27 total
Reconsideration dismissed; no error found in ruling that SABS 'incurred' provisions do not violate Human Rights Code.
The applicant requested a reconsideration of a preliminary decision which found that the 'incurred' provisions of the Statutory Accident Benefits Schedule do not violate the Human Rights Code.
The applicant argued that the Tribunal erred in its reliance on case law and its discrimination analysis regarding family members providing attendant care.
The Tribunal dismissed the request, finding that the applicant failed to demonstrate any error of law or fact that would have changed the outcome, and that the original discrimination analysis correctly applied substantive equality principles.
SABS incurred expense provisions limiting family caregiver compensation to economic loss do not violate Human Rights Code.
The applicant, who sustained catastrophic injuries in a motor vehicle accident, challenged the incurred expense provisions of the Statutory Accident Benefits Schedule under the Human Rights Code.
She argued that limiting attendant care compensation for non-professional family members to their demonstrated economic loss constructively discriminated against her based on family status and disability.
The Licence Appeal Tribunal dismissed the preliminary issue, finding that the provisions apply universally to all non-professional service providers regardless of their relationship to the insured.
The Tribunal held that the requirement to prove economic loss serves as a threshold to prevent windfalls and does not violate the Code.
Reconsideration request dismissed as applicant failed to establish errors of law or fact in original decision.
The applicant requested a reconsideration of a previous Licence Appeal Tribunal decision that denied his claims for an income replacement indemnity and a pain and suffering indemnity following a motor vehicle accident in Quebec.
The applicant alleged errors of law and fact, as well as a breach of procedural fairness, under Rule 18.2 of the Licence Appeal Tribunal Rules.
The adjudicator found that the applicant failed to establish any errors of law or fact that would have changed the outcome of the original decision, noting the lack of medical evidence to support his claims.
The request for reconsideration was dismissed.
Application for income replacement indemnity dismissed due to lack of medical evidence proving inability to work.
The applicant was involved in a motor vehicle accident in Quebec and elected to receive benefits under Quebec's Automobile Insurance Act.
He applied to the Licence Appeal Tribunal for an income replacement indemnity and an award for unreasonable delay.
The Tribunal dismissed the application, finding that the applicant failed to adduce compelling medical evidence demonstrating that the accident caused him to be unable to hold employment.
As no benefits were payable, the claims for interest and an award were also dismissed.
Application for statutory accident benefits dismissed as proposed treatments were not reasonable and necessary.
The applicant sought statutory accident benefits following a 2013 motor vehicle accident, including a home modifications assessment, yoga therapy, medical cannabis, and various physical therapies.
The respondent insurer denied the treatment plans.
The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove the treatments were reasonable and necessary.
The Tribunal noted the home modification assessment exceeded statutory limits and lacked safety justification, the yoga therapy duplicated approved attendant care, the applicant derived no benefit from medical cannabis, and physical therapies were ineffective for her resolved physical injuries.
Application for accident benefits dismissed due to non-attendance at insurer examination and lack of medical necessity.
The applicant sought $2,200 for an in-home occupational therapy assessment following a motor vehicle accident.
The insurer denied the benefit and scheduled an insurer's examination, which the applicant failed to attend without reasonable explanation.
The Tribunal found the applicant was statute-barred from proceeding under s. 55(1)(2) of the Schedule due to her non-attendance.
In the alternative, the Tribunal found the assessment was not reasonable or necessary, as it was a duplication of previously approved services and the applicant's ongoing physical complaints were not clearly linked to the accident.
The application was dismissed.
Insured ordered to repay non-earner benefits due to wilful material misrepresentation on insurance application.
The applicant insurer sought repayment of $7,585.00 in non-earner benefits paid to the respondent, alleging the respondent wilfully misrepresented material facts when applying for automobile insurance.
The respondent failed to attend the hearing.
The Tribunal found that the respondent wilfully misrepresented that he owned the insured vehicle, that it was not financed, and that it would not be used for commercial purposes.
However, because the applicant's notice of repayment only specified $2,035.00, the Tribunal limited the repayment order to that amount.
The respondent was ordered to repay $2,035.00 plus interest.
Application for accident benefits dismissed as the self-represented applicant failed to present any supporting evidence.
The self-represented applicant sought statutory accident benefits following a 2016 motor vehicle accident, including a determination of catastrophic impairment, income replacement benefits, and various treatment plans.
At the hearing, the respondent moved to dismiss the application as abandoned, which the Tribunal denied because the applicant attended.
The applicant requested an adjournment to obtain legal representation and for health reasons, which was also denied due to a lack of supporting evidence and failure to take timely steps.
As the applicant presented no evidence or witnesses to support his substantive claims, the Tribunal found he failed to meet his burden of proof and dismissed the application for benefits.
Insurer's non-compliant notices regarding treatment plan denial and examinations render the plan payable and warrant a 10% award.
The applicant sought statutory accident benefits for a physiotherapy treatment plan following a motor vehicle accident.
The respondent insurer denied the plan and required the applicant to attend insurer examinations.
The Tribunal found that the respondent's notices denying the plan and requiring the examinations did not comply with the requirements of sections 38(8) and 44(5) of the Schedule, as they failed to provide meaningful medical and other reasons.
Consequently, the applicant was not required to attend the examinations, and the treatment plan became payable under section 38(11)2 upon proof that the expenses were incurred.
The Tribunal also awarded interest and a 10 percent award under section 10 of O. Reg. 664, finding the respondent's prolonged failure to provide meaningful reasons to be stubborn and unyielding.
Union's application for interim relief to stay electronic crew sign-up system dismissed.
The Union brought an application for interim relief to stay the Employer's use of a new electronic 'Bid Web' sign-up system for crew selection, arguing it was introduced unilaterally in breach of the collective agreement and caused harm by preventing junior drivers from knowing senior drivers' choices.
The Arbitrator dismissed the application, finding that the standard sign-up system remained available and the Employer had addressed the Union's concerns.
The balance of harm favoured the Employer, given its investment in training and developing the electronic system.
Motion for production of medical records granted as documents were relevant to credibility and delay.
The respondent insurer brought a motion for the production of the appellant's medical records and information regarding a subsequent insurance policy.
The appellant opposed the motion, arguing that the only issue in the appeal was whether he had a reasonable explanation for submitting his claim late, making medical records irrelevant.
The Tribunal granted the motion, finding that there was a medical issue in the appeal regarding the cost of a Disability Certificate, and that the requested documents were relevant to assessing the appellant's credibility and his explanation for the delay.
Applicant awarded non-earner benefits at enhanced student rate and medical benefits for chronic pain coping.
The Applicant was injured in a motor vehicle accident and applied for statutory accident benefits, including non-earner benefits and medical benefits, which the Insurer denied.
The Arbitrator found that the Applicant met the criteria for non-earner benefits, as the accident materially contributed to her complete inability to carry on a normal life, despite pre-existing depression.
The Arbitrator also found the Applicant was enrolled in a full-time post-secondary program at the time of the accident, entitling her to the enhanced student rate of $320 per week after 104 weeks.
The disputed treatment plans were deemed reasonable and necessary to assist the Applicant in coping with chronic pain.
The Insurer was ordered to pay the benefits, interest, and the Applicant's arbitration expenses.
Application for accident benefits dismissed as abandoned after applicant failed to participate in proceedings.
The applicant sought statutory accident benefits following a motor vehicle accident but failed to participate in the dispute resolution process or attend a scheduled case conference.
The applicant's counsel brought a motion to be removed from the record due to a breakdown in the solicitor-client relationship, and the respondent brought a motion to dismiss the application as abandoned.
The Licence Appeal Tribunal granted both motions, removing counsel from the record and dismissing the application as abandoned pursuant to Rule 3.4 of the Licence Appeal Tribunal Rules of Practice and Procedure.
Applicant ordered to pay $1,300 in arbitration preparation expenses after late withdrawal of application.
The applicant was injured in a motor vehicle accident and applied for statutory accident benefits.
After the parties were unable to resolve their disputes through mediation, the applicant applied for arbitration.
The applicant later withdrew the application for arbitration.
The insurer sought its expenses for preparing for the arbitration and for the expense hearing.
The arbitrator found that the applicant waited too long to withdraw the application and ordered the applicant to pay $1,300 in expenses to the insurer for the arbitration preparation.
The parties were ordered to bear their own costs for the expense hearing.
Tribunal interprets settlement agreement in favour of applicant regarding firefighter fitness assessment standards.
The applicant alleged discrimination on the basis of sex when she was not hired as a probationary firefighter.
The parties entered into Minutes of Settlement requiring the applicant to pass a work-related fitness assessment.
A dispute arose over whether the applicant met the required fitness standards, with the respondent arguing she failed to meet its specific aerobic standard, while the applicant argued she passed the independent assessment as required by the settlement.
Both parties filed applications for contravention of settlement.
The Tribunal interpreted the settlement in favour of the applicant, finding that the agreement required her to pass the independent fitness assessment chosen by the respondent, rather than the specific standards set out in a former By-Law.
Applicant who lived in a separate apartment in the same building as her parents 'resided with' them for caregiver benefits.
The Applicant was injured in a motor vehicle accident and claimed caregiver benefits for the care of her elderly parents.
The Insurer denied the claim on the basis that the Applicant did not 'reside with' her parents, as she lived in a different apartment within the same building.
On a preliminary issue hearing, the Arbitrator found that the Applicant had moved to the building specifically to care for her parents and provided ongoing care.
Applying a liberal interpretation consistent with the consumer protection purpose of the Schedule, the Arbitrator concluded that the Applicant was 'residing' with her parents at the time of the accident and was not precluded from claiming caregiver benefits.
Applicant found to have suffered an impairment from a motor vehicle accident despite insurer's denial.
The applicant sought accident benefits after his vehicle struck an unknown object on the highway, causing mechanical failure and alleged soft tissue injuries.
The insurer denied the claim, arguing no accident occurred and the applicant was not injured, relying on an engineering expert and the applicant's initial statements.
The arbitrator found the applicant's version of events was corroborated by reliable records and that his initial statements were affected by a language barrier.
The arbitrator concluded the applicant suffered an impairment as a result of the accident and ordered the insurer to pay $500 in expenses for the preliminary issue hearing.
Parties ordered to bear their own expenses following arbitration due to divided success and credibility issues.
The applicant and the insurer both sought their expenses following an arbitration hearing regarding statutory accident benefits.
The arbitrator had previously awarded the applicant income replacement and housekeeping benefits for a limited duration, finding that the insurer relied on an equivocal medical report to stop benefits.
However, the arbitrator also found the applicant lacked credibility and had manufactured evidence.
Applying section 282(11) of the Insurance Act and the criteria in section 12(2) of Ontario Regulation 664, the arbitrator exercised his discretion to order that each party bear their own expenses due to divided success and the applicant's credibility issues.
Income replacement and housekeeping benefits awarded only for the period of temporary exacerbation of a pre-existing injury.
The applicant was injured in a motor vehicle accident in 2007 and sought ongoing income replacement and housekeeping benefits, claiming the accident exacerbated a pre-existing right knee injury.
The insurer terminated benefits in February 2008 based on medical assessments.
The arbitrator found the applicant's evidence lacked credibility due to inconsistencies and symptom magnification.
Relying on medical experts, the arbitrator concluded the 2007 accident only temporarily exacerbated the pre-existing knee condition, which resolved by April 18, 2008.
The applicant was awarded income replacement and housekeeping benefits up to that date, but the claim for a special award was dismissed as the insurer's termination was not unreasonable.
Human rights application dismissed as an abuse of process due to prior binding settlement agreement.
The applicant filed a human rights application alleging discrimination and reprisal by his employer.
Concurrently, his union grieved his termination and other matters, resulting in a 'Last Chance Agreement' and Minutes of Settlement that reinstated him and required him to withdraw all outstanding human rights applications.
The applicant subsequently sought to expedite his Tribunal application, arguing the Minutes were void or contrary to the Code.
The Tribunal found that the applicant had voluntarily settled the matters and that allowing the application to proceed would violate the principle of finality and constitute an abuse of process.
