Kevin H. Griffiths

The applicant sought statutory accident benefits for chiropractic and massage therapy treatment plans following a motor vehicle accident.

The respondent denied the benefits, arguing they were not reasonable and necessary.

The Tribunal found that the applicant failed to provide corroborating medical evidence to support the treatment plans, relying solely on the OCF-18 forms.

The Tribunal accepted the respondent's insurer examination report, which concluded the applicant had reached maximum medical improvement and exhibited no observable impairments.

The application was dismissed.

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 plaintiff sought to schedule motions to set aside two 2007 consent orders that dismissed his actions following a settlement for statutory accident benefits.

The plaintiff intended to argue that the settlement was void due to non-disclosure by the insurer and to raise a constitutional challenge against binding Court of Appeal precedent.

The court declined to schedule a single unified hearing, finding the proposed proceedings too complex and fraught with procedural issues.

Instead, the court directed the parties to first schedule a hearing to determine whether the court has jurisdiction (or if the License Appeal Tribunal is the proper forum) and whether the plaintiff must repay the settlement funds before challenging the settlement.

The plaintiff sought to schedule a single, three-hour motion to set aside a 2007 settlement of his statutory accident benefits claims, arguing the insurer failed to provide a mandatory disclosure notice and settled without his authority.

The court found the proposed scheduling premature and procedurally inappropriate, noting complex jurisdictional issues regarding whether the Licence Appeal Tribunal or the court is the proper forum, and whether the plaintiff must first repay the settlement funds.

The court directed the parties to discuss the proper forum and scheduling before proceeding.

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.

The appellant appealed a decision of the Licence Appeal Tribunal regarding statutory accident benefits.

At the hearing, the appellant advised the court she was not actually seeking to appeal the Tribunal's decision, but rather sought to add unresolved claims to an existing Superior Court action.

The Divisional Court dismissed the appeal, noting that the appellant had not appealed the prior Superior Court decision that barred her from adding those claims, and the time to do so had expired.

The applicant sought income replacement benefits (IRB) following a motor vehicle accident.

The respondent agreed the applicant qualified for IRB but disputed the quantum.

The applicant, who was self-employed, argued his IRB should be calculated based on his earnings in the 52 weeks prior to the accident.

The Tribunal found that under section 4(3) of the Schedule, a self-employed person's IRB must be calculated based on their income from the last completed taxation year.

Since the applicant declared no self-employment income in 2016, the last completed taxation year before the 2017 accident, his IRB entitlement was calculated at nil.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including an in-home assessment and three neuropsychological assessments.

The respondent insurer raised preliminary issues arguing the claims were statute-barred.

The adjudicator found the claim for the in-home assessment was barred under s. 38(2) of the Schedule because the expense was incurred before the treatment plan was submitted.

The adjudicator also found the claim for the neuropsychological assessments was barred under s. 56 of the Schedule because the application was filed outside the two-year limitation period.

The adjudicator declined to extend the limitation period under s. 7 of the Licence Appeal Tribunal Act, 1999, noting the applicant had previously withdrawn a timely application without explanation.

The application was dismissed.

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

The insurer raised a preliminary issue, arguing the applicant was barred from proceeding under s. 55(1)2 of the Schedule for failing to attend multiple scheduled insurer's examinations (IEs) under s. 44.

The Tribunal found the applicant failed to attend the IEs for income replacement benefits (IRBs) without a reasonable explanation, and declined to grant relief under s. 55(2), dismissing the IRB claim.

However, the Tribunal allowed the claims for chiropractic services, a functional abilities evaluation, and a psychological assessment to proceed, finding the insurer either failed to schedule an IE for the specific benefit or provided notices that lacked sufficient medical reasons.

The applicant requested a reconsideration of a preliminary decision that suspended his right to dispute entitlement to attendant care and home modification benefits due to his failure to attend section 44 insurer examinations.

The applicant argued that his mental and physical impairments prevented him from attending non-therapeutic assessments and that the Tribunal failed to consider the Ontario Human Rights Code, section 55 of the Schedule, and the totality of his medical evidence.

The Vice Chair dismissed the request, finding that the Tribunal had properly considered the lack of medical evidence supporting accommodation, correctly balanced procedural fairness, and made no errors of law or fact.

The applicant was injured in a motor vehicle accident in Michigan and sought statutory accident benefits from her Ontario insurer.

In a preliminary issues hearing, the Tribunal determined that the Ontario Schedule, not the Michigan Code, applied to the claim because the insurer had not filed a certificate in Michigan.

The Tribunal also held that an OCF-19 must be submitted for a catastrophic impairment determination, rejecting the argument that an insured could be 'deemed' catastrophically impaired.

Finally, the Tribunal found several of the applicant's claims for benefits were statute-barred by the two-year limitation period or precluded because valid applications (OCF forms) were never submitted to the insurer, though it exercised its discretion to extend the limitation period for a few specific claims.

The appellant appealed two arbitration orders denying her claims for non-earner benefits, medical benefits, and a special award, and ordering her to pay HST on the insurer's disbursements.

The Director's Delegate dismissed the appeal, finding no errors of law.

The Arbitrator correctly applied the test for non-earner benefits, properly concluded medical benefits were not incurred, and correctly applied the legislative requirement that treatment plans be signed.

The Delegate also refused to admit a new invoice as fresh evidence because it could have been adduced at the arbitration hearing.

Finally, the Delegate upheld the order requiring the appellant to pay HST on expert witness disbursements.

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

The respondent requested further independent examinations (IEs) under s. 44 of the Statutory Accident Benefits Schedule to address attendant care and home modifications.

The applicant refused to attend, citing mental and physical health issues, and argued the respondent should rely on paper reviews of his experts' reports.

The Tribunal held that procedural fairness requires the respondent to have the opportunity to challenge the applicant's medical evidence with its own assessors.

The Tribunal suspended the applicant's right to proceed with all issues, except housekeeping expenses, until he attends the requested IEs.