Shivani Mehta

The applicant requested a reconsideration of a Tribunal decision that dismissed her second application for a catastrophic impairment determination on the basis of res judicata.

The applicant argued the Tribunal breached procedural fairness by failing to address her arguments regarding the insurer's statutory obligations under Roy and the fairness exception to res judicata under CUPE.

The Adjudicator granted the reconsideration, finding that the original decision lacked adequate reasons on these central arguments, constituting a material breach of procedural fairness.

The original decision was cancelled and a written rehearing before a different adjudicator was ordered.

The applicant sought statutory accident benefits after being struck by a skid steer Caterpillar snowplow while walking in a parking lot.

The respondent denied benefits on the basis that the incident was not an 'accident' under section 3(1) of the Statutory Accident Benefits Schedule.

The Tribunal applied the Adams test and found that the snowplow was not an 'automobile' in ordinary parlance, under any insurance policy, or under any enlarged statutory definition, as it qualified as an exempt 'road-building machine' under the Highway Traffic Act.

The application was dismissed.

The applicant requested reconsideration of a Tribunal decision denying her claim for statutory accident benefits.

The applicant had witnessed a motor vehicle accident that resulted in the death of her husband and claimed psychological injuries from the event.

The original decision found she was not 'involved in' the accident under s. 3(1)(b) of the Schedule because she was merely a witness and was not struck by a vehicle.

On reconsideration, the applicant alleged factual errors regarding the medical evidence and the identity of the vehicle, as well as legal errors in the application of case law.

The Tribunal dismissed the request, finding that the applicant was attempting to re-weigh evidence and re-litigate the case, and that she failed to establish any material error of fact or law that would have changed the outcome.

The appellant appealed and sought judicial review of a Licence Appeal Tribunal (LAT) decision finding she failed to establish catastrophic impairment under Criterion 8 of the Statutory Accident Benefits Schedule.

The appellant argued the LAT adjudicator breached procedural fairness by imposing strict time limits on witness examinations, making unequal evidentiary rulings regarding expert psychiatric testimony, and admitting a late surveillance report.

The Divisional Court dismissed the appeal, holding that the adjudicator's procedural choices were within her discretion to control the tribunal's process and did not result in unfairness.

The court also found no error of law in the LAT's application of the test for catastrophic impairment.

The applicant sought statutory accident benefits following a motor vehicle accident, including non-earner benefits, attendant care benefits, and various treatment plans.

The Licence Appeal Tribunal dismissed the application in its entirety.

The Tribunal found the applicant did not meet the test for a complete inability to carry on a normal life, preferring the respondent's section 44 assessments which attributed her functional decline to pre-existing conditions and age rather than the accident.

Furthermore, the Tribunal held that the applicant's claims for attendant care and treatment plans were barred because the non-catastrophic policy limit of $65,000 had been fully exhausted and there was no catastrophic impairment designation.

Claims for interest and a special award were also dismissed.

The applicant, a pedestrian, was struck by a vehicle insured by the respondent.

The respondent was notified of the accident by its insured the following day but failed to contact the applicant or provide him with an accident benefits package.

The applicant submitted his application for benefits nearly two years later.

The respondent denied the claim, arguing the applicant failed to provide notice within seven days as required by section 32(1) of the Schedule.

The Tribunal found that the respondent's receipt of information from its insured satisfied the notice requirement and triggered its positive obligation under section 32(2) to assist the applicant.

The Tribunal held the applicant had a reasonable explanation for the delay and was not barred from proceeding with his claim.

The applicant sought a determination that she sustained a catastrophic impairment (Criterion 8) following a motor vehicle accident.

The respondent argued the application was barred by res judicata, as the Tribunal had previously dismissed an identical claim by the applicant.

The applicant contended that res judicata should be waived based on fresh evidence, including updated medical and occupational therapy reports, and an ODSP approval.

The Tribunal found that the three preconditions for res judicata were met and that the new reports did not constitute fresh evidence that would conclusively impeach the prior decision.

The application was dismissed.

The applicant sought judicial review of a Licence Appeal Tribunal decision finding she was not catastrophically impaired under Criterion 7 of the Statutory Accident Benefits Schedule.

The Tribunal had concluded her whole person impairment rating was 49%, falling short of the 55% threshold.

The Divisional Court dismissed the application, finding the Tribunal's assessment of a 0% impairment for the spine and its correction of the upper extremity impairment calculation on reconsideration were reasonable and within its statutory authority to apply the AMA Guides.

The applicant sought statutory accident benefits for psychological injuries sustained after witnessing a police cruiser strike hydro wires, which subsequently killed her husband.

The respondent denied the claim on the basis that the applicant was not an 'insured person' under s. 3(1) of the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal found that the applicant was merely a bystander and was not 'involved in' the accident, as she was not struck by the vehicle and her psychological impairments stemmed from grief rather than a fear for her own safety.

The application for benefits was dismissed.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits for various chiropractic services and assessments.

The respondent denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued for removal from the MIG due to psychological injuries and chronic pain.

The Tribunal found that the applicant failed to provide compelling medical evidence of a psychological impairment or chronic pain with functional limitations.

Consequently, the applicant's injuries were deemed predominantly minor, and he remained subject to the $3,500 MIG limit.

As the limit applied, the disputed treatment plans were not considered, and the application was dismissed.

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

The Tribunal found that the applicant's injuries were not predominantly minor due to chronic pain, removing him from the Minor Injury Guideline.

However, the Tribunal denied the claims for income replacement benefits and several physiotherapy treatment plans, finding the applicant did not suffer a substantial inability to perform his pre-accident employment and the physiotherapy was not reasonable and necessary.

A treatment plan for a chronic pain assessment was approved.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied her entitlement to pre- and post-104-week income replacement benefits.

The applicant argued that the Tribunal erred in law and fact, and committed a material breach of procedural fairness, regarding the sufficiency of the insurer's notice of determination, the onus of proof, and the review of medical documents by an expert.

The adjudicator dismissed the request, finding that the notice complied with the Statutory Accident Benefits Schedule, the onus of proof correctly remained on the applicant, and the medical expert had properly considered the functional abilities evaluation report.

The reconsideration threshold under Rule 18.2 was not met.

The applicant requested a reconsideration of a decision finding she was not catastrophically impaired.

She argued the adjudicator erred in law by failing to consider the Whole Person Impairment (WPI) ratings for medication and her right wrist provided by an orthopedic surgeon.

The adjudicator acknowledged the error of omitting these ratings.

However, after recalculating the impairment using the correct method of combining Upper Extremity Impairment values, the adjudicator determined the applicant's total WPI was 49%.

As this remained below the 55% threshold required for catastrophic impairment, the error would not have changed the result, and the request for reconsideration was dismissed.

The applicant sought a determination that she sustained a catastrophic impairment under Criterion 7 of the Statutory Accident Benefits Schedule following a motor vehicle accident.

The Tribunal assessed various Whole Person Impairment (WPI) ratings provided by multiple medical experts for physical and psychological impairments, including complex regional pain syndrome, sleep disturbances, and right upper extremity deficits.

The Tribunal rejected several of the applicant's expert ratings for failing to follow the AMA Guides' methodology and lacking objective medical evidence.

Ultimately, the Tribunal calculated a combined WPI rating of 50%, falling short of the 55% threshold required for a catastrophic impairment designation.

The application was dismissed.

The applicant sought entitlement to pre-104 and post-104 Income Replacement Benefits (IRBs) following a motor vehicle accident.

The respondent insurer terminated the IRBs based on multidisciplinary assessments indicating the applicant could return to her pre-accident employment as an Uber driver.

The adjudicator found that the applicant failed to provide compelling medical evidence to contradict the respondent's assessors, who concluded there were no ongoing objective musculoskeletal or neurological impairments caused by the accident.

Furthermore, the applicant's own psychological records did not support a diagnosis of PTSD or a driving phobia.

The adjudicator also noted the applicant received CERB and CRB during the disputed period and successfully completed education to become a medical esthetician.

The application was dismissed.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that found she had not sustained a catastrophic impairment.

The applicant argued the adjudicator committed a material breach of procedural fairness by failing to qualify her expert as a chronic pain expert, placing little weight on uncontested reports, and incorrectly interpreting the AMA Guides.

The applicant also alleged errors of law regarding the consideration of pain-based limitations and the application of the multidisciplinary approach.

The adjudicator dismissed the request, finding no breach of procedural fairness or errors of law, noting that the original decision properly weighed the evidence and correctly applied the relevant legal principles.

The applicant sought a determination that she sustained a catastrophic impairment under Criterion 8 of the Statutory Accident Benefits Schedule due to mental or behavioural disorders following a motor vehicle accident.

The Tribunal reviewed expert evidence and the applicant's self-reported activities, including maintaining sobriety, driving long distances, and regaining custody of her children.

The Tribunal preferred the respondent's experts, finding that the applicant's impairments in social functioning, concentration, persistence and pace, and adaptation did not reach the marked (Class 4) level required for a catastrophic impairment designation.

The application was dismissed.

The applicant sought a determination that she sustained a catastrophic impairment under Criterion 8 (mental and behavioural disorders) following a 2012 motor vehicle accident.

The Tribunal first dismissed the applicant's preliminary motion for summary judgment, finding no jurisdiction to dispose of substantive issues without a hearing.

On the merits, the Tribunal preferred the evidence of the respondent's psychiatric expert over the applicant's expert, finding that the applicant's functional impairments were primarily caused by physical chronic pain rather than an accident-related mental or behavioural disorder.

The Tribunal concluded the applicant did not suffer a marked or extreme impairment in any of the four areas of functioning.

The application was dismissed, and the applicant was ordered to pay $250 in costs for unreasonable delays in producing disclosures.

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

The respondent insurer scheduled multiple insurer's examinations (IEs) which the applicant allegedly failed to attend, and the respondent argued the applicant was therefore barred from proceeding under section 55 of the Schedule.

The Tribunal found that the respondent's notices of examination failed to comply with the strict requirements of section 44(5) because they did not provide sufficient medical reasons or specific details about the applicant's condition.

Consequently, the applicant was not barred from proceeding with the application.

The applicant sought statutory accident benefits for a chronic pain assessment and multidisciplinary chronic pain treatment following a motor vehicle accident.

The respondent denied the benefits.

The Tribunal found that the applicant failed to prove the treatment and assessment were reasonable and necessary, noting her significant pre-accident medical history of fibromyalgia and chronic pain, her return to full-time work, and the lack of corroborating medical evidence beyond a flawed expert report.

The application was dismissed, and claims for interest and an award under O. Reg. 664 were also denied.