Kevin Griffiths

The applicant sought payment for the unapproved balances of treatment plans for psychological services and an occupational therapy assessment following a motor vehicle accident.

The dispute centered on the hourly rate charged by a psychotherapist, which the applicant argued should match a psychologist's rate due to supervision and interpretive services provided.

The Tribunal found the applicant failed to prove the higher rate was justified by specialized training or experience.

The claims for the unapproved balances, interest, and an award under Regulation 664 were dismissed.

The applicant sought a determination that he sustained a catastrophic impairment under Criterion 8 (mental or behavioural disorder) of the Statutory Accident Benefits Schedule following a motor vehicle accident.

The adjudicator found that the applicant's limitations in activities of daily living were predominantly caused by his physical impairments rather than a mental or behavioural disorder.

The applicant failed to establish a Class 4 (marked) impairment in activities of daily living, and thus could not meet the requirement of three Class 4 impairments.

Claims for various treatment plans were dismissed as the applicant's funding limits were exhausted.

However, the adjudicator granted an award of 25% under s. 10 of O. Reg. 664, finding that the respondent unreasonably delayed the payment of two invoices that it had previously agreed to pay.

The applicant sought statutory accident benefits following a 2016 motor vehicle accident that occurred while he was being transported in a correctional vehicle.

He claimed entitlement to two neuropsychological assessments and physiotherapy services, as well as an award for unreasonable delay.

The Tribunal found the applicant was entitled to partial payment of $2,200 for the initial neuropsychological assessment, as there was a reasonable possibility of cognitive impairment stemming from accident-related chronic pain.

However, the Tribunal dismissed the claims for the subsequent neuropsychological assessment and physiotherapy services due to insufficient evidence of reasonableness and necessity.

The claim for a special award was also dismissed.

The appellant appealed a License Appeal Tribunal (LAT) decision denying his claims for a catastrophic impairment designation, attendant care benefits, and various treatment plans following a motor vehicle accident.

The Divisional Court found no errors of law in the LAT Vice-Chair's application of the 'but for' causation test or her factual findings that the appellant's ongoing impairments were not accident-related.

The court also held that the LAT correctly dismissed the claims for treatment plans and attendant care benefits, as the appellant had no accident-related impairments during the relevant periods.

The appeal was dismissed.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that awarded $5,550.00 for unreasonably withheld non-earner benefits.

The applicant argued that the adjudicator made an error of law in applying the formula for calculating the special award.

The adjudicator agreed, finding that the formula was incorrectly applied by adding interest after calculating 50% of the withheld benefits, rather than calculating 50% of the total of withheld benefits plus interest.

The adjudicator granted the reconsideration and varied the special award to $8,560.08.

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

The insurer denied income replacement benefits and three treatment plans in 2019 and 2020.

The applicant filed an application to dispute the denials in October 2023, beyond the two-year limitation period.

The Tribunal found that the insurer's denial notices were valid and compliant with the Schedule, triggering the limitation period.

The Tribunal declined to extend the limitation period as the applicant provided no submissions.

The application was dismissed as statute-barred.

The applicant was involved in a motor vehicle accident and sought non-earner benefits.

The respondent initially paid the benefits but terminated them based on insurer's examinations.

Despite receiving subsequent medical evidence indicating the applicant's deteriorating condition and catastrophic impairment, the respondent failed to reassess the applicant's entitlement for several years.

The Tribunal found that the respondent unreasonably withheld the benefits and ordered a special award under s. 10 of Regulation 664, amounting to 40% of the benefits withheld during the unreasonable delay period.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for assistive devices, chiropractic services, and physiatry and psychological assessments.

The respondent insurer denied the benefits.

The Tribunal found the assistive devices and chiropractic services were reasonable and necessary to address the applicant's chronic pain and sleep loss, supported by recommendations from her treating practitioners.

However, the Tribunal denied the physiatry and psychological assessments because their stated purpose was a 'post-104 week determination' for income replacement benefits, which is not a payable assessment under section 25 of the Schedule.

The applicant was awarded the treatment plans for assistive devices and chiropractic services, plus interest.

The applicant was involved in a 2019 rear-end motor vehicle accident and sought statutory accident benefits, including a non-earner benefit and various treatment plans.

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and that her ongoing symptoms were attributable to a prior 2014 accident.

The Tribunal found that the applicant failed to provide compelling medical evidence that her pre-existing chronic pain prevented her from achieving maximal recovery within the MIG.

The Tribunal also found the applicant did not meet the rigorous test for a non-earner benefit, as she could not establish a complete inability to carry on a normal life caused by the 2019 accident rather than her pre-existing condition.

The application was dismissed.

The applicant requested a reconsideration of a preliminary issue decision which found that the Settlement Disclosure Notice (SDN) was not defective.

The applicant argued that the Tribunal made errors of law and fact regarding the onus of proof and the compliance of the SDN with Regulation 664.

The adjudicator dismissed the request, finding that the applicant was attempting to re-argue her case and failed to establish any error of law or fact that would meet the high threshold for reconsideration.

The applicant requested a reconsideration of a Tribunal decision that found he was not entitled to benefits or a catastrophic impairment designation.

The applicant argued that the Tribunal made an error of law or fact regarding the applicable version of the Statutory Accident Benefits Schedule and the rules of discoverability for future claims.

The Tribunal dismissed the request, finding that the applicant failed to identify any specific error of law or fact in the original decision that would alter the result.

The Tribunal noted that the original decision does not prevent the applicant from applying for future benefits or arguing discoverability in the future.

The applicant sought to rescind a 2002 settlement agreement for statutory accident benefits, arguing the Settlement Disclosure Notice (SDN) did not comply with Regulation 664.

The Tribunal found that the respondent substantially complied with the regulation, and any deficiencies in the SDN were merely technical and did not warrant setting aside the settlement.

The application was dismissed.

The applicant was involved in a motor vehicle accident and sought $2,170.28 for an occupational therapy treatment plan under the Statutory Accident Benefits Schedule.

The respondent denied the benefit, relying on insurer's examinations which concluded the applicant had reached maximum medical recovery and that further treatment was not reasonable or necessary.

The Tribunal found that the applicant failed to provide compelling medical evidence to establish the treatment plan was reasonable and necessary, noting that the applicant's chiropractor was not qualified to diagnose chronic pain syndrome.

The application was dismissed, and no interest was awarded.

The applicant sought Non-Earner Benefits (NEBs) following a motor vehicle accident, claiming a complete inability to carry on a normal life.

The Tribunal applied the Heath test and found that while the applicant was less able to live her life, she continued to engage in substantially all of her pre-accident activities, such as caring for pets, doing laundry, and preparing meals, albeit to a lesser extent.

The Tribunal concluded the applicant did not suffer a complete inability to carry on a normal life and dismissed the claims for NEBs, interest, and a section 10 award.

The applicant sought a catastrophic impairment designation and entitlement to attendant care benefits and various treatment plans following a 2015 motor vehicle accident.

The central issue was causation, as the applicant experienced subsequent accidents, medical conditions including seizures and a Hills-Sachs lesion, and significant life stressors post-accident.

The Tribunal found that while the accident initially exacerbated pre-existing physical impairments and triggered some psychological symptoms, the applicant's current severe psychological impairments were caused by intervening life events and medical issues unrelated to the accident.

The Tribunal concluded the applicant did not meet the 'but for' test for causation, dismissing the application for catastrophic designation and all claimed benefits.

The applicant sought income replacement benefits following a 2017 motor vehicle accident.

A previous Tribunal decision had already determined the applicant's entitlement to these benefits was nil, and the applicant did not appeal or request reconsideration.

The applicant filed a second application for the same benefits.

The Tribunal applied the doctrine of res judicata, finding that the four preconditions were met and no exceptions applied.

The appeal was dismissed as the issue had already been finally determined.

The applicant sought reconsideration of a Licence Appeal Tribunal decision denying him a non-earner benefit following a motor vehicle accident.

The applicant argued the Tribunal failed to apply the Heath factors to assess his inability to carry on a normal life.

The Vice-Chair dismissed the request, finding the Tribunal made no material error of law or fact, as the evidence supported the conclusion that the applicant had largely returned to his pre-accident activities and function, rendering the Heath analysis unnecessary.

The appellant insurer appealed a Licence Appeal Tribunal (LAT) decision ordering it to pay for disputed chiropractic treatment plans once incurred.

The insurer argued the LAT lacked jurisdiction to order payment for expenses not yet incurred prior to the hearing.

The Divisional Court dismissed the appeal, holding that the LAT has broad remedial powers to determine entitlement to benefits, and requiring claimants to self-fund disputed treatments before accessing the LAT would defeat the consumer protection purpose of the Statutory Accident Benefits Schedule.

The applicant, an incarcerated veteran with severe pre-existing spinal stenosis, sought statutory accident benefits following two prisoner transfers in unpadded, unrestrained vehicles.

The respondent insurer denied the claims, arguing the events were not 'incidents' and the dominant feature of the impairment was the applicant's pre-existing condition, not the use or operation of an automobile.

The Tribunal found that the events were 'incidents' under a purposive interpretation of the Schedule, noting the applicant was shackled and unable to brace himself.

Applying the Greenhalgh test, the Tribunal concluded the use and operation of the vehicles were the dominant feature and a direct cause of the exacerbation of the applicant's pain.

The preliminary issue was resolved in the applicant's favour, allowing the substantive claims to proceed.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing his injuries, including chronic pain and a pre-existing knee condition, warranted removal from the Minor Injury Guideline (MIG).

The applicant passed away before the decision was rendered, but the Tribunal found the proceeding was not moot as a decision could impact deemed incurred expenses.

The Tribunal held that the applicant failed to establish on a balance of probabilities that his injuries fell outside the MIG, noting a significant 14-15 month gap in treatment and compelling medical evidence attributing his worsening pain to degenerative changes.

However, the Tribunal found the respondent failed to deny a February 2017 treatment plan within the required 10 business days under s. 38(8) of the Schedule, precluding it from relying on the MIG to deny that specific plan.

No interest was awarded.