Patrick M. Baker

The applicant applied for statutory accident benefits after slipping and falling on ice while shoveling her parking spot.

The respondent denied the claim on the basis that the incident did not meet the definition of an 'accident' under section 3(1) of the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal dismissed the application, finding that the applicant did not meet the purpose or causation tests.

The Tribunal held that shoveling an empty parking spot is not an ordinary and well-known activity to which automobiles are put, and the use or operation of the vehicle was not the direct cause or dominant feature of the applicant's injuries.

The applicant requested a reconsideration of a decision finding they suffered predominantly minor injuries subject to the Minor Injury Guideline limit.

The applicant argued the Tribunal violated procedural fairness by overlooking medical evidence of chronic pain and psychological injuries, and erred in law regarding section 38(8) notice requirements.

The Adjudicator dismissed the request, finding the medical evidence was properly considered and insufficient to remove the applicant from the MIG, and that the section 38(8) argument was an impermissible new issue.

The applicant sought income replacement benefits following two separate motor vehicle accidents.

The insurer denied the claims and the applicant applied to the Licence Appeal Tribunal more than two years after the denials.

The insurer raised a preliminary issue that the applications were statute-barred.

The Tribunal found that the insurer's denials were clear and unequivocal, triggering the two-year limitation period under s. 56 of the Statutory Accident Benefits Schedule.

The Tribunal declined to exercise its discretion under s. 7 of the Licence Appeal Tribunal Act to extend the limitation period, finding the applicant failed to demonstrate a bona fide intention to appeal within the time limit or provide compelling reasons for the delay.

The claims for ongoing entitlement were dismissed as statute-barred, though the applicant was permitted to proceed on the issue of quantum for a previously accepted period.

Two Ontario residents injured in separate accidents outside Ontario involving an all-terrain vehicle (ATV) and a dirt bike sought statutory accident benefits (SABs) under their Ontario automobile insurance policies.

Both insurers denied coverage, arguing that the definition of "automobile" under Ontario law should be determined by the law of the jurisdiction where the accidents occurred (lex loci delicti).

The Court of Appeal held that Ontario law applies to the interpretation of Ontario contracts and statutes, and that the definition of "automobile" in the Insurance Act and Off-Road Vehicles Act applies uniformly regardless of where the accident occurs.

Both vehicles qualified as automobiles under the extended definition because they would have required insurance if operated in Ontario under the Off-Road Vehicles Act.

The court allowed the appeal of the insured and dismissed the appeal of the insurer.

The applicant requested a reconsideration of a Tribunal decision that reduced the hourly rate for a psychological assessment from $149.61 to $58.19.

The Tribunal had found that the assessment was performed by a social worker acting as a psychometrist, not a psychologist.

The Vice-Chair dismissed the request for reconsideration, finding no denial of natural justice, no error of law in applying the psychometrist rate from the Professional Services Guideline, and no error of fact.

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

The respondent denied several treatment plans for chiropractic and psychological services, arguing the applicant's physical injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's diagnosed psychological impairment removed her from the MIG.

The Tribunal further held that the disputed chiropractic and psychological treatment plans were reasonable and necessary to assist with pain management and psychological recovery.

The applicant's claim for a special award under Regulation 664 was denied, as the respondent had relied reasonably on its insurer examination reports.

The applicant was injured in a motor vehicle accident and sought medical benefits for physiotherapy.

The respondent denied the treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and its $3,500 limit.

The Licence Appeal Tribunal found that while the applicant did not establish a psychological impairment, his physical injuries fell outside the MIG due to chronic pain and nerve injuries.

The Tribunal concluded that the two physiotherapy treatment plans were reasonable and necessary, and ordered the respondent to pay the benefits with interest.

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

The respondent insurer denied the treatment plans based on an insurer's examination which concluded the injuries were pre-existing or resolved.

The Tribunal found two of the treatment plans reasonable and necessary, rejecting the insurer's medical assessor's opinion as lacking foundation.

A third treatment plan was denied as a duplication.

The Tribunal awarded interest on the overdue benefits but dismissed the claim for a bad faith award, finding insufficient evidence of unreasonable delay by the insurer.

The appellant was injured in an all-terrain vehicle accident and sought statutory accident benefits.

The Licence Appeal Tribunal adjudicator found the vehicle was not an automobile and denied benefits.

The Executive Chair reconsidered the decision, cancelled it, and ordered a rehearing.

Both parties appealed the reconsideration decision to the Divisional Court.

The court dismissed both appeals, finding the Executive Chair's decision to order a rehearing was reasonable given the complexity of the case and the need to resolve factual disputes regarding the vehicle's status.

The court also held that an appeal does not stay a request for reconsideration under the Statutory Powers Procedure Act.

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

The respondent denied the claim for a psychological assessment on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued the respondent was barred from relying on the MIG because it failed to provide notice of denial within the 10-day period prescribed by section 38(8) of the Schedule.

The Tribunal found that the respondent sent the denial notice to the wrong address, meaning it was not received within the required timeframe.

Consequently, the respondent was prohibited from taking the MIG position and was required to pay for the incurred treatment.

The Tribunal adjusted the cost of the assessment to reflect the hourly rate of a psychometrist, as the assessment was conducted by a social worker rather than a psychologist.

The applicant was injured in a motor vehicle accident and subsequently suffered two workplace accidents.

He sought medical benefits for orthopaedic, chronic pain, and neurological assessments, as well as psychological treatment, arguing his injuries fell outside the Minor Injury Guideline.

The Tribunal found that the injuries from the motor vehicle accident were predominantly minor soft tissue injuries.

Furthermore, the Tribunal determined that the applicant's chronic pain and psychological impairments were caused by the subsequent workplace accidents, not the motor vehicle accident.

The application for benefits was dismissed.

The applicant was injured in a motor vehicle accident and sought non-earner benefits from the insurer.

After the applicant withdrew his application for arbitration at the Financial Services Commission of Ontario (FSCO) to proceed at the Licence Appeal Tribunal, the insurer sought its expenses for defending the FSCO application.

The arbitrator found that the applicant's initial refusal to attend an examination under oath and his unnecessary resistance to re-opening the FSCO application prolonged and hindered the proceeding.

The arbitrator ordered the applicant to pay the insurer $6,037.84 in expenses.

The applicant was involved in a motor vehicle accident and sought medical benefits for physiotherapy, massage therapy, and a psychological assessment.

The respondent denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline and the $3,500 limit had been reached.

The Tribunal found that the applicant's injuries were predominantly minor and that she failed to establish a pre-existing medical condition that would prevent maximal recovery under the Guideline.

The application for benefits and an award for unreasonable delay was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to a physiotherapy treatment plan and an orthopaedic assessment.

The insurer denied the claims on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit applied.

The applicant argued that her injuries were not predominantly minor and that she had a pre-existing condition that would prevent her from achieving maximal recovery within the MIG limit.

The Licence Appeal Tribunal found that the applicant's injuries were predominantly minor soft tissue injuries.

The Tribunal also found no compelling evidence of a pre-existing medical condition that would take the applicant outside the MIG.

As funds remained within the MIG limit, the Tribunal dismissed the claims for the treatment plan, assessment, and interest.

The applicant insurer sought reconsideration of a Tribunal decision that dismissed its application for repayment of Income Replacement Benefits.

The Tribunal had dismissed the application because the insurer failed to include a copy of the notice of repayment in its hearing submissions, despite referencing it in its application and case conference materials.

The Executive Chair granted the reconsideration, finding that the Tribunal breached procedural fairness by dismissing the application on an uncontested issue without providing the insurer an opportunity to address the missing document.

A rehearing was ordered.