7 total
Motion to compel discovery answers granted in part; post-incident remediation questions ordered answered.
The plaintiffs brought a motion to compel answers to questions refused or taken under advisement during the defendant's examination for discovery in a slip and fall action.
The court categorized the questions into three groups.
The court held that the defendant's review of six months of prior records for past issues with the floor mat was sufficient.
However, the court ordered the defendant to answer questions regarding post-incident remedial measures, finding them relevant to the standard of care.
Finally, the court ordered the defendant to provide evidence on why a Claims Management Report was prepared to allow the plaintiffs to assess the defendant's claim of litigation privilege.
Reconsideration granted and new hearing ordered due to procedural unfairness and erroneous reliance on misleading evidence.
The respondent insurer filed a Request for Reconsideration of a Licence Appeal Tribunal decision that awarded the applicant statutory accident benefits and a special award.
The insurer argued that the Tribunal violated procedural fairness by issuing summonses for third-party records in a written hearing, which delayed disclosure and prejudiced its case.
The insurer also argued the Tribunal relied on misleading log notes that actually pertained to another claimant to grant the special award.
The adjudicator granted the reconsideration, finding that the Tribunal breached its own rules and the Statutory Powers Procedure Act by issuing summonses for a written hearing.
The adjudicator also found the Tribunal made an error of fact regarding the log notes, which led to an error of law in granting the special award.
The original decision was set aside and a new hearing was ordered.
Tribunal retains jurisdiction to order an award for delayed benefits even if benefits are paid before hearing.
The applicant sought an award for unreasonably withheld or delayed income replacement benefits (IRBs).
Prior to the hearing, the respondent insurer reinstated and paid the disputed IRBs, and subsequently argued that the Licence Appeal Tribunal lacked jurisdiction to hear the claim for an award because there were no longer any substantive benefits in dispute.
The Tribunal held that it retains jurisdiction to determine if an applicant is entitled to an award even when the substantive benefits have been paid or reinstated prior to a hearing.
The Tribunal found that interpreting the legislation to allow an insurer to avoid an award by paying benefits on the eve of a hearing would create an absurd result and negate the purpose of the accident benefits scheme.
Insurer's preliminary motion dismissed; inadequate denial notice failed to trigger the two-year limitation period.
The applicant sought non-earner benefits following a motor vehicle accident, which the respondent insurer denied.
The respondent raised a preliminary issue that the applicant's appeal was statute-barred because it was not commenced within the two-year limitation period under section 56 of the Statutory Accident Benefits Schedule.
The Tribunal found that the respondent's Explanation of Benefits did not comply with the notice requirements of section 37(4) of the Schedule, as it failed to provide adequate medical and other reasons for the denial in plain language.
Consequently, the limitation period was never triggered, and the applicant's claim was not out of time.
Insurer ordered to pay disputed treatment plans and a 50% special award for unreasonable denial.
The applicant was injured in a motor vehicle accident and sought various medical benefits, including physiotherapy, occupational therapy, and psychological services, which the respondent insurer denied.
The Licence Appeal Tribunal found that the applicant's compression fracture was caused by the accident and that the disputed treatment plans were reasonable and necessary.
The Tribunal also found that the respondent unreasonably withheld benefits, particularly where its own assessors had recommended treatment, and ordered a 50% special award under s. 10 of Regulation 664 along with interest on overdue payments.
Accident benefits denied as applicant failed to prove injuries fell outside the Minor Injury Guideline.
The applicant sought payment for a general practitioner's assessment and psychological services following a motor vehicle accident.
The insurer denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).
The Tribunal found that the applicant failed to prove she suffered from a psychological impairment or chronic pain syndrome that would remove her from the MIG.
The Tribunal preferred the insurer's expert evidence, which included psychometric testing, over the applicant's evidence.
The claims for the assessment, psychological services, and interest were dismissed.
Motion to exclude late reply submissions denied as respondent suffered no prejudice.
The respondent brought a motion to exclude the applicant's reply submissions, which were filed four days after the deadline set at the case conference.
The adjudicator dismissed the motion, finding that the respondent suffered no prejudice from the delay, no new issues were raised in the reply, and all submissions were received prior to the scheduled written hearing date.
