Pamela Quesnel

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

Prior to the hearing, the applicant passed away, and no litigation guardian was formally appointed.

At the hearing, the applicant's representative requested an adjournment, arguing he lacked authority to proceed.

The Tribunal denied the oral adjournment request because it was not submitted on the proper form and the representative had six months to do so.

As the applicant presented no evidence or submissions on the substantive issues, the Tribunal found the applicant failed to meet the burden of proof and dismissed the application.

The appellant, a firefighter who responded to the 2018 Toronto van attack, sought statutory accident benefits for psychological impairments resulting from witnessing the aftermath.

The Licence Appeal Tribunal denied the claim, finding the incident did not meet the definition of an 'accident' under the Statutory Accident Benefits Schedule because the rental van was used as a weapon and the firetruck did not directly cause the injuries.

The Divisional Court dismissed the appeal, holding that the adjudicator made no error of law in applying the purpose and causation tests, and rejected the appellant's Charter argument regarding discrimination against mental injuries.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically a treatment plan for chiropractic services.

The respondent insurer denied the treatment plan on the basis that the impairments were not caused by the accident and the treatment was not reasonable and necessary.

The Tribunal found that the applicant failed to prove causation, noting extensive pre-existing medical conditions and prior physical trauma.

The Tribunal also accepted the respondent's medical examination report, which concluded that the applicant had reached maximum benefit from facility-based treatment.

The application was dismissed, along with claims for interest and a special award.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits from the respondent insurer.

The applicant disputed the denial of treatment plans for a sleep study, an EEG analysis, and an occupational therapy assessment.

The Tribunal found that the applicant failed to prove the sleep study and EEG analysis were reasonable and necessary, as the medical evidence did not support their utility.

However, the Tribunal found the occupational therapy assessment was reasonable and necessary based on multiple recommendations from treatment providers addressing the applicant's functional limitations.

The applicant was also awarded interest on the overdue payment for the occupational therapy assessment.

The applicant insurer brought an application to the Licence Appeal Tribunal to vary or revoke a 2010 order issued by the Financial Services Commission of Ontario (FSCO) that required the payment of weekly income replacement benefits.

The Tribunal considered whether it had jurisdiction to amend a FSCO order.

Applying the transitional provisions of the Insurance Act regulations, the Tribunal found that it only had jurisdiction to vary or revoke FSCO orders if the proceeding was commenced before June 8, 2019.

Because the applicant commenced the proceeding on July 22, 2019, the Tribunal lacked jurisdiction to vary the order.

The application was dismissed.

The applicant sought repayment of income replacement benefits (IRBs) that the insurer had suspended and deducted due to an alleged overpayment and non-compliance with requests for post-accident income information.

The Tribunal found that while the insurer could not rely on section 287 of the Insurance Act or section 52 of the Schedule to unilaterally reduce benefits based on an alleged error without an agreement or order, it was entitled to suspend benefits under section 33 of the Schedule due to the applicant's failure to provide requested income documentation.

The applicant's claims for repayment and a special award were dismissed.

The applicant sought various medical and rehabilitation benefits, as well as the cost of several assessments, following a motor vehicle accident.

The respondent insurer denied the treatment plans.

The Tribunal found that the applicant failed to prove the disputed treatment plans and assessments were reasonable and necessary.

The Tribunal preferred the evidence of the respondent's medical assessors, who reviewed the applicant's complete medical records and found that further facility-based treatment would not lead to significant improvements and that the applicant's psychological issues were largely pre-existing or subclinical.

The application was dismissed in its entirety.

The applicant, a firefighter who responded to the Toronto van attack, sought reconsideration of a decision finding that his psychological impairments were not caused by an 'accident' under the Statutory Accident Benefits Schedule.

The applicant argued that the adjudicator erred in applying the purpose and causation tests to both the Ryder van used in the attack and the fire truck he drove to the scene.

The Vice-Chair dismissed the request for reconsideration, finding no significant legal or evidentiary errors in the adjudicator's conclusion that the applicant's impairments were directly caused by exposure to the horrific scene rather than the use or operation of a vehicle.

The applicant insurer sought repayment of $14,983.43 in statutory accident benefits paid to the respondent, alleging wilful misrepresentation regarding a motor vehicle collision.

The insurer's accident reconstruction expert testified that event data recorder information and physical evidence showed the respondent was not a passenger in the vehicle and that the collision was intentionally caused.

The adjudicator accepted the expert's uncontradicted evidence, found the respondent's testimony not credible, and ordered repayment of the benefits with interest.

The applicant, a first responder, sought statutory accident benefits for psychological impairments sustained after attending the aftermath of the Toronto van attack.

The insurer denied the claim on the basis that the applicant was not involved in an 'accident' as defined in section 3(1) of the Statutory Accident Benefits Schedule.

The Tribunal found that the applicant did not meet the purpose or causation tests.

The van was being used as a weapon, not for its ordinary and well-known activities, and the applicant's use of the fire truck did not directly cause his impairments.

The application was dismissed.

The applicant sought various medical and assessment benefits under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The respondent denied the treatment plans on the basis that they were not reasonable and necessary.

The Tribunal found that the applicant failed to meet his burden of proving that the proposed chronic pain program, orthopaedic assessment, psychological assessment, and physiotherapy treatments were reasonable and necessary, noting a lack of objective medical evidence and reliance on subjective complaints.

The application was dismissed, and claims for interest and a special award were denied.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits.

After an initial hearing found the applicant's injuries fell under the Minor Injury Guideline (MIG), a new hearing was ordered because the respondent subsequently removed the applicant from the MIG based on a delayed psychological assessment report.

The applicant sought a special award under s. 10 of O. Reg. 664 for the delayed benefits and costs.

The Tribunal found the respondent unreasonably delayed the approval of the psychological assessment due to an administrative error in locating the insurer examination report, causing harm to the applicant.

The Tribunal awarded a 25% special award on the cost of the assessment.

Both parties' requests for costs were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically disputing the insurer's denial of treatment plans for catastrophic impairment assessments and physiotherapy.

The Tribunal found that the catastrophic impairment assessments were not payable because they were completed by an occupational therapist rather than a physician, as required by the 2010 SABS.

However, the Tribunal approved the treatment plan for physiotherapy, finding it reasonable and necessary based on the medical evidence.

The Tribunal also ruled that HST is not included in the calculation of medical and rehabilitation benefit limits, but declined to order a special award, finding the insurer's contrary position was not taken in bad faith.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for home gym equipment.

The insurer denied the claim based on an insurer's examination.

The Licence Appeal Tribunal found that the applicant proved the gym equipment was reasonable and necessary to achieve pain reduction and increase strength, particularly given her childcare responsibilities which made attending a commercial gym difficult.

The Tribunal rejected the insurer's medical evidence as contradictory.

The applicant was awarded the cost of the equipment and interest, but her claim for a special award for unreasonable delay was dismissed because the insurer's delay in processing the denial was minimal.

Following the successful summary dismissal of six actions for accident benefits as statute-barred, the defendant insurer sought costs.

The plaintiffs argued against costs, citing the novelty of the issues and the defendant's means.

The court rejected these arguments, noting the plaintiffs took a calculated risk and made meritless bad faith claims.

The court found the defendant's claimed costs, which were lower than partial indemnity, to be fair and reasonable, awarding a total of $113,500 across the six actions.

Six plaintiffs brought actions against their insurer for non-earner benefits seven to eight years after the benefits were denied.

The insurer brought motions for summary judgment, arguing the actions were statute-barred by the two-year limitation period.

The plaintiffs argued the limitation period did not begin to run because the insurer failed to provide a written explanation of benefits as required by section 32(2) of the Statutory Accident Benefits Schedule.

The court held that the insurer's denial of benefits was clear and unequivocal, which was sufficient to trigger the limitation period.

The court also found no basis for relief from forfeiture regarding the plaintiffs' failure to submit disability certificates, and dismissed the claims for bad faith.

The motions for summary judgment were granted and the actions were dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits.

Following an arbitration where the applicant was found subject to the Minor Injury Guideline and denied funding for disputed treatment plans, the insurer sought its expenses.

The arbitrator considered the parties' degree of success and written offers to settle.

Finding that the insurer was completely successful and that the applicant failed to accept the insurer's offer to settle on a timely basis, the arbitrator awarded the insurer its reasonable expenses of $10,701.50 inclusive of HST.

The applicant was injured in a motor vehicle accident and claimed attendant care benefits for services provided by his spouse, a stay-at-home parent.

The insurer denied the claim because the spouse did not sustain an economic loss.

The arbitrator held that under the 2010 Statutory Accident Benefits Schedule, a family member providing care must either sustain an economic loss or provide the services in the course of their employment, occupation, or profession.

A stay-at-home parent does not meet the definition of providing care in the course of an occupation.

The application for attendant care benefits was dismissed.

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 applicant was injured in a motor vehicle accident and received income replacement benefits (IRBs).

The insurer sent an Explanation of Benefits terminating the IRBs after the applicant returned to work.

More than two years later, the applicant sought reinstatement of IRBs after stopping work again.

The insurer argued the claim was statute-barred by the two-year limitation period.

The arbitrator found that the Explanation of Benefits was not a clear and unequivocal refusal because it contradictorily stated the applicant was both eligible and not eligible for IRBs.

Consequently, the limitation period was not triggered, and the applicant was not precluded from proceeding to arbitration.