Nick Hamilton

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming the balance of treatment plans for two iPads and a home modification assessment.

The Tribunal found that the insurer's approval of one Samsung tablet was sufficient and the applicant failed to prove that two iPads were reasonable and necessary.

The Tribunal also held that the home modification assessment was a clinical evaluation of health status and therefore subject to the $2,000 cap under section 25 of the Schedule.

The application was dismissed.

The defendants brought a motion to set aside a default judgment of $124,474.66 obtained by the plaintiff.

The action arose from a physical altercation between neighbours in an apartment building.

The court found that while one defendant was validly served with the statement of claim, the other was not, and neither was served with the motion for default judgment.

Applying the five-factor test for setting aside a default judgment, the court concluded that the interests of justice warranted granting the motion, despite the apparent weakness of the proposed defence.

The default judgment was set aside on the condition that the defendants pay the plaintiff's costs of $19,131.14 for the default judgment proceedings.

The applicant sought statutory accident benefits for chiropractic treatment and various medical expenses following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the chiropractic treatment plan was not reasonable and necessary as the medical evidence did not support the claimed functional limitations.

Furthermore, the Tribunal denied the OCF-6 expenses because the applicant, an international student, failed to first submit the claims to her available collateral benefits provider (UHIP) as required by section 47(2) of the Schedule.

The applicant was injured when he was struck by his own stolen vehicle while attempting to recover it.

He sought statutory accident benefits for treatment plans and transportation expenses to a clinic in Scarborough, despite living in Windsor.

The Tribunal found the treatment plan fees were duplicative and not reasonable and necessary.

The Tribunal also denied the transportation expenses, finding it was not reasonable and necessary to travel from Windsor to Scarborough for treatment when similar options were available locally.

The application was dismissed.

The applicant was struck by a vehicle as a pedestrian and sought statutory accident benefits.

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

The Tribunal found that the applicant's psychological injuries, including depression and anxiety, removed her from the MIG.

The Tribunal ordered the respondent to pay for the disputed chiropractic treatment plans and a psychological assessment, finding them reasonable and necessary, along with interest on overdue payments.

Both parties' requests for costs were denied.

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

The insurer denied an income replacement benefit because the applicant was convicted of impaired driving in relation to the accident, and denied a medical benefit for counselling and case management.

The Tribunal held that the applicant was excluded from the income replacement benefit under s. 31(1)(d)(i) of the Schedule due to his conviction.

However, the Tribunal found that the insurer's denial letter for the medical benefit failed to provide sufficient medical reasons, breaching s. 38(8).

Consequently, the benefit was deemed incurred under s. 3(8) and payable under s. 38(11).

The Tribunal also awarded the applicant a 20 per cent special award under Regulation 664 for the unreasonable withholding of the medical benefit.

The applicant sought a medical benefit of $2,200 for psychological services following a motor vehicle accident.

The respondent denied the claim, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) limit of $3,500, which had already been largely exhausted.

The Tribunal found that the applicant's physical injuries were soft tissue in nature and that the psychological evidence provided was insufficient to remove him from the MIG.

The Tribunal dismissed the claim for benefits and interest, and also denied the respondent's request for costs, finding no bad faith on the part of the applicant.

The appellant insurer appealed a License Appeal Tribunal decision finding that its failure to provide compliant notices denying treatment plans under s. 38 of the Statutory Accident Benefits Schedule precluded it from relying on the Minor Injury Guideline limits.

The Divisional Court dismissed the appeal, holding that the Adjudicator reasonably interpreted s. 38(11) to mean that a non-compliant notice requires the insurer to pay for the goods and services in the specific treatment plan without the $3500 limit applying, until a compliant notice is given.

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

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

The Tribunal found that while the applicant did not suffer a psychological injury warranting removal from the MIG, he did establish a chronic pain condition that placed his claims outside the MIG.

The Tribunal approved the treatment plan for chiropractic services as reasonable and necessary, but denied the treatment plan for a psychological assessment.

Interest was awarded on the overdue payments for the approved chiropractic treatment.

The applicant sought statutory accident benefits following a 2015 motor vehicle accident.

A previous Tribunal decision found the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant brought a new application claiming psychological impairments took him out of the MIG, relying on a catastrophic impairment rebuttal report from a psychiatrist.

The Tribunal assigned little weight to the applicant's psychiatric evidence due to inconsistencies with the doctor's own clinical notes and surveillance evidence showing the applicant functioning independently.

The respondent's assessors could not determine impairment levels due to the applicant's lack of credibility and cooperation.

The Tribunal concluded the applicant failed to prove his injuries fell outside the MIG, dismissing the claim for a $4,678.40 psychological treatment plan and interest.

The applicant sought accident benefits for psychological counselling after a previous application was dismissed on the basis that their injuries fell within the Minor Injury Guideline (MIG).

The respondent insurer brought a motion to dismiss the new application, arguing it was barred by res judicata.

The Tribunal dismissed the motion as premature, noting that the specific claim for psychological services was not part of the first application, the determination of whether injuries fall within the MIG is not static, and the matter had not yet proceeded to a case conference to identify the issues and exchange disclosure.

The applicant, a minor catastrophically injured in a motor vehicle accident, brought a motion seeking the production of the respondent insurer's adjuster log notes and correspondence with third parties.

The respondent agreed to produce the correspondence but opposed producing the log notes, arguing the request was a fishing expedition and that bad faith had not been alleged.

The Tribunal ordered the production of the log notes, redacted for privilege, finding them relevant to the applicant's need to understand the denial of benefits and proportionally fair given the circumstances.

The applicant sought statutory accident benefits following an alleged motor vehicle accident where he claimed he was struck by a vehicle while riding his bicycle.

The insurer denied the claim on the basis that no accident occurred.

The arbitrator found the applicant's testimony to be inconsistent and unreliable, noting contradictions regarding the mechanics of the collision and the lack of documented injuries in his medical records.

The arbitrator concluded that the applicant failed to prove on a balance of probabilities that an accident occurred within the meaning of s. 3(1) of the Schedule, and dismissed the application.