Marianne D. Davies

The applicant was injured in a motor vehicle accident and sought medical and rehabilitation benefits, including treatment plans for chiropractic therapy, a social work assessment, an in-home assessment, and the cost of a disability certificate.

The respondent insurer denied the benefits based on insurer's examinations indicating the applicant had recovered and the treatments were not reasonable and necessary.

The Licence Appeal Tribunal found that the medical evidence, including the applicant's family physician's records, showed the applicant was pain-free and functional.

The Tribunal dismissed the application, finding the applicant was not entitled to the disputed treatment plans or the cost of the disability certificate.

The applicant, who sustained a catastrophic impairment in a motor vehicle accident, sought payment for case management services (CMS) under the Statutory Accident Benefits Schedule.

The insurer partially denied a 2015 CMS plan based on the Professional Services Guideline limits and fully denied a 2018 CMS plan, arguing the applicant no longer required the services.

The Licence Appeal Tribunal dismissed the appeal, finding the insurer was not liable for amounts exceeding the Guideline limits for the 2015 plan.

For the 2018 plan, the Tribunal preferred the insurer's nursing assessment, which demonstrated the applicant's current capacity to independently manage her treatment and rehabilitation, concluding the CMS was not reasonable and necessary.

The applicant sought payment for several treatment plans and assessments following a motor vehicle accident, which the respondent insurer denied.

The Licence Appeal Tribunal found that the applicant failed to provide sufficient medical evidence to prove the treatment plans were reasonable and necessary.

The Tribunal preferred the evidence of the insurer's assessors, who concluded the physical injuries were minor and had largely resolved, and that there was no objective evidence linking the applicant's psychological issues to chronic physical pain.

The application was dismissed.

The defendants appealed a motion judge's decision regarding the applicable pre-judgment interest rate and the quantum of costs following a settlement in a motor vehicle accident claim.

The Divisional Court held that the legislative amendment reducing the pre-judgment interest rate was substantive and did not apply retroactively.

The Court also upheld the motion judge's decision to award the plaintiff unrecovered costs from a statutory accident benefit arbitration, finding that the recovery of those benefits constituted a benefit to the defendants in the tort action.

The appeal was dismissed with costs awarded to the plaintiff.

York Fire applied to revoke a previous arbitration order which found that Dorna Osbourne was the spouse of its insured, Winston Smart, making York Fire responsible for the applicant's statutory accident benefits.

York Fire introduced new evidence demonstrating that both Osbourne and Smart had lied under oath during the initial hearing about their marital histories and continuous cohabitation.

The arbitrator admitted the new evidence, found the witnesses' credibility severely undermined, and revoked the previous order.

The arbitrator concluded that Osbourne and Smart were not spouses at the time of the accident, and ordered Allstate to respond to the applicant's claims.