Daniel Mark Himelfarb

The applicant was involved in a motor vehicle accident and sought post-104 week income replacement benefits (IRBs) and interest.

The respondent denied the benefits, arguing the applicant could maintain employment.

The Tribunal found the applicant suffered a concussion and mild traumatic brain injury, leading to significant physical and psychological impairments.

Preferring the evidence of the applicant's experts over the respondent's, the Tribunal concluded the applicant demonstrated a complete inability to engage in any employment for which she is reasonably suited by education, training, or experience.

The applicant was awarded IRBs of $168.59 per week from August 24, 2023, to date, plus interest.

The applicant sought a determination that she sustained a catastrophic impairment following a motor vehicle accident.

Her initial application was dismissed by the Tribunal and upheld on judicial review.

She filed a new application, and the respondent raised the preliminary issue of res judicata.

The applicant also raised a constitutional challenge, arguing the Tribunal's practice of holding written preliminary issue hearings violated section 7 of the Charter.

The Tribunal dismissed the constitutional challenge, finding the practice direction was a non-binding guideline and the applicant had consented to the written format.

The Tribunal further held that the application was barred by res judicata, as the issues had been previously decided on their merits and the applicant failed to demonstrate a material change in circumstances that would conclusively impeach the original decision.

The applicant sought a determination that she sustained a catastrophic impairment following a motor vehicle accident, after a previous Tribunal decision found she did not meet the criteria.

The respondent raised a preliminary issue that the application was barred by res judicata.

The applicant also raised a constitutional challenge, arguing the Tribunal's practice of holding preliminary issue hearings in writing violated her section 7 Charter rights.

The Tribunal dismissed the constitutional challenge, finding the practice direction was a non-binding guideline and the applicant had consented to the written format.

The Tribunal further held that the application was barred by res judicata, as the same question had been decided in a final decision between the same parties, and the applicant failed to demonstrate a material change in circumstances that would conclusively impeach the original result.

The applicant sought statutory accident benefits following a 2022 motor vehicle accident, claiming catastrophic impairment under Criterion 8, income replacement benefits, attendant care benefits, and various treatment plans.

The Licence Appeal Tribunal dismissed the majority of the claims, finding the applicant's self-reports of pre-accident functioning were inaccurate, as he was receiving long-term disability and Canada Pension Plan disability benefits prior to the accident.

Surveillance evidence and testimony contradicted the applicant's claims of severe social and functional isolation.

The Tribunal found the applicant did not sustain a catastrophic impairment, was not entitled to an IRB, and was only entitled to a minor portion of one treatment plan due to a late denial by the insurer.

The applicant sought post-104 week income replacement benefits (IRBs) after a motor vehicle accident.

The insurer argued the application was time-barred, relying on a denial issued before the 104-week mark when the applicant had temporarily returned to work.

The Tribunal found that the initial denial was premature regarding post-104 week IRBs, as entitlement to those benefits was not yet discoverable.

The Tribunal held the application was filed within the two-year limitation period triggered by a subsequent valid denial.

In the alternative, the Tribunal granted an extension of the limitation period under section 7 of the Licence Appeal Tribunal Act, finding minimal prejudice to the insurer and sufficient merit to the claim.

The applicant sought various statutory accident benefits following a motor vehicle accident, including treatment plans for occupational therapy, vocational assessments, case management, attendant care, and housekeeping.

The respondent denied the benefits on the basis that the applicant had reached maximum medical recovery and had returned to her pre-accident employment as a personal support worker.

The Tribunal found that the disputed treatment and assessment plans were not reasonable and necessary, relying on the respondent's multidisciplinary assessments which confirmed the applicant's independence in daily activities and her return to work.

The application was dismissed in its entirety.

The applicant sought statutory accident benefits following a motor vehicle accident, including removal from the Minor Injury Guideline (MIG), a non-earner benefit (NEB), and funding for physiotherapy.

The Licence Appeal Tribunal found that the applicant failed to establish on a balance of probabilities that she suffered from chronic pain with functional impairment warranting removal from the MIG.

The Tribunal also dismissed the claim for an NEB, finding insufficient evidence of the applicant's pre-accident activities and how her impairments prevented her from engaging in them.

Claims for treatment plans, an award, interest, and costs were consequently dismissed.

The applicant sought statutory accident benefits following the death of his son in a motor vehicle accident.

The insurer denied the claims on the basis that the applicant was not a 'dependant' of the deceased under section 3(7)(b) of the Schedule.

The Tribunal found that the applicant was not principally dependent on his son for financial support or care, as the financial contributions from the son did not amount to 51% or more of the applicant's household expenses.

The Tribunal also dismissed the claim for funeral benefits because the applicant failed to prove he incurred the expenses.

The application was dismissed.

The applicant sought statutory accident benefits, including a death benefit and a psychological assessment, following the death of her son in a motor vehicle accident.

The respondent denied the benefits on the basis that the applicant was not a 'dependant' under s. 3(7)(b) of the Schedule.

The Tribunal applied the Miller factors and found that the applicant was not principally dependent on the insured for financial support or care, as the financial contributions from the insured did not amount to 51% or more of the applicant's household expenses.

The application was dismissed.

The applicant sought $12,430.00 for catastrophic impairment assessments following a 2014 motor vehicle accident.

The Licence Appeal Tribunal found that the applicant failed to demonstrate on a balance of probabilities that the assessments were reasonable and necessary.

The Tribunal noted the applicant's conservative use of benefits over ten years and the lack of contemporaneous medical evidence supporting a marked impairment.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit, attendant care benefits, and numerous treatment plans for psychological, cognitive, and occupational therapy assessments and services.

The Tribunal found the claim for the non-earner benefit was statute-barred because the applicant failed to dispute the insurer's clear and unequivocal denial within the two-year limitation period.

The Tribunal dismissed the claims for the treatment plans and attendant care benefits, finding the applicant failed to prove they were reasonable and necessary for accident-related injuries, largely due to significant pre-existing psychological conditions and a lack of supporting medical evidence.

Claims for interest and an award for unreasonable delay were also dismissed.

The applicant sought housekeeping and home maintenance (HH) benefits and a special award following a catastrophic motor vehicle accident.

The Tribunal found that the applicant's traumatic brain injury and physical impairments resulted in a substantial inability to perform his pre-accident HH tasks, rejecting the insurer's reliance on surveillance footage and an Examination Under Oath.

However, the Tribunal denied payment of the HH benefits because the applicant failed to prove the expenses were incurred under section 3(7)(e) of the Schedule.

The claim for a section 10 award was dismissed as the insurer's conduct was not excessive or imprudent.

The applicant, a minor injured in a motor vehicle accident, sought $4,099.25 for an occupational therapy treatment plan for tutoring services.

The Licence Appeal Tribunal found that the applicant failed to prove the tutoring was reasonable and necessary as a result of the accident, noting that medical evidence pointed to ADHD rather than accident-related impairments.

The Tribunal also found the insurer's denial notice complied with section 38(8) of the Schedule.

The application was dismissed and no interest was awarded.

The applicant sought judicial review of a Licence Appeal Tribunal (LAT) decision dismissing her claims for statutory accident benefits, including income replacement benefits, catastrophic impairment designation, and attendant care benefits.

The Divisional Court dismissed the application, finding that the LAT's decisions regarding the 104-week deadline for income replacement benefits, the assessment of catastrophic impairment criteria, and the reduction of attendant care benefits were reasonable.

The court also rejected the applicant's claims of procedural fairness violations, concluding that the LAT appropriately controlled its own process.

The applicant sought entitlement to two psychological treatment plans, a special award, and interest following a 2018 motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the proposed treatment plans were redundant and duplicative of previously funded assessments.

The Tribunal noted a lack of contemporaneous evidence in the family doctor's clinical notes to support the need for further mental health assessments three to four years post-accident.

As no benefits were payable, the claims for interest and a special award were also dismissed.

The applicant was injured in a motor vehicle accident while working and initially received WSIB benefits.

He subsequently opted out of WSIB to claim statutory accident benefits and later commenced a tort action.

The insurer argued the applicant was barred under s. 61 of the Schedule because his election was made primarily to claim accident benefits.

The Tribunal agreed, finding insufficient evidence of a bona fide intention to pursue a tort claim at the time of the election.

The application for accident benefits was dismissed as statute-barred.

The applicant sought payment for an occupational therapy assessment following a motor vehicle accident.

The insurer denied the treatment plan, arguing it was for attendant care beyond the 104-week limit.

The Tribunal found the insurer's denial failed to comply with s. 38(8) of the Schedule because it did not address the actual benefit claimed (an OT assessment) and lacked proper medical reasons.

Consequently, the applicant was entitled to the cost of the assessment if incurred.

The Tribunal dismissed the claim for an award under s. 10 of Regulation 664, finding the insurer's defective denial was a mistake rather than excessive or imprudent conduct.

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

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

After the applicant was removed from the MIG, the respondent failed to provide updated denial notices with medical reasons for several treatment plans.

The Tribunal applied the Divisional Court's decision in Suarez, holding that the defective notices could not be cured, and ordered those treatment plans payable once incurred.

The Tribunal also evaluated the substantive reasonableness and necessity of the remaining treatment plans, granting entitlement to psychological and occupational therapy based on the applicant's exacerbated pre-existing conditions, while denying further physical therapy and neurological assessments.

The claim for a special award was dismissed as the insurer's reliance on its assessors was not unreasonable.

The applicant requested a reconsideration of a Tribunal decision that denied his claims for income replacement benefits, treatment plans, and educational expenses, and ordered him to repay benefits due to material misrepresentation.

The applicant argued the Tribunal made errors of law and breached procedural fairness regarding the weighing of evidence, the insurer's obligations, and the calculation of policy limits.

The Tribunal dismissed the request, finding no errors of law or breaches of procedural fairness, and noted the applicant was attempting to relitigate issues already decided at the initial hearing.

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

The respondent insurer denied several physiotherapy treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant suffered from accident-related chronic pain syndrome with functional impairment, justifying removal from the MIG.

The Tribunal ordered the respondent to pay for the disputed physiotherapy treatment plans with interest, but denied the applicant's request for a special award under s. 10 of Regulation 664.