Lori J. Sprott

The applicant requested a reconsideration of a Tribunal decision that found he remained within the Minor Injury Guideline (MIG) and was not entitled to disputed treatment plans.

The applicant argued the adjudicator erred in fact and law by failing to find he suffered a neurocognitive disorder or psychological impairment, and sought to introduce new evidence of a concussion.

The Tribunal dismissed the request, finding the applicant was attempting to re-litigate the case and re-weigh evidence.

The Tribunal held that the adjudicator provided comprehensive reasons for rejecting the applicant's evidence, and the new evidence did not meet the test for reconsideration.

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

The respondent denied the claims, arguing the injuries were minor.

The Tribunal found the applicant's self-reported limitations inconsistent with his post-accident ability to attend school and work.

The Tribunal gave no weight to the applicant's treating practitioners, who were not qualified as experts and relied on assumptions or invalid test profiles.

Accepting the respondent's expert evidence, the Tribunal concluded the applicant failed to meet his burden to prove his injuries fell outside the MIG.

All claims for attendant care, treatment plans, and an award were dismissed.

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

The Tribunal found the applicant was barred from proceeding with three issues due to her failure to attend a properly scheduled insurer's examination under s. 44 of the Schedule.

On the substantive issues, the Tribunal granted entitlement to two occupational therapy treatment plans, finding them reasonable and necessary for pain management and sleep hygiene.

The Tribunal denied entitlement to the unapproved amounts of several other physiotherapy and occupational therapy treatment plans because the applicant failed to provide evidence that the overall costs were reasonable.

The applicant was awarded interest on overdue benefits but denied an award under s. 10 of Reg. 664.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to income replacement benefits (IRBs), various treatment plans, and removal from the Minor Injury Guideline (MIG).

The Tribunal found that the applicant failed to prove her injuries fell outside the MIG, as contemporaneous medical evidence and expert assessments indicated she suffered only soft-tissue sprain/strain injuries.

The Tribunal also dismissed the claim for IRBs, finding the applicant did not demonstrate a substantial inability to perform her pre-accident employment tasks or a complete inability to engage in any employment, noting she had returned to work post-accident and was deemed fit for sedentary duties.

As the applicant remained within the MIG and the limits were exhausted, the disputed treatment plans and claims for interest were denied.

The applicant requested a reconsideration of a decision finding he did not sustain a catastrophic impairment.

He argued the Tribunal committed a material breach of procedural fairness by providing inadequate reasons and raising issues on its own, and that it erred in fact and law in assessing the medical evidence.

The Vice-Chair dismissed the request, finding the reasons were adequate, the evidence relied upon was properly before the Tribunal, and the applicant was improperly attempting to re-weigh the evidence rather than identifying actual errors.

The applicant sought a determination that he was catastrophically impaired under Criterion 8 of the Statutory Accident Benefits Schedule due to mental and behavioral disorders resulting from a motor vehicle accident.

While the Tribunal accepted that the applicant sustained post-traumatic stress disorder, a major depressive episode, and substance use disorder as a result of the accident, it found that these impairments did not reach the threshold of a marked (Class 4) impairment in any of the four functional domains.

The Tribunal concluded that the applicant retained some useful functioning in activities of daily living and social functioning, and therefore dismissed the application.

Certas Home and Auto Insurance Company appealed an arbitration decision regarding loss transfer indemnification from Intact Insurance Company for statutory accident benefits paid to an insured.

The arbitrator found Certas had grossly mishandled the claim by failing to follow its own adjusting plan and continuing benefits despite medical opinions and the insured's completion of vocational training.

The Superior Court of Justice upheld the arbitrator's decision, finding no palpable and overriding error in the arbitrator's conclusion that Certas grossly mismanaged the claim, thereby limiting Intact's indemnification obligation.

The applicant sought reconsideration of a preliminary issue decision which found she was not involved in an 'accident' under the Statutory Accident Benefits Schedule.

The applicant argued the Tribunal erred in its application of the purpose and causation test regarding a natural gas explosion following a vehicle collision, and sought to introduce new medical evidence.

The Tribunal dismissed the request, finding no error of law or fact, and held that the new evidence could have been obtained previously and would not have changed the outcome.

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

The respondent denied certain chiropractic treatment 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 chronic pain and psychological impairments.

The Tribunal found insufficient evidence of functional impairment from chronic pain or a psychological impairment caused by the accident.

As the MIG limits were exhausted, the treatment plans were not payable and the application was dismissed.

The applicant sought a determination of catastrophic impairment based on a mental and behavioural disorder following a 2017 motor vehicle accident.

The respondent argued the applicant's psychological impairments predated the accident and were caused by prior life events, including a 2013 accident and trauma in his home country.

The Tribunal found that the applicant was receiving disability benefits prior to the 2017 accident and had a documented history of similar physical and psychological symptoms.

Applying the 'but for' test, the Tribunal concluded the 2017 accident was not a necessary cause of the applicant's impairments and dismissed the application.

The applicant sought statutory accident benefits for psychological impairments after a vehicle struck a neighbour's house, causing a natural gas explosion that destroyed multiple homes including hers.

The respondent denied benefits on the basis that the applicant was not involved in an automobile accident.

The Tribunal found that the applicant only witnessed the aftermath of the collision and was not directly involved in the automobile accident.

As she did not meet the definition of an 'insured person' under section 3(1) of the Schedule, the application was dismissed.

Intact Insurance Company appealed an arbitrator's decision that found a motorcycle passenger and driver were spouses under the Insurance Act, obliging Intact to pay accident benefits.

The passenger was in a committed five-year relationship with the driver but maintained a separate residence and was still married to another individual.

The Superior Court of Justice allowed the appeal, finding the arbitrator committed an extricable error of law by applying family law principles to the definition of 'spouse' for insurance purposes and by failing to adhere to the bright-line test requiring parties to have lived together in the same residence for three years to be considered spouses under the Insurance Act.

The court applied a correctness standard of review.

The applicant, who sustained a catastrophic impairment in a motor vehicle accident, sought attendant care benefits for services allegedly provided by his wife.

The insurer denied the claim on the basis that the wife did not meet the requirements for a provider under the Schedule and did not incur an economic loss.

The Licence Appeal Tribunal found that the applicant failed to prove on a balance of probabilities that the attendant care services were provided by his wife over and above the professional care already received.

Furthermore, the applicant did not prove that his wife sustained an economic loss as a result of providing the care.

The claims for attendant care benefits, interest, and a special award were dismissed.

The respondent insurer requested a reconsideration of a Tribunal decision awarding the applicant the costs of a chronic pain assessment and a chiropractic functional impairment assessment following a motor vehicle accident.

The insurer argued the Tribunal erred in its causation analysis, its determination of what constitutes a valid medical reason for denying a treatment plan, and its finding that an assessment was for accident benefits rather than a tort claim.

The Adjudicator found that while the Tribunal erred in determining that 'insufficient documentation' was not a valid medical reason for denial, this error would not have changed the ultimate outcome.

The Adjudicator found no other significant errors of law or fact and dismissed the request for reconsideration.

The applicant was injured in a motor vehicle accident and sought payment for five medical assessments under the Statutory Accident Benefits Schedule.

The insurer denied the assessments.

The Licence Appeal Tribunal found that the psychological, orthopaedic, and physiatry assessments were not reasonable and necessary.

However, the Tribunal ordered the insurer to pay for the chronic pain assessment, finding it reasonable and necessary to explore treatment options, and the functional impairment assessment, as the insurer failed to provide a proper medical reason for denial within the required timeframe.

The applicant was awarded interest on overdue payments but denied a special award under section 10 of Regulation 664.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits, including income replacement, attendant care, and housekeeping benefits.

The insurer denied the claims.

The arbitrator dismissed all of the applicant's claims, finding that the applicant lacked credibility and failed to prove on a balance of probabilities that he suffered a substantial inability to perform the essential tasks of his employment or his housekeeping tasks.

The arbitrator also found that the applicant's wife did not sustain an economic loss to justify the attendant care and housekeeping claims.

Claims for a special award and interest were consequently dismissed.

The applicant applied for statutory accident benefits following a motor vehicle accident but failed to participate in the arbitration process or communicate with his counsel, who subsequently withdrew.

The insurer brought a motion to dismiss the application as frivolous or vexatious under Rule 68 of the Dispute Resolution Practice Code.

The arbitrator declined to find the claim frivolous or vexatious but deemed the application withdrawn under Rule 70 due to the applicant's abandonment of the proceeding.

The applicant was ordered to pay the insurer's expenses of $1,712.63.