under section 10 of Regulation 664 was dismissed due to the applicant's failure to comply with the page limit for written submissions.

The applicant, who sustained catastrophic mental and behavioural impairments in a motor vehicle accident, sought various medical and rehabilitation benefits, home modifications, and a special award.

The Licence Appeal Tribunal partially approved the treatment plans, allowing funding for physiotherapy, exercise programs, and specific assistive devices that promoted independence, such as a Nespresso machine and slip-on shoes.

However, claims for chiropractic care, massage therapy, a laptop, and a lift chair were denied for lack of medical recommendation or inconsistency with the applicant's demonstrated functionality.

The tribunal also dismissed the claim for over $1.1 million in home modifications and an accessible apartment lease, relying on surveillance evidence showing the applicant could independently traverse stairs.

The request for a special award under section 10 of Regulation 664 was denied, as the insurer's investigation into overlapping attendant care benefits was deemed reasonable.

The applicant sought various statutory accident benefits following a November 2019 motor vehicle accident.

The Tribunal found the applicant was statute-barred from proceeding with a claim for an orthopaedic assessment due to her failure to attend a scheduled insurer's examination without a reasonable explanation.

Regarding the substantive claims, the Tribunal denied the majority of the disputed treatment plans for chiropractic services, massage therapy, and assistive devices, finding the applicant failed to prove they were reasonable and necessary on a balance of probabilities.

The Tribunal awarded $200 for documentation support activity with interest, but denied the claim for a section 10 award.

The plaintiffs, John Jordan and William Nielson, sought damages from Commonwell Mutual Insurance Group and Finnegan Insurance Brokers Ltd. regarding a policy of insurance on a hunting camp and outbuildings destroyed by fire in 2018.

The plaintiffs alleged that Finnegan failed in its duty to ensure adequate insurance coverage and acted in bad faith, and that Commonwell improperly closed the file while issues remained.

The defendants moved for non-suit, arguing that replacement insurance was not available for this type of property and that the plaintiffs had been referred to arbitration.

The court granted the summary judgment motions, dismissing the claims against both defendants, finding no credible evidence to support the plaintiffs’ claims and that the settlement cheque issued was appropriate.

The applicant insurer sought a stay of Licence Appeal Tribunal (LAT) proceedings pending a judicial review of the LAT's refusal to adjourn a hearing date.

Neither counsel for the applicant nor the respondent were available for the scheduled hearing dates.

The LAT opposed the stay and argued the judicial review was premature.

The single judge of the Divisional Court adjourned the stay motion to a full panel, noting the motion's outcome would likely resolve the underlying judicial review.

The applicant sought to enforce a settlement agreement allegedly reached with the respondent insurer regarding her statutory accident benefits claim.

The parties had negotiated an agreement in principle via email, but the applicant refused to sign a release that included the tortfeasor (Ryder).

The Tribunal found that a mutually agreeable release was an essential term of the settlement.

Because the applicant amended the settlement disclosure notice without agreement and did not execute the required release, no binding and enforceable settlement agreement was reached.

The application to enforce the settlement was dismissed.

The appellant, Chubb Insurance Company of Canada, appealed an arbitration decision that held it solely liable for Statutory Accident Benefits (SABS) payments to an injured person, despite Zurich Insurance Company being the actual primary insurer.

The Supreme Court of Canada had previously ruled that Chubb, as the first insurer to receive a misdirected SABS application, was deemed an insurer for the claim.

The Superior Court found that the arbitrator erred by not fully analyzing the interplay between the Insurance Act and O. Reg. 283/95.

The court concluded that both Chubb and Zurich were insurers of equal priority due to the unique circumstances and must share liability 50/50, with each responsible for 2% compound interest for delays attributable to them.

The applicant insurer sought repayment of medical benefits and a declaration barring the respondent from income replacement benefits, alleging the respondent wilfully misrepresented his address to secure a lower premium and staged the accident.

The respondent failed to participate in the written hearing.

The Tribunal found the respondent provided a falsified lease and bank statement to misrepresent his address, which constituted a material misrepresentation.

The Tribunal ordered the respondent to repay $2,315.00 in medical benefits with interest and barred him from receiving income replacement benefits.

The insurer's request for costs was denied.

The applicants sought judicial review of an interlocutory decision by the Licence Appeal Tribunal, which had dismissed their motion to disqualify the insurer's counsel and adjuster for alleged conflict of interest and privacy breaches.

The Divisional Court dismissed the application for judicial review as premature.

The court held that absent exceptional circumstances, judicial review of administrative decisions should not be brought until the tribunal proceedings are complete, and the applicants failed to establish that this was a rare case warranting early intervention.

The applicant sought reconsideration of a decision denying entitlement to a neuropsychological assessment, multidisciplinary catastrophic impairment assessment, and SPECT scan.

The applicant argued procedural unfairness, errors of law and fact, and sought to introduce new evidence.

The Adjudicator dismissed the request, finding no procedural unfairness, no errors in weighing the medical and surveillance evidence, and that the applicant failed to explain why the new evidence could not have been obtained prior to the hearing.

The applicant sought reconsideration of a decision finding he made a material misrepresentation on his automobile insurance application, which excluded him from income replacement benefits and required him to repay $72,881.74 to the insurer.

The applicant argued the Tribunal lacked jurisdiction, violated procedural fairness, made factual errors, and that new evidence was available.

The adjudicator dismissed the request, finding no procedural unfairness, confirming the Tribunal's jurisdiction over the dispute, and concluding the applicant was improperly attempting to relitigate the initial findings.

The adjudicator also held that the alleged new evidence could have been obtained prior to the initial hearing with due diligence.

The applicant was injured in a motor vehicle accident and sought various statutory accident benefits, including treatment plans for occupational therapy, a chronic pain program, and assessments for neuropsychological, chronic pain, functional cognitive, and catastrophic impairment, as well as a SPECT scan.

The insurer denied the claims.

The Licence Appeal Tribunal dismissed the application in its entirety, finding that the applicant failed to demonstrate on a balance of probabilities that the proposed plans were reasonable and necessary.

The Tribunal relied on insurer examination reports and surveillance evidence showing the applicant engaging in normal activities, which contradicted the applicant's self-reported functional limitations and the opinions of his assessors.

The applicant was involved in a motor vehicle accident in Michigan and elected to receive benefits under Michigan law from his Ontario insurer.

The insurer later discovered the applicant had failed to disclose a prior at-fault accident and a cancelled insurance policy on his application, and terminated his income replacement benefits (IRBs) due to material misrepresentation.

The Licence Appeal Tribunal found that the applicant made material misrepresentations that induced the insurer to enter into the contract.

The Tribunal held that the applicant was excluded from receiving IRBs under section 31(1)(b) of the Schedule, and that this exclusion applied even though he had elected to receive Michigan Work Loss Benefits.

Alternatively, the Tribunal found the applicant would be disqualified under Michigan common law.

The applicant was ordered to repay $72,881.74 in benefits paid, plus interest.

The applicants, three brothers involved in separate motor vehicle accidents, brought a motion seeking to disqualify the respondent insurer's counsel and adjuster, alleging breaches of privacy and a conflict of interest due to the sharing of information between their related accident benefits claims.

The Licence Appeal Tribunal held that while it has jurisdiction to disqualify counsel for a conflict of interest, it lacks the authority to disqualify an adjuster.

On the merits, the Tribunal found that the applicants had expressly consented to the sharing and pooling of their information for the purpose of investigating and verifying their claims when they signed the OCF-1 forms.

The Tribunal concluded there was no breach of privacy and no disqualifying conflict of interest, and dismissed the motion.

This appeal addressed whether Harmonized Sales Tax (HST) on attendant care benefits was included within the statutory maximums under the Statutory Accident Benefits Schedule (SABS) for accidents occurring before June 3, 2019.

The appellant (insured) argued that HST should be payable in addition to the maximums, while the respondent (insurer) contended it was part of the maximums.

The Court of Appeal upheld the Divisional Court's decision, finding that the relevant SABS provisions were unambiguous and that HST constituted a "reasonable and necessary expense" included within the $6,000 monthly and $1,000,000 total maximums for attendant care benefits.

The court emphasized that the same words in a statute must be given the same meaning throughout.