Doug Wallace

The applicant requested a reconsideration of a Licence Appeal Tribunal decision which found that the Tribunal lacked jurisdiction under s. 280 of the Insurance Act over her claim for the $45,054.65 balance of her medical and rehabilitation policy limit.

The applicant argued that the Tribunal breached procedural fairness, made errors of law and fact, and that new evidence in the form of an adjuster's file warranted reconsideration.

The adjudicator dismissed the request, finding no breach of procedural fairness as the preliminary issue was correctly identified from the Case Conference Report and Order.

The adjudicator also found no error of law or fact, noting there were no specific treatment plans in dispute at the time of the hearing, and concluded that the new evidence would not have affected the outcome.

The applicant requested reconsideration of a Tribunal decision that found her application for medical and rehabilitation benefits was barred by the two-year limitation period.

The applicant argued the adjudicator erred in fact and law by finding she had sufficient information to dispute the denials, claiming she did not receive the denials due to an outdated address.

The Tribunal dismissed the request, finding the adjudicator correctly applied the law regarding clear and unequivocal denials and properly addressed the evidence that the denials were faxed to her legal representative.

The applicant failed to establish grounds for reconsideration under Rule 18.2(b).

The applicant sought statutory accident benefits following a 2016 motor vehicle accident, including payment for two chiropractic treatment plans and the balance of her $50,000 medical and rehabilitation policy limits.

The respondent raised a preliminary issue that the claims for the treatment plans were statute-barred as the applicant failed to dispute the denials within the two-year limitation period.

The Tribunal found that the respondent's denials were clear and unequivocal, triggering the limitation period, and declined to extend the time under s. 7 of the LAT Act.

The Tribunal also dismissed the claim for the balance of the policy limits, finding no statutory authority to order such a payment without reference to a specific incurred expense.

The application was dismissed in its entirety.

The applicant sought payment of $45,054.65, representing the balance of her medical and rehabilitation policy limits following a 2014 motor vehicle accident.

The respondent insurer argued the Tribunal lacked jurisdiction because there was no specific denied benefit or treatment plan in dispute.

The adjudicator agreed, finding that under s. 280 of the Insurance Act, the Tribunal's jurisdiction is triggered only by a dispute over a denied benefit.

As the applicant had not submitted a claim for a specific benefit that was denied, there was no dispute.

The application was dismissed for lack of jurisdiction.

The applicant sought to enforce a settlement agreement for statutory accident benefits, alleging she never received the $8,000 settlement funds.

The respondent had issued the funds to the applicant's former lawyer in trust, and the cheque was cashed before the lawyer passed away.

The Licence Appeal Tribunal dismissed the application, finding it lacked jurisdiction under section 280 of the Insurance Act to order the respondent to pay the settlement funds a second time due to the alleged dishonesty of the applicant's own lawyer.

This is an appeal from an order dismissing an action, primarily sounding in defamation, under Ontario's anti-SLAPP legislation (s. 137.1 of the Courts of Justice Act).

The motion judge had dismissed the action, finding that the plaintiff (appellant) had not discharged his burden under s. 137.1(4).

The Court of Appeal found that the motion judge erred in his consideration of the respondents' defences to the defamation claims and in his weighing of the public interest in the expressions against the plaintiff's interest in proceeding.

The Court of Appeal concluded that the plaintiff had established grounds to believe the action had substantial merit and the respondents had no valid defence, and that the public interest in permitting the action to continue outweighed the public interest in protecting the impugned expressions.

The appeal was allowed, and the action was permitted to proceed in its entirety.

The plaintiff brought an unopposed motion for approval of a negotiated settlement and class counsel fees in a class action arising from the defendant's failure to follow public health standards in sterilizing medical instruments at its wound care clinics.

The court approved the settlement, which established a $195,000 fund to compensate the Infected Persons Class, finding it fair, reasonable, and in the best interests of the class.

The court also approved class counsel fees of $112,078.93 and a representative plaintiff honorarium of $1,500.

This endorsement addresses costs and damages following the dismissal of the plaintiff's anti-SLAPP action against several defendants.

The court applied the presumptive full indemnity costs rule under s. 137.1(7) of the Courts of Justice Act, finding no reason to depart from it given the retaliatory nature of the plaintiff's litigation and his failure to provide a costs outline for comparison.

The court fixed costs for each successful defendant, making minor reductions from the amounts claimed.

While damages were sought by two defendants under s. 137.1(9), only one was awarded, as the court found the other defendant's conduct contributed to her stress, making a damages award inappropriate.

The applicant suffered a catastrophic brain injury in a 1999 motor vehicle accident.

The respondent insurer initially paid attendant care benefits (ACB) but reduced and then suspended them in November 2000 without proper notice.

The applicant sought retroactive and ongoing ACB at 24-hour care levels.

The Tribunal found that 24-hour care was not medically necessary, as the applicant had achieved a level of independent living with family support.

The Tribunal upheld the $120.40 monthly rate but ordered a top-up for two six-month periods following changes in living arrangements.

The Tribunal also awarded a 10% penalty under section 10 of Regulation 664 due to the insurer's 20-year delay in reinstating the suspended benefits, along with 2% monthly interest under the 1996 Schedule.

This is an appeal of an arbitration decision concerning a priority dispute between two insurance companies, Intact and Gore Mutual, regarding statutory accident benefits for a claimant injured in an Alberta automobile accident.

The claimant, an Alberta resident, submitted an Ontario claim.

The arbitrator found Gore Mutual in greater priority under both Ontario and Alberta law and ordered reimbursement to Intact.

The Superior Court allowed the appeal, finding the arbitrator's decision on Ontario law unreasonable because the claimant was not an "insured person" under Gore Mutual's Ontario policy.

The court also held that the arbitrator exceeded jurisdiction by determining priority under Alberta law and ordering reimbursement based on it, as the arbitration agreement was limited to Ontario legislation.

The applicants, two brothers, suffered serious burn injuries from an explosion and fire while replacing the fuel pump of an inoperable vehicle in a residential garage.

They applied for statutory accident benefits, which their insurers denied on the basis that the incident was not an 'accident' under the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal held a preliminary issue hearing to determine if the incident met the definition of an accident.

Applying the purpose and causation tests, the Tribunal found that repairing an inoperable vehicle hoisted on jacks is not an ordinary and well-known activity to which automobiles are put by motorists.

The Tribunal concluded the applicants were not using the vehicle for a motoring purpose, and therefore the incident was not an accident within the meaning of the Schedule.

The applications for benefits were dismissed.

The applicant was injured while repairing a vehicle and applied for statutory accident benefits from Unifund, his personal auto insurer.

Unifund denied the claim, relying on the 'garage worker' exclusion, and did not initiate a priority dispute against Intact, the applicant's commercial liability insurer.

The arbitrator held that FSCO does not have jurisdiction to determine coverage exclusions in this context, as such issues must be resolved through a private priority dispute arbitration under O. Reg. 283/95.

Unifund, as the first insurer to receive the application, was ordered to respond to and adjust the claim.

The application against Intact was not dismissed to prevent further prejudice to the applicant.

The applicant, a 17-year-old, was injured in a motor vehicle accident while driving a vehicle owned by the father of the family he was living with.

The insurer denied his claim for a non-earner benefit under section 30(1)(d) of the Statutory Accident Benefits Schedule, arguing he knew or should reasonably have known he was driving without the owner's consent.

The arbitrator found that the insurer failed to meet its burden of proof, as the applicant had a reasonable belief, akin to a colour of right, that the owner's son had the authority to consent to his use of the vehicle.

The applicant was therefore not barred from receiving the benefit.

The insurer appealed an arbitration decision reinstating the insured's income replacement benefits, arguing the Arbitrator failed to apply the 'crumbling skull' rule to the insured's pre-existing heart condition.

The Director's Delegate dismissed the appeal, finding the Arbitrator correctly applied the 'significant or material contribution' test from Athey v. Leonati.

The Arbitrator's factual finding that the insured's heart condition did not deteriorate significantly after the accident and did not impact his functional ability was supported by the evidence and not reviewable as an error of law.

The applicant was seriously injured in a motor vehicle accident and sought payment for services provided by a rehabilitation consultant.

The insurer denied payment, arguing the services were case management, which are only compensable if the insured suffered a catastrophic impairment.

The arbitrator found that the statutory definition of 'case manager' is exhaustive and limited to coordinating medical, rehabilitation, or attendant care benefits.

Services coordinating other benefits, such as caregiver or housekeeping benefits, are not case management and may be compensable as rehabilitation benefits under section 15.

The arbitrator concluded that some of the consultant's services were case management and not compensable, while others were rehabilitation services and potentially compensable.

The applicant was injured in a motor vehicle accident and received income replacement benefits until the insurer terminated them based on a disability assessment.

The applicant sought ongoing benefits, arguing that accident-related headaches, neck, and back pain prevented him from working full-time as a travel agent.

The arbitrator found that the applicant suffered a substantial inability to perform the essential tasks of his pre-accident employment due to chronic pain from soft-tissue injuries and aggravated pre-existing conditions.

The arbitrator ordered the insurer to pay ongoing income replacement benefits but denied the applicant's claim for a special award, finding the insurer's termination of benefits was not unreasonable.

The applicant was injured in a motor vehicle accident and received income replacement benefits (IRBs) until the insurer terminated them.

She applied for arbitration seeking ongoing IRBs, housekeeping expenses, and a special award.

The arbitrator found that the applicant suffered from physical and psychological impairments, including post-traumatic stress disorder and chronic pain, caused by the accident.

The arbitrator concluded that she suffered a substantial inability to perform the essential tasks of her pre-accident employment as a fabric cutter and awarded ongoing IRBs.

Housekeeping expenses were partially awarded for the initial period following the accident.

The claim for a special award was dismissed, and the issue of repayment was deferred.

The applicant was injured in a motor vehicle accident and sought medical and rehabilitation benefits from the insurer.

The insurer denied further benefits and discouraged the applicant from applying, without explicitly requesting a treatment plan.

The insurer later raised the applicant's failure to submit a treatment plan as a preliminary issue at mediation.

The arbitrator held that the applicant failed to submit a valid treatment plan.

However, because the insurer breached its statutory duty to assist the applicant by failing to promptly advise her that a treatment plan was required, the applicant was permitted to proceed to arbitration for expenses incurred before the mediation date.

The applicant was barred from proceeding for expenses incurred between the mediation date and the hearing date, as she was aware of the requirement by that time.

The Applicant was injured in a motor vehicle accident and received income replacement benefits until they were terminated by the Insurer.

The Applicant sought reinstatement of benefits for a closed period, while the Insurer sought payment of a cancellation fee for a missed psychological assessment.

The Arbitrator found that the Applicant failed to provide cogent medical evidence to prove a substantial inability to perform the essential tasks of his employment, relying instead on a multidisciplinary assessment that concluded he was not disabled.

The Arbitrator also dismissed the Insurer's claim for the cancellation fee, finding that the Applicant was not given sufficient notice of the appointment to comply with the cancellation policy.

The arbitration was dismissed.

The Applicant was injured in a motor vehicle accident and applied for statutory accident benefits.

A dispute arose regarding the calculation of her gross income for income replacement benefits.

The Applicant was both employed and self-employed in the four weeks preceding the accident.

The arbitrator held that under section 8(2) of the Statutory Accident Benefits Schedule, because the Applicant was self-employed at any time during the four weeks before the accident, she must designate either the 52 weeks before the accident or the last fiscal year of her business to calculate her gross income.

The Applicant was awarded her reasonable expenses of the arbitration.