Matthew Dugas

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

The Licence Appeal Tribunal found the applicant was entitled to $1,112.91 for physiotherapy services, as supported by the treating family physician's records.

However, the Tribunal dismissed claims for an orthopedic assessment, a functional cognitive assessment, and psychological services, finding them either unsupported by medical evidence or duplicative of previously approved plans.

The claim for an award under s. 10 of Reg. 664 was also dismissed, but interest was awarded on the overdue physiotherapy payment.

The applicant sought statutory accident benefits following a motor vehicle accident, including an OCF-18 for occupational therapy (involving airfare for family) and attendant care benefits (ACB).

The Tribunal found the respondent's denial notice for the OCF-18 was defective under s. 38(8) of the Schedule as it failed to provide sufficient medical reasons, ordering the respondent to pay the OCF-18 with interest.

However, the Tribunal dismissed the applicant's claims for increased ACB, finding the respondent properly relied on a prior Insurer's Examination and the applicant failed to prove the increased ACB was reasonable and necessary.

The claim for an award under s. 10 of Regulation 664 was dismissed.

The applicant sought attendant care benefits under the "deemed incurred" provision of s. 3(8) of the Schedule, arguing the respondent unreasonably denied her claim by initially taking the position she was not involved in an "accident".

The Tribunal found that the respondent's initial denial was not unreasonable given the nuanced factual and legal issues surrounding the bicycle incident.

Furthermore, the applicant failed to prove that she did not incur the attendant care expenses because of the respondent's denial.

The application for attendant care benefits, interest, and an award was dismissed.

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

The Licence Appeal Tribunal found the applicant was barred from receiving income replacement benefits because she was driving with a suspended licence at the time of the accident, which constitutes driving without a valid licence under s. 31(1)(a)(ii) of the Schedule.

Consequently, the insurer was entitled to repayment of $9,483.76 in previously paid benefits.

The Tribunal also dismissed the applicant's claims for various medical and rehabilitation benefits, finding she failed to prove the proposed treatments were reasonable and necessary.

The applicant was injured when her bicycle slipped on an oily substance on the road.

She applied for statutory accident benefits, but the respondent insurer denied the claim on the basis that the incident did not meet the definition of an 'accident' under the Schedule.

The Tribunal found that the substance was likely deposited by an automobile, satisfying the purpose test, and that there was no intervening act breaking the chain of causation.

The Tribunal concluded that the applicant was involved in an accident and is entitled to proceed with her claim for benefits.

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

A videoconference hearing was scheduled, but the applicant failed to attend despite receiving proper notice.

The Tribunal proceeded in the applicant's absence pursuant to section 7(3) of the Statutory Powers Procedure Act.

As the applicant provided no submissions or evidence to demonstrate that the proposed treatment plans were reasonable and necessary, she failed to meet her onus.

The application was dismissed.

The appellant's appeal was dismissed after being deemed abandoned, as she filed only a Notice of Appeal and requests for time extensions.

The respondent sought $4,992.40 in legal expenses for the appeal proceeding.

The Director's Delegate found the respondent's claimed expenses to be exaggerated and not commensurate with the effort required to obtain a dismissal, noting the appellant's arguments were largely generic.

The Director's Delegate ordered the appellant to pay $750.00 in legal expenses to the respondent.

The appellants appealed a motion judge's decision dismissing their action against the respondent insurance company for denial of accident benefits.

The action was commenced on August 25, 2015, more than two years after the respondent's final denial of benefits on January 29, 2013.

The Court of Appeal upheld the motion judge's conclusion that the action was statute barred under the applicable limitation period.

The appellants' assertion of bias against the motion judge was rejected as having no merit on the record.

The appellant appealed an arbitrator's decision allowing her to withdraw her application for arbitration and awarding expenses to the respondent.

The appellant failed to file written appeal submissions by the original deadline and a subsequent extended deadline.

After receiving no response to a final notice warning that the appeal would be dismissed as abandoned, the Director's Delegate dismissed the appeal.

The plaintiffs were injured in motor vehicle accidents and sought statutory accident benefits from their insurers.

After disputes arose, the plaintiffs applied to the Financial Services Commission of Ontario (FSCO) for mediation.

When 60 days passed without a mediator being appointed, the plaintiffs commenced civil actions.

The insurers moved to strike or stay the actions, arguing that under s. 281(2) of the Insurance Act, mediation must actually be attempted and fail before an action can be brought.

The Court of Appeal dismissed the insurers' appeals, holding that the 60-day time limit in the legislation is mandatory, and mediation is deemed to have failed if not concluded within that period, freeing the insured to commence a court action.

The court determined costs arising from four similar insurance motions brought by separate defendants in related actions.

The plaintiffs sought partial indemnity costs of $36,500.

The court found that a deduction was required because some counsel time related to unargued Charter applications rather than the motions themselves.

Applying the principles from Hunt v. TD Securities Inc., the court declined to award substantial indemnity costs and instead reduced the requested amount by $8,000.

The plaintiffs were awarded $28,500 plus HST, payable equally among the defendants.

The plaintiffs, injured in motor vehicle accidents, applied for mediation through the Financial Services Commission of Ontario regarding entitlement to statutory accident benefits.

Mediation was not scheduled within 60 days of filing their applications, and the regulator refused to issue reports declaring mediation had failed, asserting the 60‑day period began only once a mediator was appointed.

The plaintiffs commenced court actions and the insurers moved to strike the claims for lack of jurisdiction.

The court held that Rule 19 of the Dispute Resolution Practice Code imposes a mandatory requirement that mediation be concluded within 60 days of filing the mediation application.

Because that period had expired, mediation was deemed to have failed and the plaintiffs were not required to obtain a failed mediation report or pursue internal appeals or judicial review before commencing their actions.