Ken Yip

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that awarded a 15% special award under section 10 of O. Reg. 664 but failed to address the mandatory interest on that award.

The adjudicator found that the failure to specify that interest was payable on the lump sum award was an error of law, as section 10 interest is mandatory and distinct from the discretionary lump sum component.

The decision was varied to include entitlement to interest in accordance with Reg. 664, but the adjudicator declined to quantify the exact amount owing due to insufficient information.

The applicant insurer sought repayment of $7,710.19 in Income Replacement Benefits (IRBs) paid to the respondent, alleging wilful misrepresentation of post-accident income.

The respondent argued the application was statute-barred by a two-year limitation period and that any repayment should be deducted from future benefits rather than paid as a lump sum.

The Tribunal found the application was not statute-barred, as the limitation period in section 56 of the Schedule applies to an insurer's refusal to pay, not a claim for repayment.

The Tribunal concluded the respondent wilfully misrepresented his post-accident income and failed to comply with production requests.

The insurer was awarded a lump sum repayment of $7,710.19 plus interest.

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

The Tribunal found that the applicant sustained an accident-related concussion, removing him from the Minor Injury Guideline.

However, the claim for an income replacement benefit was dismissed because the applicant failed to establish the essential tasks of his employment or a substantial inability to perform them.

The Tribunal approved treatment plans for a concussion assessment and a neurological assessment, but denied plans for a driving evaluation, a psychological assessment, and a second concussion assessment.

The claim for a bad faith award was dismissed.

TD General Insurance Company applied to the Licence Appeal Tribunal for a lump sum repayment of $17,581.64 in overpaid Income Replacement Benefits (IRBs) from the respondent after he was retroactively approved for Canada Pension Plan Disability benefits.

The respondent argued for repayment via ongoing IRB deductions, but his IRBs had been suspended under section 57 of the Schedule for failing to attend treatment.

The Tribunal found that because IRBs were not currently being paid, the insurer was entitled to a lump sum repayment under section 52(4) of the Schedule, along with interest under section 52(5).

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for various treatment plans and assessments.

The respondent denied the plans.

The Tribunal found the applicant was entitled to a functional abilities evaluation and a worksite/occupational demands assessment, as they were reasonable and necessary and not duplicative of the insurer's own assessments.

However, the Tribunal denied the plans for an in-home assessment, a chronic pain assessment, and physical therapy, finding them to be duplicative or unsupported by the medical evidence.

The claim for an award under s. 10 of Reg. 664 was dismissed.

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

The respondent partially denied a treatment plan for occupational therapy and assistive devices, claiming lower retail prices were available but failing to provide evidence.

The respondent later approved the balance of the treatment plan after the applicant applied to the Tribunal.

The Tribunal awarded the applicant interest on the overdue balance from the date of the application to the date of settlement.

The Tribunal also ordered the respondent to pay an award of 15% of the disputed treatment plan amount, finding that the respondent unreasonably withheld payment by failing to comply with the Superintendent's Guideline regarding proof of retail prices.

The applicant sought reconsideration of a Tribunal decision that found he did not sustain a catastrophic impairment.

The Associate Chair initiated a review and found that the Tribunal committed a material breach of procedural fairness by relying on the respondent's expert report after the expert was not made available for cross-examination.

The Tribunal's failure to allow cross-examination on central evidence, while still relying on the report to support its conclusions, warranted cancelling the original and reconsideration decisions.

A new hearing was ordered.

The applicant, a pedestrian making a delivery for Uber Eats, was struck by an e-scooter and sought statutory accident benefits.

The respondent denied the claim on the basis that an e-scooter is not an 'automobile' and therefore the incident was not an 'accident' under s. 3(1) of the Schedule.

The Tribunal applied the Adams test and found that the applicant failed to provide sufficient evidence regarding the e-scooter's features to prove it was an automobile in ordinary parlance.

The application was dismissed.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision which found she was not catastrophically impaired and denied a treatment plan for a catastrophic assessment.

The applicant argued the adjudicator erred in weighing the medical evidence, particularly regarding a pre-existing 2019 accident, and placed undue weight on surveillance evidence showing her speeding.

The Vice-Chair dismissed the request, finding the applicant was improperly attempting to re-weigh the evidence rather than identifying an error of law or fact.

The Tribunal also upheld the denial of the treatment plan balance, noting the applicant failed to explain why an amount greater than the statutory cap was reasonably required.

The minor applicant was involved in a motor vehicle accident at age three.

The respondent insurer denied benefits because the application (OCF-1) was submitted nearly two years after the accident, outside the timelines in the Statutory Accident Benefits Schedule.

The Tribunal found that the applicant had a reasonable explanation for the delay, as he was a minor under a legal disability, entirely reliant on his guardians, and his psychological injuries were not immediately apparent.

The applicant was permitted to proceed with his claim.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for chiropractic services and a psychological assessment.

The respondent insurer denied the treatment plans.

The adjudicator found that the applicant failed to meet her burden of proving the chiropractic treatment plan was reasonable and necessary, as the submitted evidence was not contemporaneous and lacked specific goals.

However, the adjudicator approved the psychological assessment, preferring the evidence of the applicant's assessors over the insurer's examiner, finding it necessary to evaluate the exacerbation of the applicant's pre-existing psychological conditions.

The applicant was also awarded interest on the overdue payment for the psychological assessment.

The applicant requested a reconsideration of a preliminary issue decision which found she was not entitled to non-earner benefits prior to submitting a completed disability certificate.

The applicant argued the Tribunal erred by failing to consider the insurer's obligation to communicate the consequences of a delay in submitting the certificate.

The Tribunal dismissed the request, finding the applicant was attempting to re-litigate arguments already addressed in the initial decision and failed to establish an error of law or fact under Rule 18.2(b).

The applicant sought a determination that she sustained a catastrophic impairment under Criterion 8 (mental or behavioural disorder) as a result of a motor vehicle accident, as well as payment for the unapproved balance of a catastrophic assessment treatment plan.

The respondent brought a preliminary motion arguing the claim was barred by res judicata due to a prior Tribunal decision denying non-earner benefits.

The adjudicator dismissed the motion, finding the prior decision did not rule on psychological impairments.

On the merits, the adjudicator found the applicant was not catastrophically impaired, preferring the respondent's psychiatric evidence that the applicant's impairments were pre-existing from a 2019 accident and that she had returned to her premorbid baseline.

Surveillance evidence and the applicant's ongoing activities, including attending college and travelling, contradicted claims of marked impairment.

The claim for the unapproved treatment plan balance was also dismissed as the applicant failed to justify costs exceeding the statutory maximums.

The applicant, who suffered a catastrophic impairment in a 2007 motor vehicle accident, sought funding for a recreational vehicle ($226,200), home modifications including backyard cement work and pool upgrades ($14,443.65), and business class air tickets ($8,239.84) to facilitate travel and family engagement.

The Licence Appeal Tribunal dismissed the application, finding that none of the requested expenses were reasonable and necessary.

The Tribunal relied on medical evidence indicating that the applicant's physical and psychological limitations would prevent her from safely and effectively utilizing the RV, the proposed backyard modifications, or the business class flights to achieve the stated rehabilitation goals.

The applicant, a pedestrian struck by a vehicle, sought a determination of catastrophic impairment and various statutory accident benefits, including attendant care and housing modifications.

The Tribunal found the applicant was not catastrophically impaired, noting extensive pre-existing psychiatric and behavioural issues, including prior traumatic brain injuries and a need for 24/7 supervisory care that predated the accident.

The Tribunal preferred the respondent's expert evidence, finding the applicant's functional impairments were not caused by the subject accident.

All claims for benefits, assessments, and an award were dismissed.

The applicant sought a non-earner benefit following a motor vehicle accident but failed to submit a completed disability certificate (OCF-3) until July 21, 2023.

The insurer denied the benefit for the period prior to the submission of the OCF-3.

The Licence Appeal Tribunal held that under section 36 of the Statutory Accident Benefits Schedule, no non-earner benefit is payable for any period before the OCF-3 is submitted.

The application was dismissed.

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

The respondent denied benefits, arguing that the applicant's traumatic brain injury was caused by an intervening event—a fall from an examination table during medical treatment months after the accident.

The Tribunal agreed, finding the fall broke the chain of causation.

Consequently, the claim for a non-earner benefit and assessments related to the brain injury were dismissed.

However, the Tribunal found that treatment plans for chiropractic, physiotherapy, and aqua therapy services related to the accident injuries were reasonable and necessary, and ordered their payment with interest.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision finding he had not sustained a catastrophic impairment.

The applicant argued the Tribunal breached procedural fairness by relying on the untested report of the respondent's psychiatric expert, who did not attend the hearing for cross-examination.

The adjudicator dismissed the request, finding no procedural unfairness because the parties knew from the outset the expert would not testify, the report was properly admitted under section 15(1)(b) of the Statutory Powers Procedure Act, and the Tribunal appropriately assigned it less weight.

The applicant sought a determination of catastrophic impairment and entitlement to attendant care benefits and assessment costs following a motorcycle accident.

The Licence Appeal Tribunal found that the applicant did not meet the threshold for catastrophic impairment under either criterion 7 or 8, preferring the evidence of the respondent's experts over the applicant's expert, whose conclusions relied heavily on inconsistent self-reporting.

The Tribunal also dismissed the claims for attendant care benefits and assessment costs due to a lack of evidence demonstrating incurred expenses or reasonable necessity.

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

The respondent denied a treatment plan on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.

The applicant argued she should be removed from the MIG due to chronic pain and psychological injuries.

The Tribunal found that the applicant's injuries were predominantly minor, preferring the in-person assessments of the respondent's experts and the clinical notes of the applicant's family physician over the virtual assessment of the applicant's expert.

The Tribunal concluded the applicant failed to demonstrate chronic pain with functional impairment or a psychological injury, and dismissed the application.