Kadey Schultz

The applicant, who sustained catastrophic injuries in a motor vehicle accident, sought $12,887.06 for a home massage chair under the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to provide sufficient medical evidence to demonstrate that the massage chair was reasonable and necessary.

The Tribunal noted that the treatment plan alone, without supporting medical documentation or recommendations from treating practitioners, was insufficient to meet the applicant's burden of proof.

The applicant sought statutory accident benefits following a 2018 motor vehicle accident.

The issues in dispute included entitlement to interest on previously paid income replacement and attendant care benefits, funding for a new home purchase and modifications, psychological and social rehabilitative services, physical therapies, and an award for unreasonable delay.

The Tribunal found the applicant was not entitled to interest on the IRB and ACB payments, as the respondent had already remitted the appropriate amounts.

The claim for a new home and modifications was dismissed because the applicant failed to prove it was more reasonable to purchase a new home than to renovate his existing one.

The Tribunal approved the psychological services and partially approved the social rehabilitative and physical therapies, finding them reasonable and necessary to address the applicant's accident-related impairments.

The claim for an award under section 10 of Regulation 664 was dismissed due to the applicant's failure to comply with the page limit for written submissions.

The applicant sought to enforce a settlement agreement allegedly reached with the respondent insurer regarding her statutory accident benefits claim.

The parties had negotiated an agreement in principle via email, but the applicant refused to sign a release that included the tortfeasor (Ryder).

The Tribunal found that a mutually agreeable release was an essential term of the settlement.

Because the applicant amended the settlement disclosure notice without agreement and did not execute the required release, no binding and enforceable settlement agreement was reached.

The application to enforce the settlement was dismissed.

The applicant insurer sought repayment of medical benefits and a declaration barring the respondent from income replacement benefits, alleging the respondent wilfully misrepresented his address to secure a lower premium and staged the accident.

The respondent failed to participate in the written hearing.

The Tribunal found the respondent provided a falsified lease and bank statement to misrepresent his address, which constituted a material misrepresentation.

The Tribunal ordered the respondent to repay $2,315.00 in medical benefits with interest and barred him from receiving income replacement benefits.

The insurer's request for costs was denied.

The applicant sought reconsideration of a decision denying entitlement to a neuropsychological assessment, multidisciplinary catastrophic impairment assessment, and SPECT scan.

The applicant argued procedural unfairness, errors of law and fact, and sought to introduce new evidence.

The Adjudicator dismissed the request, finding no procedural unfairness, no errors in weighing the medical and surveillance evidence, and that the applicant failed to explain why the new evidence could not have been obtained prior to the hearing.

The applicant was injured in a motor vehicle accident and sought various statutory accident benefits, including treatment plans for occupational therapy, a chronic pain program, and assessments for neuropsychological, chronic pain, functional cognitive, and catastrophic impairment, as well as a SPECT scan.

The insurer denied the claims.

The Licence Appeal Tribunal dismissed the application in its entirety, finding that the applicant failed to demonstrate on a balance of probabilities that the proposed plans were reasonable and necessary.

The Tribunal relied on insurer examination reports and surveillance evidence showing the applicant engaging in normal activities, which contradicted the applicant's self-reported functional limitations and the opinions of his assessors.

The applicant was injured in a single-vehicle collision when his car left the road and struck a rock face.

The respondent insurer denied accident benefits, arguing the incident was an intentional suicide attempt and therefore not an 'accident' under the Statutory Accident Benefits Schedule.

The Tribunal found the applicant's testimony credible that he lost control of the vehicle and did not intend to commit suicide, despite his history of mental health issues and suicidal ideation.

The Tribunal concluded the incident met the purpose and causation tests for an accident, as the use or operation of the automobile was the direct cause of the injuries.

The applicant was injured when his vehicle left the road and struck a rock face.

The respondent insurer denied statutory accident benefits, arguing the incident was an intentional suicide attempt and therefore not an 'accident' under section 3 of the Schedule.

The Tribunal found the applicant's testimony credible that he lost control of the vehicle and did not intend to commit suicide, despite his history of mental health issues and police/hospital notes suggesting a suicide attempt.

The Tribunal concluded the incident met the purpose and causation tests for an accident, as the use or operation of the vehicle was the direct cause of the injuries.

The applicant was involved in a motor vehicle accident and failed to submit an application for accident benefits until nearly 17 months later.

The respondent raised a preliminary issue arguing the application was time-barred.

The Tribunal found that the applicant failed to provide a reasonable explanation for the delay, noting that he had sought medical attention for symptoms he attributed to the accident months earlier but did not contact his insurer.

The Tribunal concluded the applicant is barred from proceeding with his application.

The applicant sought statutory accident benefits following a 2016 motor vehicle accident, including funding for chiropractic treatment, a social work assessment, and a neurological assessment.

The Licence Appeal Tribunal found the chiropractic treatment plan to be reasonable and necessary, relying on the respondent's own assessors who acknowledged the applicant's chronic pain and potential benefit from facility-based treatment.

However, the Tribunal denied the social work and neurological assessments, finding them duplicative and unsupported by the medical evidence.

Claims for an award for unreasonably withheld benefits and costs were also dismissed.

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

The respondent insurer argued that the applicant was statute-barred from disputing the denial of social worker fees, HST expenses, and catastrophic impairment assessments because the application was not commenced within two years of the refusal.

The Tribunal found that the denial of the social worker fees was clear and unequivocal, rendering that claim statute-barred.

However, the Tribunal held that the denials for the HST expenses and the catastrophic impairment assessments were ambiguous and indeterminate, meaning the limitation period had not been triggered.

The application was permitted to proceed on those issues.

The respondent insurer requested a reconsideration of a Tribunal decision which found that HST claimed with respect to attendant care services was to be paid outside of the attendant care benefit limits prescribed by the Statutory Accident Benefits Schedule.

The insurer argued the Tribunal made multiple errors of law, including finding that HST is not an 'expense' subject to the limits, relying on non-binding FSCO Bulletins, and misapprehending expert evidence.

The Tribunal dismissed the request for reconsideration, finding no significant errors of law that would warrant a different outcome.

The Tribunal affirmed that interpreting HST as a tax rather than a 'reasonable and necessary expense' is consistent with a plain reading of the Schedule.

The applicant, who was catastrophically impaired in a motor vehicle accident, sought a determination that the HST charged on attendant care services should be paid outside the statutory monthly limit of $6,000.

The respondent insurer had been paying the HST out of the benefit limit.

The Tribunal found that HST is a tax, not a 'reasonable and necessary expense' under section 19 of the Schedule, and therefore must be paid outside of the attendant care benefit limit.

The Tribunal dismissed the applicant's claim for a special award under O. Reg. 664, finding that the insurer's interpretation of the Schedule, while incorrect, was not unreasonable given the lack of explicit guidance on the issue.

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

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

The Tribunal found that the applicant's injuries fell outside the MIG due to chronic pain and objective evidence of disc bulges and protrusions.

The Tribunal approved a treatment plan for chiropractic services as reasonable and necessary, but denied a plan for various assessments for a rebuttal report due to insufficient evidence.

Interest was awarded on overdue payments.

The applicant was injured in a slip and fall accident while exiting his vehicle and sought statutory accident benefits.

He submitted a treatment plan for psychological assessment and therapy, which the respondent denied based on an insurer's examination finding no diagnosable psychological impairment.

The adjudicator found the treatment plan was neither reasonable nor necessary, noting it duplicated an earlier plan and the applicant's psychologist failed to review relevant medical records or explain why the symptoms were attributed to the first accident despite an intervening second accident.

The application was dismissed, and the respondent's request for costs was also dismissed for failing to provide required particulars.

The appellant, a licensed paralegal, appealed an Arbitrator's decision ordering him to personally pay a portion of the insurer's expenses after his client's application for arbitration was withdrawn.

The Arbitrator had found the application frivolous and vexatious.

On appeal, the Director's Delegate found that the appellant was not given a reasonable opportunity to make representations regarding his personal liability for expenses, as required by section 282(11.4) of the Insurance Act, because he was only notified of the claim against him the day before the hearing.

The appeal was allowed, the order for expenses against the appellant was set aside, and the issue was remitted for re-hearing.

The applicant, a taxicab driver, sought statutory accident benefits after being assaulted by a passenger's companion.

After dropping off passengers and receiving payment, the applicant inadvertently bumped one of the passengers while reversing his taxi.

The passenger's companion then punched the applicant, causing severe injuries.

The arbitrator applied the two-part test to determine if the incident was an 'accident' under the Schedule.

The arbitrator found that the completion of the trip and the criminal assault were intervening acts that broke the chain of causation between the use of the vehicle and the injuries.

Therefore, the incident did not qualify as an accident.

The applicant sought to withdraw her application for accident benefits at the start of a preliminary issue hearing.

The insurer consented to the withdrawal but sought expenses, arguing the claim was time-barred, frivolous, and vexatious.

Evidence revealed the applicant had submitted falsified bank statements to support her claim for income replacement benefits, and her paralegal representative had pursued the time-barred claim while failing to comply with production requests.

The arbitrator granted the withdrawal and ordered the applicant to pay $18,871.40 in expenses, while ordering her representative to personally pay $838.96 in expenses for his unprofessional conduct.