Supriya Sharma

The applicant was catastrophically impaired in a motor vehicle accident and sought statutory accident benefits, including attendant care and home modifications.

The respondent insurer partially denied the claims based on its own assessments.

The Licence Appeal Tribunal found that the applicant's functional limitations, including cognitive and physical impairments, necessitated the maximum attendant care benefit of $6,000 per month and home modifications totaling $344,864, which included an in-home elevator and therapy room.

The Tribunal also awarded the cost of a housing analysis assessment but denied the cost of a second attendant care assessment submitted prematurely.

Finally, the Tribunal ordered a special award under s. 10 of Regulation 664, finding the respondent unreasonably withheld benefits by failing to properly investigate the applicant's functional needs despite having access to medical evidence supporting the claims.

The plaintiff brought an action for damages arising from a motor vehicle accident.

Following a jury verdict awarding net general damages of $11,181.03, the court considered whether the plaintiff's injuries met the statutory threshold under the Insurance Act.

The court found that the plaintiff, whose primary role was a homemaker, sustained permanent and serious impairments to important physical and psychological functions, including PTSD and depression.

The court ruled that the injuries met the threshold and dismissed the defendant's motion.

The applicant was injured in a motor vehicle accident and sought accident benefits, claiming he sustained a catastrophic impairment.

The insurer denied the claim, arguing that any catastrophic impairment was the result of a stroke the applicant suffered two years after the accident.

The arbitrator found that the applicant's psychological impairments resulting from the accident met the threshold for catastrophic impairment, and that the accident materially contributed to the stroke.

The arbitrator awarded attendant care benefits for incurred professional services but denied them for family-provided care due to a lack of evidence of economic loss.

A special award was granted against the insurer for unreasonably withholding payments.

The applicant was struck by a city bus as a pedestrian, sustaining soft tissue injuries and a mild traumatic brain injury.

She subsequently developed severe depression, anxiety, and post-traumatic stress disorder.

She applied for a determination that her impairments met the catastrophic threshold under the Statutory Accident Benefits Schedule.

The Tribunal found that while her cognitive complaints were largely psychogenic rather than organic, her psychological impairments were genuine and severely debilitating.

Relying on comprehensive neuropsychological and occupational therapy assessments, the Tribunal concluded the applicant suffered a marked impairment in the adaptation domain, thereby meeting the criteria for a catastrophic impairment under s. 2(1.2)(g) of the Schedule.

The applicant sought accident benefits following a motor vehicle accident, claiming her injuries were catastrophic.

The arbitrator found the applicant lacked credibility, noting she had returned to work shortly after the accident, retrained for a more physically demanding job, and was observed on surveillance performing activities she claimed she could not do.

The arbitrator preferred the insurer's expert evidence over the applicant's, concluding the applicant failed to prove her injuries were catastrophic or that the claimed attendant care and medical benefits were reasonable, necessary, and directly caused by the accident.

All claims were dismissed.

The defendants appealed an interlocutory decision granting the plaintiff's motion to add a receptionist at the Ocular Health Clinic as an individual defendant.

The Divisional Court allowed the appeal, finding that the proposed pleading failed to disclose a reasonable cause of action against the receptionist personally for either negligence or wilful misrepresentation.

The court emphasized that employees are generally protected from personal liability unless their actions are tortious in themselves or exhibit a separate identity or interest from the employer.

The appellant insurer was successful on an appeal regarding a special award and sought its legal expenses of the appeal.

The appellant claimed approximately $8,260 in expenses.

The respondent opposed the award, arguing the amounts were excessive and that the issue should be left to the hearing arbitrator.

The Director's Delegate rejected the respondent's argument, finding that the appeal expenses must be decided by the appeal decision-maker.

Considering the relative simplicity of the matter and the appellant's success, the Director's Delegate fixed the appellant's expenses at $3,000.

The applicant sought interim accident benefits, including non-earner benefits, attendant care benefits, and medical/assessment benefits, following a motor vehicle accident.

The insurer denied the benefits.

The arbitrator found that the applicant had significant pre-existing physical and psychological conditions that were not proven to be exacerbated by the accident.

The arbitrator concluded that the applicant failed to demonstrate a compelling need or urgency for interim benefits, as he continued to receive medical treatment and had some assistance for his day-to-day needs.

The motion for interim benefits was dismissed.

The insurer appealed an arbitrator's decision granting the insured a $13,000 Special Award for unreasonably withholding or delaying accident benefits.

The Director's Delegate allowed the appeal, finding that the arbitrator erred in law by failing to provide sufficient reasons to justify the award, considering irrelevant factors such as an offer to settle and litigation strategy, and denying natural justice by considering the timing of a payment without allowing submissions.

The issue of the Special Award was remitted to a different arbitrator for a fresh determination.

The appellant was injured in a motor vehicle accident and awarded damages by a jury.

The jury questions lumped together damages for medical/rehabilitation, attendant care, and housekeeping.

The trial judge reduced these awards to nil under s. 267.8 of the Insurance Act because the appellant had already received statutory accident benefits exceeding the jury's award.

The appellant appealed, arguing the reduction was improper without a benefit-by-benefit breakdown.

The Court of Appeal dismissed the appeal, holding that the trial judge reasonably reduced the award to prevent double recovery, despite the poorly structured jury questions.

The appellant insurer sought to stay an arbitrator's order requiring it to pay a special award and legal expenses to the respondent insured, pending an appeal.

The arbitrator had found the insurer unreasonably delayed paying benefits and adjusting the claim.

The Director's Delegate dismissed the request for a stay, finding that the insurer failed to demonstrate strong grounds for the appeal or that it would suffer prejudice if the stay was not granted, whereas granting the stay would undermine the legislative purpose of the special award to punish and deter unreasonable delay.

The insurer brought a motion to compel the applicant to produce her cell phone records for the date of the motor vehicle accident.

The insurer argued the records were necessary to locate a witness to clarify discrepancies regarding the circumstances of the accident.

The arbitrator dismissed the motion, finding that the insurer did not dispute that the accident occurred and made no allegation of fraud.

The cell phone records were deemed not relevant to the substantive issues in dispute, and their probative value did not outweigh the applicant's reasonable expectation of privacy.

The applicant was injured in a motor vehicle accident and claimed attendant care, housekeeping, and caregiver benefits from her insurer under a transitional policy.

The central legal issue was whether the new 'incurred' definition in the 2010 Statutory Accident Benefits Schedule, which requires non-professional service providers to demonstrate an economic loss, applied to her claims.

The arbitrator held that the applicant's rights vested on the date of the accident, meaning the 2010 Schedule's definition of 'incurred' applied.

Because the applicant's family members could not demonstrate a quantifiable economic loss, the claims for attendant care and caregiver benefits were denied.

However, the applicant was awarded partial housekeeping benefits for services provided by professional cleaners during the period she was substantially disabled from performing those tasks.