Yalda Aziz

The respondent suffered injuries after slipping and falling on ice in a parking lot while reaching for his vehicle's door handle.

He received statutory accident benefits (SABs) after a LAT adjudicator found the incident was an 'accident' under the SABs Schedule.

He subsequently sued the parking lot owner and winter maintenance provider for occupiers' liability.

The appellants moved to determine whether any damages awarded must be reduced by the SABs received under s. 267.8 of the Insurance Act, and whether OHIP's subrogated claim was barred under s. 30(5) of the Health Insurance Act.

The motion judge found the tort claim did not arise directly or indirectly from the use or operation of an automobile, meaning the statutory deductions and subrogation bars did not apply.

The Court of Appeal dismissed the appeal, finding no error in the motion judge's substantive approach or her conclusion that the context and purpose of the LAT proceeding differed from the tort action, precluding abuse of process or issue estoppel.

The defendant brought a motion to compel the plaintiff to attend a neuropsychological assessment and for leave to serve the resulting expert report after the deadline set by Rule 53.03.

The defendant's new counsel argued the delay was due to assuming carriage of the file late in the litigation.

The court dismissed the motion, finding no reasonable explanation for the two-year delay by the defendant's previous counsel in arranging the assessment.

The court also noted that allowing a late report on the eve of trial would cause significant prejudice to the plaintiff and likely result in a lengthy trial adjournment.

The appellant was injured in a motor vehicle accident and suffered an intracranial brain contusion.

The insurer placed her in the Minor Injury Guideline (MIG) under the Statutory Accident Benefits Schedule (SABS), limiting her benefits to $3,500.

The Licence Appeal Tribunal upheld this decision, finding that the definition of 'minor injury' includes all contusions, including brain contusions.

On appeal, the Divisional Court found the Tribunal erred in law by focusing on the degree of impairment rather than the nature of the injury.

The court held that an intracranial brain contusion is not a 'minor injury' under the SABS, allowed the appeal, and ordered the appellant removed from the MIG.

The applicant sought non-earner benefits and interest following a motor vehicle accident.

The Licence Appeal Tribunal applied the Heath test to determine if the applicant suffered a complete inability to carry on a normal life.

While the Tribunal accepted that the applicant's injuries prevented him from continuing his pre-accident employment and impacted his housekeeping duties, it found that his personal care tasks were not sufficiently affected.

The Tribunal concluded the applicant failed to meet the high threshold for non-earner benefits.

The application was dismissed.

The Ontario Trial Lawyers Association (OTLA) brought a motion for leave to intervene as a friend of the Court in an appeal concerning the interpretation of 'minor injury' under the Statutory Accident Benefits Schedule.

The court dismissed the motion, finding that OTLA's proposed submissions overlapped substantially with the appellant's factum and that the perspective and interests were adequately represented without OTLA's involvement.

The court concluded that OTLA was unlikely to make a useful contribution to the resolution of the appeal.

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

The insurer denied benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and she did not qualify for a non-earner benefit.

The Licence Appeal Tribunal found the applicant failed to prove her pre-existing psychological condition prevented maximal recovery within the MIG.

The Tribunal also dismissed the claim for a non-earner benefit, finding the medical evidence demonstrated the applicant continued to engage in her pre-accident activities and did not suffer a complete inability to carry on a normal life.

The application was dismissed.

The applicant sought statutory accident benefits for psychological services following a motor vehicle accident.

The respondent insurer denied portions of four treatment plans, arguing that the first plan was barred by the two-year limitation period and that the hourly rate requested for a social worker in the subsequent plans was unreasonable.

The Tribunal found that the limitation period was not triggered for the first plan because the insurer's initial notice of denial was unclear and non-compliant.

However, the Tribunal dismissed the claims on the merits, finding that the applicant failed to provide objective medical evidence to support the first treatment plan and failed to prove that the higher hourly rate of $149.61 for a social worker was reasonable compared to the $100.00 rate approved by the insurer.

The application was dismissed in its entirety.

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

The respondent denied the treatment plans, initially placing the applicant in the Minor Injury Guideline (MIG) before removing him upon discovering a toe fracture.

The Tribunal found that the disputed treatment plans, including laser therapy, a bone growth stimulator, further chiropractic and physiotherapy services, and a chronic pain management program, were not reasonable and necessary.

The Tribunal preferred the respondent's medical evidence, finding that the toe fracture was uncomplicated and that the applicant did not meet the criteria for chronic pain syndrome under the AMA Guides.

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

The Tribunal initiated a review of a previous reconsideration decision under Rule 18.5 because the applicant's properly filed submissions were not before the adjudicator.

The Vice-Chair found this omission constituted a material breach of procedural fairness, cancelled the previous reconsideration decision, and reheard the applicant's request for reconsideration.

On the merits of the request, the Vice-Chair found the applicant failed to establish any errors of fact or law, or any breach of procedural fairness in the initial decision regarding her removal from the Minor Injury Guideline.

The request for reconsideration was dismissed.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision which found her injuries fell within the Minor Injury Guideline and denied a disputed treatment plan.

The adjudicator dismissed the request for reconsideration because the applicant failed to file any submissions by the required deadline.

The applicant sought accident benefits following a motor vehicle accident, claiming entitlement to several chiropractic and psychological treatment plans outside the Minor Injury Guideline (MIG).

The respondent denied the benefits, arguing the injuries were predominantly minor.

The Tribunal found that the applicant did not sustain a concussion, chronic pain with functional impairment, or a psychological impairment warranting removal from the MIG.

Relying on the insurer's multidisciplinary assessments, the Tribunal concluded the injuries were predominantly minor.

As the applicant was subject to the MIG limit, the disputed treatment plans and interest were denied.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming her psychological injuries and chronic pain warranted removal from the Minor Injury Guideline (MIG).

The Tribunal found the applicant's evidence, including psychiatric and chronic pain assessments, lacked corroboration from her family doctor's records and was internally inconsistent.

Preferring the respondent's psychological and physiatry assessments, the Tribunal concluded the applicant failed to establish on a balance of probabilities that she suffered a psychological injury or chronic pain with functional impairment.

The application was dismissed, and the applicant's injuries were deemed predominantly minor and subject to the $3,500 MIG limit.

The applicant sought statutory accident benefits following a 2019 motor vehicle accident.

The respondent denied a chiropractic treatment plan and the cost of a walker.

The applicant appealed to the Licence Appeal Tribunal after the two-year limitation period expired.

The Tribunal applied the Manuel factors and extended the limitation period under section 7 of the Licence Appeal Tribunal Act, finding merit in the appeal and no prejudice to the respondent.

However, on the substantive issues, the Tribunal dismissed the claims, finding the chiropractic plan and walker were not reasonable and necessary as a result of the accident.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming the balance of a treatment plan for psychological services, an award for unreasonable delay, and interest.

The respondent had already approved the majority of the treatment plan.

The Tribunal found that the applicant failed to meet the burden of proving that the remaining balance for communication sessions was reasonable and necessary.

As no benefits were overdue and the respondent acted in good faith, the claims for interest and an award were also dismissed.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied her entitlement to a non-earner benefit and interest following a motor vehicle accident.

The applicant argued that the adjudicator erred in law and fact by failing to properly apply the Heath test and compare her pre- and post-accident activities, and sought to introduce new evidence including medical reports and her ODSP file.

The Tribunal dismissed the request, finding no error of law or fact, as the original decision properly assessed causation and the applicant's failure to meet her burden of proof regarding her activities between two successive accidents.

Furthermore, the Tribunal held that the proposed new evidence either could have been obtained previously or would not have likely affected the outcome of the hearing.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically funding for psychological assessments, psychological counselling, and chiropractic treatment.

The respondent insurer denied the treatment plans.

The applicant argued that the insurer failed to comply with the notice requirements under s. 38(8) of the Statutory Accident Benefits Schedule, which would trigger an obligation to pay.

The Tribunal found that the insurer's explanation of benefits letters provided sufficient medical and other reasons for the denials, including the absence of updated medical records and reliance on prior insurer's examinations.

As the insurer complied with s. 38(8), the applicant was not entitled to the disputed treatment plans, interest, or an award for unreasonable delay.

The applicant sought statutory accident benefits following a rear-end motor vehicle accident.

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

The Tribunal found that the applicant failed to meet her burden of proving that her physical or psychological impairments warranted removal from the MIG, noting a lack of objective medical evidence for chronic pain or a concussion.

The application for disputed treatment plans, interest, and an award for unreasonable delay was dismissed.

The applicant sought statutory accident benefits for two chiropractic treatment plans following a motor vehicle accident.

The respondent insurer denied the benefits.

The adjudicator found that the applicant failed to prove the treatment plans were reasonable and necessary, as the medical evidence, including the insurer's independent medical examinations, indicated the applicant's ongoing pain was related to pre-existing conditions rather than the subject accident.

The application was dismissed and no interest was payable.

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

The respondent denied several treatment and assessment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.

The applicant argued for removal from the MIG due to post-concussion syndrome, pre-existing scoliosis, and psychological injuries.

The Tribunal found that the applicant did not sustain a concussion or psychological injury warranting removal, and failed to provide compelling medical evidence that her pre-existing conditions precluded recovery within the MIG.

The Tribunal also found the respondent's denial notices were compliant with the Schedule.

The application was dismissed.

The applicant sought non-earner benefits following a September 2022 motor vehicle accident.

The respondent denied the claim, arguing the applicant's impairments stemmed from pre-existing depression and a prior accident in June 2022.

The Tribunal applied the 'but for' causation test and the Heath framework, finding the applicant failed to prove her impairments were caused by the September accident.

The Tribunal preferred the respondent's section 44 assessors, who properly compared the applicant's functioning before and after both accidents, over the applicant's section 25 assessors, who failed to review pre-accident records or account for the prior accident.

The application was dismissed.