Michael A. Yermus

The applicant was involved in a motor vehicle accident while driving for Uber and reported the accident to the insurer the next day, stating he suffered no injuries.

Over a year later, he submitted an application for accident benefits.

The insurer denied the claim due to late notice.

The Tribunal found that the applicant failed to notify the insurer of his intention to claim benefits within the seven-day limit under section 32(1) of the Schedule.

The Tribunal rejected the applicant's explanation that he was misled by Uber, finding it lacked credibility and evidentiary support.

The application was dismissed pursuant to section 55(1).

The applicant sought statutory accident benefits following a rear-end motor vehicle collision.

The respondent 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 pre-existing condition, a concussion, or chronic pain that would warrant removal from the MIG.

Consequently, the applicant was not entitled to the disputed treatment plans as they exceeded the $3,500 funding limit, and no interest was payable.

The application was dismissed.

This motion sought court approval for a proposed settlement affecting a minor plaintiff who sustained a wrist fracture from a slip and fall accident at school.

The defendants denied liability, raising issues of causation and damages.

The action settled for $30,000 at mediation.

The court approved the settlement, finding it reasonable, fair, and in the minor plaintiff's best interests, and also approved the counsel's fees and disbursements, noting the role of contingency fee agreements in providing access to justice.

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

The respondent denied certain claims, including a chronic pain assessment and treatment, arguing the injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit was exhausted.

The Tribunal found the applicant failed to prove on a balance of probabilities that her injuries fell outside the MIG due to chronic pain or psychological impairment.

The Tribunal dismissed the application, finding the disputed assessment and treatment plans were not payable as the MIG limit had been exhausted.

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

The respondent denied a treatment plan for physiotherapy on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued her injuries were outside the MIG due to chronic pain syndrome and pre-existing medical conditions.

The Licence Appeal Tribunal found that the applicant failed to prove her chronic pain caused functional impairment or disability beyond the sequelae of soft tissue injuries.

Furthermore, there was no compelling evidence that her pre-existing conditions would prevent maximal recovery under the MIG limit.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought Income Replacement Benefits (IRBs).

The insurer suspended and later terminated the benefits, arguing the applicant failed to provide requested financial documentation under s. 33 of the Schedule and no longer met the disability test.

The Tribunal found that the applicant breached s. 33 without a reasonable explanation, disentitling her to benefits for the period of non-compliance.

Furthermore, the Tribunal held that the applicant failed to prove on a balance of probabilities that she suffered a substantial inability to perform the essential tasks of her employment as a restaurant owner, relying on the insurer's multidisciplinary assessments.

The application and request for costs were dismissed.

The applicant was struck by a motor vehicle as a pedestrian and sought statutory accident benefits for chiropractic services.

The respondent insurer denied the treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant's injuries, which included chronic pain, fell outside the MIG based on the detailed medical evidence of her chronic pain specialist.

The Tribunal ordered the respondent to pay the disputed medical benefits, finding them reasonable and necessary, along with interest on the overdue amounts.

The Appellant insurer sought a stay of an Arbitrator's order requiring it to pay income replacement benefits, attendant care, housekeeping, and medical benefits to the Respondent insured, pending an appeal.

The Director's Delegate denied the stay request, finding that under subsection 283(6) of the Insurance Act, a stay is the exception rather than the rule.

The Delegate held that the Appellant failed to establish that the pre-arbitration status quo ought to be preserved, noting that the appeal was restricted to questions of law and that staying the payment orders would constitute a hardship to the Respondent that outweighed any hardship to the Appellant.

The appellant insurer appealed an arbitration decision that found the respondent's application for arbitration was not statute-barred.

The dispute centered on when the 90-day limitation period under s. 281.1(2)(b) of the Insurance Act commenced following a failed mediation.

The Director's Delegate held that the arbitrator erred in strictly applying the Rules of Civil Procedure to conclude that delivery of the mediator's report to the claimant's representative was required, finding instead that the period runs from the earlier of delivery to the insured or their representative.

Furthermore, the Delegate found that the arbitrator breached natural justice by denying the insurer the opportunity to cross-examine the respondent's legal assistant on her affidavit regarding the receipt date of the report.

The appeal was allowed, the arbitration decision rescinded, and the matter remitted for a new preliminary issue hearing.

The appellant insurer sought to appeal a preliminary arbitration decision which found that the respondent insured had not missed the 90-day limitation period to apply for arbitration after mediation.

The arbitrator had held that the limitation period only began to run upon service of the mediator's report on the insured's representative, and that deemed service by mail could not be relied upon without a post office stamp.

The Director's Delegate accepted the appeal from the preliminary order, finding that it raised significant issues of law regarding service and limitation periods that could resolve the entire dispute and avoid a lengthy arbitration.

However, the appellant's request for a stay of the arbitration proceeding was denied.