Benjamin Hutchinson

The applicant sought statutory accident benefits following a motor vehicle accident, including funding for hyperbaric oxygen therapy and two catastrophic impairment assessments.

The respondent denied the treatment plans.

The Tribunal found that the applicant failed to prove the hyperbaric oxygen therapy was reasonable and necessary, noting a lack of medical evidence supporting its effectiveness for her injuries and deeming it experimental.

The Tribunal also denied the catastrophic impairment assessments, finding the applicant failed to justify the need for multiple assessments in single disciplines and the duplication of services across the two treatment plans.

The application was dismissed, and claims for interest and an award were denied.

The applicant sought various medical and rehabilitation benefits following a motor vehicle accident.

The respondent denied several treatment plans, arguing that the $65,000 non-catastrophic monetary limit had been exhausted.

The Tribunal found that the respondent failed to prove the limit was exhausted and that several of its denial notices were non-compliant with s. 38(8) of the Schedule for failing to clearly state that the limit was fully reached at the time of denial.

Consequently, the Tribunal ordered payment for several treatment plans subject to the non-catastrophic limit, while dismissing claims for other plans that were either duplicative or not reasonable and necessary.

The applicant's request for a special award was denied.

The applicant was injured in a motor vehicle accident and sought $2,078.10 for the unapproved portion of a treatment plan for physiotherapy services, which included yoga therapy.

The respondent had partially approved the plan, paying the maximum hourly rate for unregulated providers for the yoga sessions.

The Tribunal found that the yoga therapy fell under unregulated provider expenses and was subject to the maximum hourly rate of $58.19.

The Tribunal also found no evidence to support an additional $200 reassessment cost.

The application was dismissed.

The applicant sought payment for a forensic audit report after entering into a full and final settlement of her statutory accident benefits claim.

The respondent argued the application was barred because the applicant had not rescinded the settlement agreement or returned the settlement funds pursuant to section 9.1 of Regulation 664.

The Tribunal found that the settlement agreement was valid and binding, and the applicant was barred from proceeding with her application.

The respondent's request for costs was dismissed.

The applicant sought statutory accident benefits following a motor vehicle incident and was denied by the respondent insurer.

A preliminary issue hearing was scheduled to determine if the applicant was barred from proceeding with a claim for income replacement benefits due to failing to submit an OCF-3.

In its written submissions, the respondent withdrew this issue and instead attempted to argue that the applicant failed to attend insurer's examinations under s. 44 of the Schedule.

The adjudicator declined to consider the new issue as it was not properly added via a notice of motion, and ordered that the applicant may proceed with their application.

The applicant sought reconsideration of a decision finding she was not catastrophically impaired and denying various benefits.

The applicant argued the adjudicator breached procedural fairness by inserting causation as an issue in dispute when it was not listed in the Case Conference Report and Order.

The Tribunal agreed, finding that deciding the issue of causation without notice denied the applicant the right to fairly present evidence and argument.

The reconsideration request was granted, the original decision was cancelled, and a new hearing was ordered.

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

The respondent denied four physiotherapy treatment plans 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 for removal from the MIG due to pre-existing psychological conditions and accident-related chronic pain.

The Tribunal found insufficient medical evidence that the pre-existing conditions prevented maximal medical recovery within the MIG.

Relying on the respondent's physiatry assessment, the Tribunal concluded the injuries were predominantly minor.

The application was dismissed.

The applicant sought statutory accident benefits following a 2017 motor vehicle accident, claiming catastrophic impairment and entitlement to income replacement benefits, treatment plans, and a special award.

The respondent denied the benefits, arguing the applicant's impairments were caused by a prior 2015 accident, pre-existing conditions, and subsequent unrelated incidents.

The Tribunal found that the applicant failed to prove on a balance of probabilities that her injuries were caused by the 2017 accident, noting her failure to follow medical advice regarding the prolonged use of a knee brace.

Consequently, the Tribunal dismissed the claims for catastrophic impairment, income replacement benefits, treatment plans, and the special award.

The appellant appealed a trial judgment determining his net entitlement to insurance proceeds following a house fire.

The trial judge had allowed the insurer to set off an overpayment for the house's replacement cost against the appellant's damages for contents, despite the insurer failing to plead set-off as an affirmative defence.

The Divisional Court held that the trial judge erred in law by allowing the unpleaded set-off, as it caused trial unfairness and prejudiced the appellant's litigation and settlement strategy.

The appeal was allowed in part to set aside the set-off, but dismissed regarding the trial judge's factual findings on artwork valuation and additional living expenses.

The applicant was injured in a motor vehicle accident and sought a Non-Earner Benefit (NEB) and medical benefits for physical therapy and a chronic pain program.

The insurer denied the benefits, arguing the applicant did not suffer a complete inability to carry on a normal life and that his injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's pre-accident life was already significantly restricted by a pre-existing intestinal condition, and the accident did not continuously prevent him from engaging in substantially all of his pre-accident activities.

Furthermore, the Tribunal concluded that the applicant's physical and psychological injuries, including mild chronic pain, were predominantly minor and subject to the $3,500 limit.

The application was dismissed.

The plaintiff in a motor vehicle accident claim brought a motion to add a proposed defendant to the action after the apparent expiry of the two-year limitation period.

The plaintiff argued that the claim against the proposed defendant was not discovered until after the Statement of Defence was received.

The court found that the plaintiff failed to lead evidence to overcome the statutory presumption that the claim was discovered on the date of the accident, especially given that the plaintiff had sent a notice of action to the proposed defendant's insurer prior to issuing the Statement of Claim.

The motion to add the proposed defendant was dismissed.

The applicant requested a reconsideration of a preliminary decision which found she was statute-barred from disputing entitlement to caregiver and housekeeping benefits due to an expired limitation period.

The applicant argued the adjudicator erred in law by finding the insurer could request a disability certificate and an insurer's examination contemporaneously, and by finding the insurer was not required to send the examination report to her health practitioner.

The adjudicator dismissed the request for reconsideration, finding no error of law or breach of procedural fairness.

The insurer was permitted to request both contemporaneously, and there was no obligation to send the report to a health practitioner because the applicant never submitted a disability certificate.

The respondent insurer brought a motion to prohibit the applicant from proceeding with an application for statutory accident benefits regarding three treatment plans.

The respondent argued the applicant failed to attend scheduled insurer's examinations under section 44 of the Statutory Accident Benefits Schedule.

The Tribunal found that the requested examinations were reasonably necessary and that the applicant failed to attend them without reasonable explanation.

Consequently, the applicant was found to be in non-compliance with section 44, and pursuant to section 55, was barred from proceeding with the application for the disputed treatment plans.

The respondent's request for costs was denied as there was insufficient evidence of unreasonable or bad faith conduct.

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

The applicant failed to attend the arbitration hearing.

As the applicant bore the onus of proving entitlement to the benefits and presented no evidence, the arbitrator dismissed the claims.

The insurer was awarded $1,750 in expenses due to the applicant's failure to participate in the pre-hearing process and the hearing.