Matthew J. Sutton

The applicant sought entitlement to statutory accident benefits for rehabilitation support worker services and chiropractic treatment following a motor vehicle accident.

The Tribunal found that the rehabilitation support worker plans were not reasonable and necessary, as the applicant's pre-existing impairments were consistent with his post-accident presentation and the goals of the plans had not produced any meaningful change in his activity.

The Tribunal also denied the chiropractic treatment plan, preferring the respondent's orthopedic surgeon's opinion that the accident-related pathology had healed.

The application was dismissed.

The applicants sought judicial review of an umpire's appraisal award regarding a fire loss at the respondent's property.

The dispute centered on whether an indoor pool could be repaired or required replacement.

The umpire determined repair was not a viable option and awarded replacement cost.

The Divisional Court dismissed the application, finding the umpire did not exceed his jurisdiction, as determining the amount of loss includes deciding between repair and replacement.

The court also rejected allegations of bias and procedural fairness, emphasizing the umpire's broad discretion to control the appraisal process.

The applicants sought judicial review of a Workplace Safety and Insurance Tribunal decision barring their civil action for a motor vehicle accident.

The applicant was struck by a dump truck driven by a co-worker while walking back from a personal bank errand during his workday.

The Tribunal found the applicant was in the course of employment because he was required to carry and answer a work-issued cell phone during his break, thereby retaining employer control.

The Divisional Court dismissed the application, finding the Tribunal's interpretation of its policies and the resulting decision were reasonable and owed deference.

The applicant was involved in a motor vehicle accident and sought a determination of catastrophic impairment due to a mild traumatic brain injury and psychological impairments.

The Licence Appeal Tribunal found that the applicant did not meet the criteria for catastrophic impairment under Criterion 6 (Glasgow Outcome Scale) because she maintained some independence and employment.

However, the Tribunal concluded that the applicant sustained a marked impairment in adaptation under Criterion 8 due to her somatic symptom disorder and cognitive challenges.

The Tribunal awarded attendant care benefits of $1,561.89 per month, various treatment plans, and interest, but denied the claim for 24/7 attendant care and a special award under Regulation 664.

The applicant sought a determination that he sustained a catastrophic impairment due to a psychological condition resulting from a 2014 motor vehicle accident.

The respondent insurer argued the applicant was malingering and that any impairment stemmed from a prior 2011 accident.

Despite evidence of the applicant deliberately frustrating the respondent's psychological assessments, the Tribunal preferred the evidence of the applicant's neuropsychiatrist, finding a marked deterioration in the applicant's mental health.

The Tribunal concluded the applicant suffered a Class 4 marked impairment in three spheres and that, but for the 2014 accident exacerbating his pre-existing condition, he would not have sustained a catastrophic impairment.

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

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

The Tribunal found that the applicant was statute-barred from disputing two of the treatment plans because the insurer had provided clear and unequivocal denials more than two years prior to the application.

On the merits, the Tribunal concluded that the applicant failed to establish that her injuries, including alleged chronic pain and psychological issues, fell outside the MIG.

Consequently, the applicant was bound by the $3,500 funding limit, and the remaining treatment plan was denied.

Claims for an award and interest were also dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for a chronic pain program and assessment.

The respondent insurer denied the benefits, arguing the injuries fell within the $3,500 Minor Injury Guideline (MIG) cap and that the chronic pain was not caused by the accident.

The Tribunal found that the applicant suffered from pre-existing chronic pain that was exacerbated by the accident, preventing maximal medical recovery within the MIG limits.

Relying on medical evidence, including reports from the respondent's own independent examiners, the Tribunal concluded the applicant's injuries were not predominantly minor.

The applicant was removed from the MIG and awarded the disputed treatment plans and assessment, along with interest on overdue benefits.

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

The insurer denied income replacement benefits beyond December 2016 and took the position that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant did not suffer a substantial inability to perform the essential tasks of her employment as a packager, noting her pre-existing conditions and lack of objective accident-related impairment.

The Tribunal also concluded that the applicant's injuries were predominantly minor and that her pre-existing degenerative disc disease and osteoarthritis did not prevent her from achieving maximal recovery within the $3,500 MIG limit.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought approval for a multi-disciplinary catastrophic impairment assessment totaling $22,416.69.

The respondent partially approved the treatment plan for $7,006.00.

The applicant applied to the Licence Appeal Tribunal for the unapproved balance of $15,410.69.

The adjudicator found that most of the disputed assessments were either duplicitous, ancillary to the psychological assessment, or exceeded the $2,000 statutory cap per assessment under s. 25(5)(a) of the Schedule.

The applicant was awarded $2,000 for the CAT Rating/Executive Summary and $200 for the OCF-19 completion fee, plus interest, with the remainder of the claim dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including non-earner benefits and medical benefits for various treatments.

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 funding limit had been exhausted.

The Tribunal found the applicant was not entitled to non-earner benefits because they returned to work two days after the accident and did not suffer a complete inability to carry on a normal life.

The Tribunal also held the applicant failed to prove their injuries, including alleged chronic pain and pre-existing conditions, warranted removal from the MIG.

As the MIG funding limit was exhausted, the disputed treatment plans and examination costs were not payable.

The defendants, Raphael David Junior Hassan and Carol Precious Hassan, brought a motion seeking an order for the plaintiff, Nicola Federico, to attend a further defence neurological examination and to vary a prior court order regarding timelines for defence medical assessments.

The plaintiff opposed, arguing the defendants had not met the test for a further assessment and were not compliant with the existing timeline.

The court granted the defendants' motion, finding a neurological assessment necessary for trial fairness given the plaintiff's ongoing neurological complaints and expert reports.

The court also extended the timeline for the assessment and the service of the responding neurological report, noting the plaintiffs' inconsistent stance on the original deadline.

The applicant was injured in a motor vehicle accident and applied for a determination of catastrophic impairment under the Statutory Accident Benefits Schedule.

The core issue was whether his mental and behavioural impairments, specifically his cannabis dependence and adaptation difficulties, constituted a marked impairment (Class 4).

The arbitrator found the applicant's evidence lacking in credibility and preferred the insurer's expert evidence, concluding that the applicant's impairments were only moderate (Class 3) and his combined whole person impairment did not meet the 55% threshold.

The application was dismissed, and the insurer was awarded partial expenses due to the applicant's conduct prolonging the proceeding.

The applicant brought a motion to remove the insurer's counsel as solicitor of record, alleging a conflict of interest because the same law firm represented the insurer in two separate accident benefits arbitrations involving the applicant.

The arbitrator dismissed the motion, finding no evidence of a conflict of interest or abuse of process, as both claims were for accident benefits and the duty owed by the insurer to the applicant was the same in both claims.