Robert H. Littlejohn

The applicant requested a reconsideration of a preliminary issue decision that found his claim for post-104 income replacement benefits (IRBs) was statute-barred due to a pre-emptive denial by the insurer.

The adjudicator granted the reconsideration, applying the recent Court of Appeal decision in Tomec v. Economical.

The adjudicator found that the limitation period is tied to the accrual of the cause of action and subject to discoverability.

Because the applicant was working full-time and not eligible for IRBs at the time of the pre-emptive denial, the cause of action had not yet accrued.

The preliminary decision was reversed, allowing the applicant to proceed with his claim.

The applicant sought post-104-week income replacement benefits (IRBs) following a 2013 motor vehicle accident.

The respondent insurer denied the claim, arguing the applicant failed to dispute its initial 2013 denial within the two-year limitation period.

The applicant argued the 2013 denial was not clear and unequivocal because it used the word 'eligible' rather than 'entitled' and he had not intended to apply for IRBs at that time.

The Tribunal found the 2013 denial was valid, clear, and unequivocal, triggering the limitation period.

The Tribunal also declined to extend the limitation period under section 7 of the LAT Act due to the significant four-year delay and lack of bona fide intention to appeal within the time limit.

The application was dismissed as statute-barred.

Following a successful hearing for statutory accident benefits, the applicant sought a special award and costs.

The Licence Appeal Tribunal found that the insurer unreasonably withheld and delayed payments by failing to properly respond to treatment plans, failing to explain why injuries were no longer in the Minor Injury Guideline, and failing to continually adjust the file despite conflicting insurer examination reports.

The Tribunal awarded the applicant a special award of $4,711.77 (representing 30% to 50% of the delayed benefits) plus interest.

Both parties' requests for costs were dismissed, as neither party's conduct rose to the level of being unreasonable, frivolous, vexatious, or in bad faith.

The applicant requested an adjournment of the scheduled hearing, arguing that he would not receive necessary medical and payroll documents in time.

The respondent opposed the request, asserting that the medical issues were irrelevant as the dismissal was for economic reasons.

The Tribunal denied the adjournment request, finding it premature and speculative, and noted that document production delays could be addressed through other means such as allowing late production.

The applicant was injured in a motor vehicle accident and received income replacement benefits, which the insurer later terminated.

The applicant applied for arbitration.

The insurer subsequently requested that the applicant attend a medical examination with a respirologist.

The applicant refused, and a preliminary issue hearing was held to determine if the examination was reasonably necessary under section 42 of the Statutory Accident Benefits Schedule.

The arbitrator found that the examination was not reasonably necessary for claims adjustment, as the insurer had been aware of the applicant's medical condition for years and had already made its adjusting decision.

The arbitration was ordered to proceed as scheduled.

The applicant sought an assessment of his arbitration expenses following a decision that denied his claim for income replacement benefits but allowed his claim for housekeeping expenses.

The applicant claimed $35,691.16 in legal fees and disbursements.

The arbitrator reduced the hourly rate and preparation time claimed by the applicant's counsel, finding them excessive given the complexity of the case and counsel's conduct.

The arbitrator also reduced certain disbursements, including the cost of an accountant's report and travel expenses.

The insurer was ordered to pay the applicant $18,424.74 in arbitration expenses.

The complainant in a human rights proceeding brought a motion for the production of documents relating to his termination, including the corporate respondent's financial statements and Parts Department sales figures.

The respondents brought a cross-motion for productions, which was consented to.

The adjudicator ordered the production of the Parts Department sales figures for the three years prior to and the year of the complainant's termination to assist in establishing his work performance, but declined to order the production of the broader financial statements.

The complainant brought a motion for the production of documents relating to his termination, including the corporate respondent's financial statements and Parts Department sales figures.

The respondents brought a cross-motion for productions, which was consented to.

The adjudicator ordered the respondents to produce the year-end Parts Department sales figures for the three years prior to the complainant's termination and the year of termination, as they were relevant to establishing the complainant's work performance.

The request for financial statements was denied as unnecessary given the production of the sales figures.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits, including income replacement benefits (IRBs) and housekeeping expenses.

The insurer denied the claims.

At arbitration, the central issue was whether the applicant was an employee or self-employed, which dictated the information required to calculate his IRB.

The arbitrator found the applicant was self-employed and had failed to provide the necessary financial information to calculate the benefit, disentitling him to IRBs under section 33 of the SABS-1996.

However, the arbitrator awarded housekeeping expenses based on medical evidence of his impairments and ordered the insurer to pay the applicant's arbitration expenses.

Surveillance evidence obtained deceptively by the insurer was excluded.

The applicant sought interest on an award of expenses previously made against the insurer following an arbitration for statutory accident benefits.

The insurer disputed the arbitrator's jurisdiction to award interest on expenses.

The arbitrator held that the Insurance Act and the Statutory Accident Benefits Schedule do not grant an arbitrator the authority to award interest on expenses, as interest is a substantive right requiring express statutory authorization.

However, the arbitrator noted that the applicant could enforce the expenses order in the Superior Court of Justice to obtain post-judgment interest under the Courts of Justice Act.

Despite being unsuccessful on the motion, the applicant was awarded $350 in expenses because the insurer had delayed payment of the original expenses award and the issue raised was novel.

The applicant sought expenses following an arbitration hearing regarding statutory accident benefits.

The arbitrator found that the applicant was largely successful in his claims, raised legitimate concerns about the reliability of the REC DAC assessment, and presented his case efficiently.

Applying the criteria under section 12(2) of O.Reg. 464/96, the arbitrator awarded the applicant his reasonable expenses and denied the insurer's request for expenses.

The applicant sought an assessment of his expenses and a special award following an arbitration where he succeeded on claims for housekeeping expenses and interim benefits.

The insurer disputed the legal fees account as excessive.

The arbitrator found the applicant's counsel's preparation time reasonable given the complexity of the issues and the insurer's late request for an adjournment, which resulted in costs thrown away.

The arbitrator awarded $18,180 in legal fees plus GST.

The arbitrator denied the claim for a special award under section 282(10) of the Insurance Act, finding that the provision applies to the late payment of statutory accident benefits, not to a bill of expenses.

The applicant was injured in a motorcycle accident and received income replacement benefits.

The insurer terminated these benefits, and the parties disputed the applicant's residual earning capacity.

Following a residual earning capacity assessment, the arbitrator determined the applicant was capable of working full-time as an electronics assembler, setting his residual earning capacity at $268.49 per week.

The arbitrator also held that the insurer was required to pay income replacement benefits until 14 days after the issuance of a valid assessment report, as the initial report was invalid and did not establish a failure to co-operate.

The applicant's request for a special award due to delayed payment of interim benefits was dismissed.

The insurer applied for variation or revocation of an interim arbitration order requiring it to pay interim income replacement benefits to the insured pending a Designated Assessment Centre report.

The Director's Delegate rejected the application, finding that the arbitrator's decision was based on the procedural obligations set out in the Statutory Accident Benefits Schedule and that the insurer should pay the amounts ordered and pursue any remedies before the hearing arbitrator.

The applicant was injured in a motorcycle accident and applied for arbitration regarding his income replacement benefits and loss of earning capacity.

The insurer moved to stay the arbitration pending a report from a designated assessment centre (DAC) regarding residual earning capacity.

The applicant opposed the stay and moved for interim benefits, interim expenses, and housekeeping expenses.

The arbitrator declined to stay the arbitration but adjourned the loss of earning capacity issues pending a proper DAC report.

The arbitrator severed the housekeeping claim and awarded the applicant $500 in outstanding housekeeping expenses and $50 per week ongoing.

The arbitrator also ordered the insurer to pay interim income replacement benefits at $292.07 per week and interim disbursements of $1,738.