Lawrence A. Berg

The applicant sought non-earner benefits and a physiotherapy treatment plan following a motor vehicle accident.

The Licence Appeal Tribunal excluded several of the applicant's medical reports because they were submitted eight months past the document exchange deadline, prejudicing the respondent.

On the merits, the Tribunal dismissed the claim for non-earner benefits, finding the applicant failed to provide sufficient evidence comparing her pre- and post-accident activities to establish a complete inability to carry on a normal life.

The Tribunal preferred the respondent's multidisciplinary insurer examination reports, which found no significant functional impairments.

The claim for the physiotherapy treatment plan was also dismissed as the applicant provided minimal argument or evidence to demonstrate it was reasonable and necessary.

The applicant, a 69-year-old retiree, was involved in a motor vehicle accident and sought a non-earner benefit from the respondent insurer.

The respondent denied the benefit, arguing the applicant did not suffer a complete inability to carry on a normal life and had a pre-existing shoulder injury.

The Tribunal found that the applicant failed to establish that his impairment continuously prevented him from engaging in substantially all of his pre-accident activities.

Medical evidence and the applicant's own self-reporting indicated he had returned to most of his activities of daily living.

The application for a non-earner benefit was dismissed, and the respondent's request for costs was also dismissed.

The applicant sought a non-earner benefit following a motor vehicle accident.

The Tribunal applied the Heath test and found that the applicant failed to prove a complete inability to carry on a normal life.

The Tribunal preferred the respondent's medical and occupational therapy assessments, which concluded the applicant could perform her normal life activities, over the applicant's expert evidence, which lacked cogent explanation connecting her limitations to a complete inability to carry on a normal life.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs).

The respondent insurer terminated IRBs after initially paying them, arguing the applicant could return to her pre-accident employment as a furniture salesperson.

The Tribunal found that the applicant's physical impairments, including exacerbated pre-existing degenerative conditions, and psychological impairments rendered her substantially unable to perform the essential tasks of her employment, which included prolonged standing, walking, and lifting furniture.

The Tribunal ordered the respondent to pay the weekly IRB of $336.45 from the date of termination, plus interest.

The applicant, who was injured in a motor vehicle accident while a passenger on a motorcycle, sought a medical benefit of $2,200 for a psychological assessment.

The respondent insurer denied the claim.

The Tribunal found that the applicant failed to prove on a balance of probabilities that the assessment was reasonable and necessary.

The Tribunal preferred the evidence of the respondent's psychological assessor, who found only mild symptoms and no identifiable impairment, over the applicant's evidence, which included an inappropriate diagnosis of acute stress disorder 18 months post-accident.

The application was dismissed.

The applicant sought statutory accident benefits following the death of her husband in a motor vehicle accident in Somaliland, Africa.

The insurer denied the claim on the basis that the accident occurred outside the territorial limits set out in the Statutory Accident Benefits Schedule.

The applicant argued the legislation was ambiguous regarding accidents outside Canada and the United States and that contra proferentem should apply.

The arbitrator found no ambiguity in the legislation, concluding that the legislature intentionally restricted benefits to accidents occurring in Canada or the United States.

The applicant was therefore precluded from claiming benefits.

The applicant was injured in a motor vehicle accident and received statutory accident benefits from the insurer.

The applicant subsequently signed a release in exchange for a lump sum settlement of $9,500.

The applicant later sought further benefits, arguing he misunderstood the duration of his entitlement and would not have signed the release had he known benefits could continue past age 65.

The insurer denied further benefits, relying on the release.

In a preliminary issue hearing, the arbitrator found no fraud, misrepresentation, or other vitiating factor to set aside the settlement.

The arbitrator concluded the applicant entered into a final and binding settlement and could not proceed to arbitration.

The applicant was awarded expenses for the preliminary hearing.

The applicant was injured in a motor vehicle accident and received weekly income benefits for 156 weeks.

The insurer terminated benefits thereafter.

The applicant sought ongoing weekly income benefits under section 12(5)(b) of the Statutory Accident Benefits Schedule, as well as rehabilitation and occupational training.

The arbitrator found that the applicant's physical restrictions prevented him from engaging in any occupation for which he was reasonably suited by education, training, or experience, and ordered ongoing weekly income benefits.

The arbitrator also ordered the insurer to pay for a comprehensive vocational rehabilitation assessment.

Finding that the insurer acted unreasonably in terminating benefits despite medical and functional capacity reports supporting the applicant's disability, the arbitrator ordered a special award of 35% of the outstanding weekly income benefits.

The applicant was injured in a motor vehicle accident and received weekly income benefits for over 156 weeks.

The insurer terminated benefits, arguing the applicant did not meet the stricter post-156 week test of being continuously prevented from engaging in any occupation for which he is reasonably suited by education, training, or experience.

The arbitrator found that while the applicant had chronic injuries preventing heavy physical work, he was capable of performing lighter or sedentary work consistent with his education and experience.

The arbitrator concluded the applicant's failure to pursue such work was due to a lifestyle choice rather than physical restrictions.

The application for ongoing benefits was dismissed, but the applicant was awarded expenses.