Colin MacDonald

The applicant was injured in a motor vehicle accident and sought attendant care benefits (ACBs) from the respondent insurer.

The parties had previously executed a settlement agreement fixing the monthly ACB amount at $1,200.00.

The respondent partially denied subsequent invoices, arguing its liability was strictly capped by the maximum hourly rates in the Superintendent's Guideline.

The Tribunal found that the 2018 Guideline uses hourly rates to calculate the monthly benefit but does not strictly cap the insurer's liability on a per-invoice basis once the monthly amount is fixed.

The Tribunal ordered the respondent to pay the incurred ACBs up to the $1,200.00 monthly limit, plus interest, but declined to order an award under s. 10 of Reg. 664.

Zurich appealed a Superior Court decision that held Zurich and Chubb equally responsible for paying statutory accident benefits to a claimant injured in a rental vehicle.

The claimant initially applied to Chubb, who denied the claim and failed to notify Zurich within 90 days as required by O. Reg. 283/95.

The second arbitrator found Chubb solely responsible for the benefits due to its breaches of sections 2 and 3 of the Regulation.

The appeal judge overturned this, finding the insurers should share responsibility.

The Court of Appeal allowed Zurich's appeal and reinstated the arbitrator's award, holding that the appeal judge erred in treating the insurers as having equal priority under section 268 of the Insurance Act.

The arbitrator reasonably exercised his discretion in requiring Chubb to pay the benefits permanently as a consequence of its breaches.

The applicant applied to the Licence Appeal Tribunal seeking a determination that the respondent's counsel was in a conflict of interest for requesting an examination under oath regarding accident benefits after previously conducting one for a priority dispute.

The applicant did not dispute any specific entitlement to accident benefits.

The Tribunal held that under s. 280(1) of the Insurance Act, its jurisdiction is limited to disputes regarding entitlement to or the amount of statutory accident benefits.

Because the conflict of interest was raised as a standalone issue without an underlying benefits dispute, the Tribunal found it lacked jurisdiction and dismissed the application.

The Applicant sought payment for four treatment plans for psychological services and a chronic pain assessment following a motor vehicle accident, as well as an award for unreasonable delay.

The Tribunal found that the Applicant failed to meet their onus to establish that the treatment plans were reasonable and necessary, as they provided no specific submissions or evidence addressing the disputed plans.

The claims for the treatment plans, interest, and a section 10 award were dismissed.

The applicant sought statutory accident benefits following a 2018 motor vehicle accident, claiming catastrophic impairment under Criteria 6, 7, and 8 of the Schedule.

The Tribunal gave no weight to the applicant's key expert witness, who failed to attend the hearing for cross-examination, citing procedural fairness.

Relying on surveillance evidence that contradicted the applicant's claims of severe impairment and social isolation, the Tribunal found the applicant did not meet the threshold for catastrophic impairment.

Consequently, claims for medication expenses beyond the non-catastrophic limit, a special award, and interest were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing her injuries warranted removal from the Minor Injury Guideline (MIG) due to chronic pain, a pre-existing condition, and psychological impairment.

The Licence Appeal Tribunal found that the applicant's injuries fell within the MIG, as the medical evidence did not establish chronic pain with functional impairment, a significant aggravation of her pre-existing back pain, or a psychological impairment.

The Tribunal also dismissed the claim for non-earner benefits, finding the applicant did not suffer a complete inability to carry on a normal life.

The respondent's request for costs based on the applicant's prior withdrawal of a similar application was denied, as both parties had engaged in similar procedural behaviour and no bad faith was established.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to non-earner benefits and funding for psychological and chiropractic treatment plans outside the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant's injuries were predominantly minor and that he failed to establish a pre-existing condition or psychological impairment warranting removal from the MIG.

The Tribunal also dismissed the claim for non-earner benefits, finding insufficient medical evidence to demonstrate a complete inability to carry on a normal life.

As the MIG limit was exhausted, the disputed treatment plans and claim for interest were denied.

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

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued for removal from the MIG based on pre-existing conditions and chronic pain syndrome.

The Tribunal found the applicant failed to provide compelling medical evidence that a pre-existing condition precluded maximal recovery within the MIG, nor did he meet the criteria for chronic pain under the AMA Guides.

The Tribunal also dismissed the claim for an income replacement benefit, finding insufficient evidence of a substantial inability to perform essential work tasks.

The application was dismissed.

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

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant sought removal from the MIG based on a partial shoulder tear, pre-existing conditions, chronic pain syndrome, and psychological issues.

The Tribunal found that the applicant failed to provide compelling medical evidence to support removal from the MIG on any of these grounds.

The applicant's expert reports were given less weight due to non-compliance with procedural rules and lack of functional impairment evidence.

The Tribunal concluded the applicant remains within the MIG and is not entitled to the disputed treatment plans.

The appellant, Chubb Insurance Company of Canada, appealed an arbitration decision that held it solely liable for Statutory Accident Benefits (SABS) payments to an injured person, despite Zurich Insurance Company being the actual primary insurer.

The Supreme Court of Canada had previously ruled that Chubb, as the first insurer to receive a misdirected SABS application, was deemed an insurer for the claim.

The Superior Court found that the arbitrator erred by not fully analyzing the interplay between the Insurance Act and O. Reg. 283/95.

The court concluded that both Chubb and Zurich were insurers of equal priority due to the unique circumstances and must share liability 50/50, with each responsible for 2% compound interest for delays attributable to them.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits nearly a year later.

The respondent denied the claim on the basis that the applicant failed to submit the application for benefits within the prescribed time limits under section 32 of the Schedule.

The applicant argued she had a reasonable explanation for the delay because her injuries were latent.

The Tribunal found the applicant's explanation was not credible, as medical records contradicted her claim that she was unaware of her injuries until months later.

The Tribunal held the applicant was statute-barred from proceeding with her application.

The applicant sought accident benefits following a motor vehicle accident, which the respondent insurer denied on the basis that the injuries fell within the Minor Injury Guideline (MIG).

The applicant argued for removal from the MIG due to chronic pain, but the Tribunal found insufficient evidence of functional limitations or psychological impairment to warrant removal.

The Tribunal also dismissed the applicant's claim for a non-earner benefit, noting a lack of evidence demonstrating a complete inability to carry on a normal life.

Finally, the Tribunal found the respondent provided sufficient medical reasons for denying the disputed treatment plans within the required timelines.

The application was dismissed in its entirety.

The applicant sought statutory accident benefits following a road rage incident where he pursued the assailant's vehicle on foot and was injured upon making contact with it.

The respondent denied benefits on the basis that the incident was not an 'accident' under s. 3(1) of the Schedule.

The Tribunal applied the Greenhalgh purpose and causation test, finding that while the vehicle was being used in a normal fashion at the exact moment of injury, the incident failed all three parts of the causation test.

The applicant's decision to pursue the vehicle broke the chain of causation, and the dominant feature of the incident was the individuals, not the vehicle.

The Tribunal concluded the incident was not an accident.

The respondent's request for costs was denied as there was no evidence the applicant acted unreasonably or in bad faith.

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

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and that the treatment plans and non-earner benefit were not payable.

The Tribunal found that the applicant failed to meet the burden of proving his injuries warranted removal from the MIG.

Furthermore, the Tribunal held that the respondent's denial letters complied with the requirements of the Statutory Accident Benefits Schedule, and the applicant was not entitled to the non-earner benefit, the disputed treatment plans, or interest.

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

The respondent denied the benefits because the applicant failed to notify it of his intention to apply within the seven-day period prescribed by section 32(1) of the Schedule.

The applicant argued that his delay of three months was reasonable because he does not like to complain.

The Tribunal found this explanation unreasonable and held that the applicant failed to establish a basis for waiver or estoppel under section 131 of the Insurance Act.

The application was dismissed as statute-barred.

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

The respondent denied several treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's chronic back pain, which caused functional impairment, warranted removal from the MIG.

The Tribunal approved treatment plans for physiotherapy and a psychological assessment, finding them reasonable and necessary, but denied other plans for lack of evidence or because they were duplicative.

Interest was awarded on the overdue benefits.

The applicants sought judicial review of an interlocutory decision by the Licence Appeal Tribunal, which had dismissed their motion to disqualify the insurer's counsel and adjuster for alleged conflict of interest and privacy breaches.

The Divisional Court dismissed the application for judicial review as premature.

The court held that absent exceptional circumstances, judicial review of administrative decisions should not be brought until the tribunal proceedings are complete, and the applicants failed to establish that this was a rare case warranting early intervention.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's determination that her injuries fell within the Minor Injury Guideline (MIG).

The applicant claimed ongoing physical and psychological impairments warranted removal from the MIG and sought funding for various treatment plans and assessments.

The Tribunal found that the applicant's injuries were predominantly minor, relying on the unanimous conclusions of several independent medical examiners and the lack of compelling medical evidence of chronic pain or psychological conditions.

As the $3,500 MIG funding limit had already been exhausted, the applicant was not entitled to the disputed treatment plans or interest.

The application was dismissed.

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

The respondent insurer denied several treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's pre-existing and accident-related psychological conditions warranted removal from the MIG.

The Tribunal ordered the respondent to pay for several psychological and social work assessments and treatments, as well as one chiropractic treatment plan, finding them reasonable and necessary.

The Tribunal also ordered a $1,000 special award under s. 10 of O. Reg. 664, finding that the respondent unreasonably maintained the applicant in the MIG despite its own assessor's opinion to the contrary.

The applicant sought reconsideration of a decision finding he made a material misrepresentation on his automobile insurance application, which excluded him from income replacement benefits and required him to repay $72,881.74 to the insurer.

The applicant argued the Tribunal lacked jurisdiction, violated procedural fairness, made factual errors, and that new evidence was available.

The adjudicator dismissed the request, finding no procedural unfairness, confirming the Tribunal's jurisdiction over the dispute, and concluding the applicant was improperly attempting to relitigate the initial findings.

The adjudicator also held that the alleged new evidence could have been obtained prior to the initial hearing with due diligence.