Mohamed Elbassiouni

The appellant appealed and sought judicial review of a Licence Appeal Tribunal (LAT) decision finding she was not an 'insured person' under the Statutory Accident Benefits Schedule.

The appellant's uninsured son was in an accident, and they sought benefits under her brother's spouse's policy, requiring proof of dependency.

The Divisional Court dismissed the appeal, finding the LAT did not breach procedural fairness by holding a written hearing and made no error of law in applying both a 'big picture' and mathematical approach to conclude the appellant was not principally dependent on the named insured.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to 24/7 attendant care benefits (ACBs) at $6,000 per month due to catastrophic psychiatric impairments.

The respondent insurer approved a lower monthly amount, arguing that 24/7 care was contrary to the recommendations of hospital psychiatrists and would hinder recovery.

The Tribunal found that 24/7 supervisory care was reasonable and necessary, relying on the applicant's treating psychiatrist who noted severe suicidal ideation.

The Tribunal ordered the respondent to pay $15,120 in past incurred ACBs plus interest, but declined to deem further ACBs incurred or order a special award, finding the insurer's reliance on its assessors was not unreasonable.

The appellant insurer appealed a Licence Appeal Tribunal (LAT) decision granting attendant care benefits to the respondent, who suffered from severe autism and was injured in a minor motor vehicle accident.

The appellant argued there was a reasonable apprehension of bias because the LAT adjudicator had a history of, and continued, public advocacy for autism caregivers after his appointment.

The Divisional Court agreed, finding that the adjudicator's ongoing advocacy efforts following his appointment raised a reasonable apprehension of bias in a case specifically determining attendant care benefits for an autistic claimant.

The appeal was granted and the matter remitted to the LAT for a new hearing before a different adjudicator.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied her claims for a catastrophic assessment treatment plan and an income replacement calculation report.

The adjudicator found a material error of fact regarding a March 12, 2021 notice letter, which failed to comply with s. 38(8) of the Statutory Accident Benefits Schedule.

A rehearing was ordered to determine if sufficient notice was provided prior to the treatment plan being incurred.

The request for reconsideration regarding the income replacement calculation report was dismissed, as the applicant failed to establish an error of law or fact.

The applicant requested a reconsideration of a preliminary issue decision which found she was not an 'insured person' under the Statutory Accident Benefits Schedule because she was not a dependant of the named insured.

The applicant argued the Tribunal breached procedural fairness by denying a virtual hearing and made errors of law and fact in assessing her dependency.

The Licence Appeal Tribunal dismissed the request, finding no breach of procedural fairness as the applicant failed to object to the written hearing format, and concluding that the original decision properly considered the evidence of financial and emotional dependency.

The applicant, who sustained a catastrophic impairment from a 2015 motor vehicle accident, sought $6,000 per month in attendant care benefits (ACBs), the cost of a cell phone and robotic vacuum, an award for unreasonable delay, and interest.

The Tribunal found the opinions of both parties' occupational therapists flawed and conducted its own assessment of the applicant's needs, awarding $3,062.92 per month in ACBs.

The Tribunal also approved $225 for the cell phone but denied the robotic vacuum.

The claim for a special award under s. 10 of Regulation 664 was dismissed as the applicant failed to prove the insurer acted unreasonably.

Interest was awarded on the overdue benefits.

The applicant sought statutory accident benefits following her son's motor vehicle accident, claiming she was an 'insured person' as a dependent of the named insured (her brother's spouse).

The respondent denied benefits and brought a preliminary issue hearing.

The Tribunal found that the applicant's monthly government financial assistance surpassed the 50%+1 threshold of her expenses, meaning she was not principally dependent on the named insured or her spouse for financial support.

The Tribunal also dismissed the respondent's motion to strike the applicant's sur-reply materials and admitted examination under oath transcripts from a related priority dispute.

The application was dismissed.

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

The respondent denied benefits on the basis that the applicant was not an 'insured person' under the Schedule.

In a preliminary issue hearing, the Tribunal considered whether the applicant was principally dependent for financial support or care on the named insured or her spouse.

Applying the Miller and Allstate dependency criteria, the Tribunal found the evidence insufficient to establish that the applicant, who was 19 years old and working at the time, was principally dependent on the named insured or her spouse.

The application was dismissed.

The applicant sought payment for a catastrophic impairment assessment and an income replacement calculation report following a motor vehicle accident.

The Licence Appeal Tribunal found that the insurer's denial notices complied with s. 38(8) of the Schedule.

The Tribunal dismissed the claims, concluding the applicant failed to prove the separate catastrophic assessments were reasonable and necessary, and that the income replacement calculation was not sufficiently complex to warrant a professional accounting report.

The respondent insurer requested a reconsideration of a Tribunal decision finding the applicant catastrophically impaired.

The insurer alleged a reasonable apprehension of bias because the hearing adjudicator had a background in autism advocacy, which was relevant to the causation analysis of the applicant's impairments.

The Tribunal dismissed the request, finding the insurer improperly waited until after an unfavourable decision to raise the bias allegation.

Furthermore, the adjudicator's subject matter expertise did not displace the strong presumption of impartiality.

The insurer's remaining arguments regarding factual errors were dismissed as mere disagreements with the Tribunal's weighing of evidence.

The applicant sought reconsideration of a Tribunal order that dismissed his application for accident benefits as abandoned.

The applicant argued the Tribunal erred in fact and that new evidence regarding his mental capacity should be considered.

The Tribunal found no error of fact or law in the original decision based on the evidence available at the time.

However, the Tribunal granted the reconsideration based on new evidence—a capacity assessment and the appointment of a litigation guardian—which demonstrated the applicant lacked capacity to instruct counsel when the application was dismissed.

The Tribunal varied the original order and reinstated the application to proceed to a hearing.

The appellant appealed a Licence Appeal Tribunal decision denying her claim for catastrophic impairment and income replacement benefits following a 2015 motor vehicle accident.

The Tribunal had found that the accident was not a necessary cause of her psychological impairment and that a subsequent 2018 volleyball injury was an intervening event.

The Divisional Court dismissed the appeal, finding no extricable errors of law in the Tribunal's assessment of causation, pre-existing injuries, or the intervening event.

The applicant, who had pre-existing autism, was involved in a motor vehicle accident while riding her bike.

She sought a determination of catastrophic impairment and various statutory accident benefits.

The respondent denied the benefits, arguing her impairments were solely related to her pre-existing autism.

The Tribunal found that the accident was a necessary cause of her worsened psychological condition, leading to an extreme impairment in adaptation.

The applicant was deemed catastrophically impaired and awarded ongoing attendant care benefits and partial occupational therapy costs, but denied past attendant care benefits and other treatment plans.

The applicant sought reconsideration of a decision finding she was not catastrophically impaired and denying various benefits.

The applicant argued the adjudicator breached procedural fairness by inserting causation as an issue in dispute when it was not listed in the Case Conference Report and Order.

The Tribunal agreed, finding that deciding the issue of causation without notice denied the applicant the right to fairly present evidence and argument.

The reconsideration request was granted, the original decision was cancelled, and a new hearing was ordered.

The applicant sought an income replacement benefit (IRB) following a motor vehicle accident.

The applicant did not attend the hearing.

The core issue was whether the applicant properly responded to a request for further information under s. 36(4)(c) of the Statutory Accident Benefits Schedule.

The Tribunal found that the respondent validly requested further information via fax to the applicant's representative, despite the lack of a cover letter.

Because the applicant failed to comply with the request for information, s. 33(6) was triggered, and the IRB was not payable.

The application was dismissed.

The applicant sought reconsideration of a Licence Appeal Tribunal decision regarding his entitlement to attendant care benefits.

He argued the Tribunal violated procedural fairness and erred in law by denying an adjournment, refusing to admit new evidence after the hearing, misinterpreting section 42(12) of the Statutory Accident Benefits Schedule regarding the submission of a new Form 1, and failing to address arguments raised in his reply submissions.

The adjudicator dismissed the request, finding no violation of procedural fairness or errors of law that would have changed the outcome of the original decision.

The applicant sought statutory accident benefits following a 2017 motor vehicle accident, claiming catastrophic impairment and entitlement to income replacement benefits, treatment plans, and a special award.

The respondent denied the benefits, arguing the applicant's impairments were caused by a prior 2015 accident, pre-existing conditions, and subsequent unrelated incidents.

The Tribunal found that the applicant failed to prove on a balance of probabilities that her injuries were caused by the 2017 accident, noting her failure to follow medical advice regarding the prolonged use of a knee brace.

Consequently, the Tribunal dismissed the claims for catastrophic impairment, income replacement benefits, treatment plans, and the special award.

The applicant was catastrophically injured in a motor vehicle accident and sought statutory accident benefits, including custom orthotics and attendant care benefits (ACBs).

The respondent denied the orthotics and partially denied the ACBs.

The Tribunal found the orthotics were reasonable and necessary, noting the respondent's notice was proper but the medical evidence supported the claim.

Regarding ACBs, the Tribunal weighed competing Form 1 assessments, finding the applicant's assessor recommended excessive hours while the respondent's assessor failed to account for the applicant's psychological impairments and lack of motivation.

The Tribunal awarded ACBs at $3,121.57 per month.

Claims for a Regulation 664 award were dismissed, but interest was awarded on overdue payments.

The applicant sought a determination that she sustained a catastrophic (CAT) impairment due to psychological issues following a 2015 motor vehicle accident, along with entitlement to income replacement benefits (IRBs).

The Tribunal found significant inconsistencies in the applicant's reported pre- and post-accident functioning, noting she continued to work for two and a half years post-accident.

The Tribunal determined that an intervening volleyball injury in 2018 was the actual cause of her decline in function and inability to work.

Relying on the respondent's psychological assessment which identified symptom exaggeration, the Tribunal concluded the accident was not a necessary cause of her impairments.

The application for CAT status, IRBs, interest, and an award was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits from her insurer, Wawanesa.

The Licence Appeal Tribunal found that the applicant sustained a catastrophic impairment due to marked impairments in adaptation and concentration, persistence, and pace, stemming from somatic symptom disorder and major depressive disorder.

The Tribunal also found the applicant entitled to both pre-104 and post-104 income replacement benefits, as her physical and psychological impairments prevented her from working as a personal support worker or in any suitable employment.

Several treatment plans were deemed payable because Wawanesa failed to provide proper medical and other reasons for denial in its notices, violating s. 38(8) of the Schedule.

Finally, the Tribunal ordered a 30% special award under Regulation 664, finding that Wawanesa unreasonably withheld benefits by blindly following its assessors' reports without considering the totality of the medical evidence or continuously adjusting the file.