Sandra Train

The applicant sought statutory accident benefits, claiming he suffered severe psychological injuries following the death of his mother in a motor vehicle accident.

The respondent denied the claims, arguing the applicant was not an 'insured person' under s. 3(1) of the Schedule because his psychological issues were pre-existing and not caused by the accident.

The Tribunal found that the applicant had significant pre-existing psychological impairments, including major depression, and failed to establish on a balance of probabilities that these conditions were caused or aggravated by his mother's death.

The Tribunal gave little weight to the applicant's s. 25 psychological assessment because it relied on inaccurate self-reporting and the assessors did not review pre-accident records.

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

The applicant sought statutory accident benefits for psychological injuries arising from his mother's death in a 2016 motor vehicle accident.

The respondent insurer denied the claim, arguing the applicant failed to notify it of his intention to apply within the timelines under section 32(1) of the Schedule.

The Tribunal found that the applicant had notified the respondent of the accident in a timely manner when seeking death and funeral benefits, triggering the respondent's obligation under section 32(2) to provide application forms and information.

Because the respondent failed to prove it met this obligation, and the applicant provided a credible explanation that he was unaware he could make a claim, the Tribunal held the applicant had a reasonable explanation for the delay under section 34.

The applicant was permitted to proceed with his claim.

The applicant sought payment for a treatment plan for window inserts and earplugs to address noise sensitivity following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove the items were reasonable and necessary.

The Tribunal noted that the applicant's own medical assessors did not identify noise sensitivity as the cause of her sleep disruption or limited productivity, and there was insufficient evidence that the proposed items would be effective or that their cost was proportionate.

The applicant sought a non-earner benefit of $185 per week following a motor vehicle accident, along with interest and costs.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to submit a completed disability certificate (OCF-3) supporting his entitlement, as required by section 36 of the Statutory Accident Benefits Schedule.

Furthermore, the Tribunal held that the applicant failed to prove on a balance of probabilities that his accident-related impairments continuously prevented him from engaging in substantially all of his pre-accident activities.

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

The respondent denied the benefits, placing the applicant in the Minor Injury Guideline, and requested an insurer's examination under section 44 of the Statutory Accident Benefits Schedule.

The applicant refused to attend, arguing the notice lacked proper medical reasons.

The respondent brought a motion to bar the applicant from proceeding.

The Tribunal found the respondent's notices met the statutory requirements and stayed the hearing until the applicant attends the requested examination.

The plaintiff's counsel sought court approval of a solicitor and client account based on a 30% contingency fee agreement following a $200,000 settlement with the Motor Vehicle Accident Claims Fund.

The court found the contingency fee agreement was not fair or reasonable, noting the lack of complexity, the limited time docketed compared to the proposed fee, and the absence of evidence that the plaintiff was advised of the limited recovery available from the Fund.

The court deemed the agreement unenforceable and reduced the approved fee to $30,000 plus HST and disbursements.

The applicant sought payment for two physiotherapy treatment plans following a motor vehicle accident.

The insurer denied the plans based on section 44 assessments indicating the applicant had achieved maximal medical recovery.

The Tribunal found the applicant failed to demonstrate the treatment plans were reasonable and necessary, noting limited evidence of improvement, the applicant's self-reported normal function, and the lack of objective referrals for treatment.

The application was dismissed.

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

The respondent deducted a $700 weekly disability benefit the applicant received from a private Industrial Alliance policy, arguing it was an 'income continuation benefit plan' under s. 3(7)(d) of the Schedule.

The Tribunal agreed, finding the private policy was tied to employment and calculated based on gross weekly earnings, making it deductible.

The Tribunal also found the respondent provided proper notice of overpayment and was entitled to repayment for a specific 12-month period.

The applicant's request for costs was denied.

The applicant sought accident benefits after a vehicle crashed into her home, causing her severe psychological and cognitive decline.

The insurer sought to stay the arbitration until the applicant attended further insurer examinations (IEs) under section 44 of the Schedule.

The applicant sought interim benefits.

The arbitrator dismissed the insurer's request for a stay, finding that further IEs would not assist the insurer and were not reasonably necessary given the unopposed expert evidence that further assessments risked causing the applicant serious psychological deterioration.

The arbitrator granted the applicant's request for interim benefits in part, awarding $7,000 for past medical expenses based on a demonstrated prima facie case, financial need, and urgency.

The plaintiff sought damages for injuries sustained during a recreational non-contact hockey game, alleging that an opposing player intentionally or negligently checked him into the boards and that the league operator failed to provide a safe playing environment.

The court considered the negligence standard applicable to sporting events and the doctrine of implied consent to the inherent risks of hockey.

The evidence did not establish that the opposing player acted with intent to injure or in a reckless manner outside the ordinary risks of play.

The court further held that the league had appropriate rules, referees, and disciplinary systems, and that the plaintiff had signed a clear waiver releasing the league from liability for injuries arising from hockey participation.

The action was therefore dismissed.

A statutory third party insurer sought leave to bring a motion after the action had been set down for trial in order to compel the plaintiff to attend a psychiatric defence medical examination.

The insurer argued that it had only recently become aware of the psychiatric component of the claim and that, as a statutory third party with separate interests from the defendant insurer, it was entitled to its own medical examination.

The court held that there had been no unexpected or substantial change in circumstances justifying leave after the matter was set down for trial.

The court also found that the insurer’s interests were effectively the same as the defendant insurer’s and that a psychiatric defence examination had already been obtained.

The motion was therefore dismissed.