Paul Barnes

The applicant sought a determination that she sustained a catastrophic impairment (Criterion 8) due to psychological impairments following a motor vehicle accident, as well as entitlement to a treatment plan for optometric services.

The Tribunal found that while the applicant had marked impairments in Concentration, Persistence and Pace, and Adaptation, she did not meet the threshold of three marked impairments or one extreme impairment required for catastrophic designation.

The Tribunal also dismissed the claim for optometric services, preferring the respondent's ophthalmological assessment that found no accident-related ocular sequelae over the applicant's neuro-optometrist report.

The application was dismissed in its entirety.

The applicant sought statutory accident benefits following a motor vehicle accident, including an income replacement benefit (IRB) and removal from the Minor Injury Guideline (MIG) due to chronic pain and psychological impairments.

The Tribunal first determined that the applicant was not barred from proceeding despite failing to attend an insurer's examination, as the examination was requested months after the application was filed.

On the merits, the Tribunal found the applicant was not entitled to an IRB because she failed to prove a substantial inability to perform the essential tasks of her pre-accident employment as a customer service representative, having focused her evidence on her post-accident goal of becoming a hairdresser.

The Tribunal also held that the applicant's injuries remained within the MIG, rejecting her claims of chronic pain and psychological impairment due to insufficient medical evidence and methodological flaws in her expert's psychological assessment.

Finally, the Tribunal found the insurer's denial notices were compliant with the Schedule, dismissing the application in its entirety.

The applicant sought statutory accident benefits following a motor vehicle accident and was denied by the respondent insurer.

The respondent raised a preliminary issue arguing the applicant was barred from proceeding with his application for catastrophic impairment because he failed to attend insurer examinations.

The Tribunal found that the respondent's notices of examination did not comply with section 44(5) of the Schedule because they failed to provide specific medical reasons or refer to the applicant's medical conditions.

As the notices were deficient, the applicant was not barred from proceeding to a substantive hearing.

The applicant sought income replacement benefits (IRBs) following a motor vehicle accident.

The respondent insurer denied the IRBs in an Explanation of Benefits form in May 2016.

The applicant applied to the Licence Appeal Tribunal in February 2021, well past the two-year limitation period.

The Tribunal found that the respondent's denial was clear and unequivocal, validly triggering the limitation period.

The Tribunal declined to extend the limitation period under section 7 of the Licence Appeal Tribunal Act, finding no bona fide intention to appeal within the time limit, an extraordinary delay, prejudice to the respondent, and weak merits of the claim.

The application was dismissed as statute-barred.

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

The insurer partially approved a treatment plan for a home accessibility assessment, capping it at $2,000 pursuant to s. 25(5)(a) of the Schedule.

The applicant argued the cap only applied to medical assessments.

The Tribunal held that the $2,000 limit applies to any assessment, including home accessibility assessments, as the report involved an appraisal of the applicant's health status.

The Tribunal also awarded the applicant $200 under s. 10 of Regulation 664 due to the insurer's unreasonable delay in paying for occupational therapy cognitive training sessions.

The plaintiff sought damages for personal injuries sustained in a 2013 motor vehicle accident.

Following a jury trial where the jury awarded zero damages, the defendant brought a threshold motion under s. 267.5(5) of the Insurance Act.

The court found that the plaintiff failed to prove on a balance of probabilities that he sustained a permanent serious impairment of an important physical, mental or psychological function caused by the 2013 accident.

The plaintiff's medical evidence was flawed because his experts were either unaware of or could not parse out the effects of three subsequent motor vehicle accidents.

The defendant's motion was granted and the plaintiff's claim for non-pecuniary loss was dismissed.

The applicant was injured in a rear-end motor vehicle collision and sought medical benefits beyond the $3,500 Minor Injury Guideline (MIG) limit, claiming a psychological injury and a partial muscle tear.

The Licence Appeal Tribunal found that the applicant's physical injuries, including the partial tear, were expressly included within the MIG.

The Tribunal also rejected the psychological injury claim, noting that the applicant's evidence predated the accident and the respondent's psychological assessment found only temporary, resolved symptoms.

The application for additional benefits was dismissed, though the applicant was permitted to use the remaining $129.81 of the MIG limit.

The applicant sought payment for various medical treatments, assessments, disability certificates, and Income Replacement Benefits (IRBs) following a motor vehicle accident.

The insurer denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The adjudicator found that the applicant failed to prove on a balance of probabilities that he suffered from chronic pain or a psychological impairment that would remove him from the MIG.

Consequently, the claims for medical benefits and assessments were denied.

Furthermore, while the applicant may have been entitled to IRBs, he failed to provide sufficient financial records to calculate the quantum, resulting in an award of $0 per week.

The respondent in a statutory accident benefits dispute brought a motion to exclude a letter from the case file, arguing it contained privileged case conference information and inflammatory content.

Following discussions between the parties, the respondent withdrew its motion.

The applicant fell from a ladder while installing security cameras and sought statutory accident benefits, claiming a vehicle struck his ladder.

The insurer argued it was a simple slip and fall.

With no witnesses and the applicant unable to remember the fall, the applicant relied on a forensic engineering expert who concluded the ladder's damage was caused by a vehicle's trailer hitch.

The arbitrator accepted the expert evidence, noting the insurer provided no rebuttal report, and found the incident met the definition of an 'accident' under Section 3(1) of the Schedule.

The applicant applied for statutory accident benefits following a motor vehicle accident.

After disputes arose, the applicant filed for arbitration but subsequently failed to attend the scheduled hearing.

The insurer presented evidence that the parties had previously agreed to dismiss the application without costs.

The arbitrator accepted the evidence of the settlement agreement and dismissed the application for arbitration without costs.

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

Following a pre-hearing where the applicant failed to appear and her counsel was removed from the record, the arbitrator ordered the applicant to contact the tribunal by a specified date.

The applicant failed to respond or provide written submissions.

The arbitrator dismissed the application for arbitration due to the applicant's failure to meet her onus of proof and non-compliance with the tribunal's orders.

The insurer appealed an arbitrator's interim order requiring it to produce an engineering report, claiming the report was protected by litigation privilege.

The insurer also sought to remove the arbitrator for a reasonable apprehension of bias.

The Director's Delegate allowed the appeal in part, finding that the arbitrator erred in ordering production of the report because it was commissioned after the insured applied for mediation, establishing a prima facie right to litigation privilege.

However, the Delegate dismissed the request to remove the arbitrator, finding no reasonable apprehension of bias.

The applicant was injured when he fell from a ladder, allegedly after a vehicle struck it.

The insurer denied statutory accident benefits on the basis that the incident was not a motor vehicle accident.

During the assessment phase, the insurer commissioned an engineering report.

The applicant brought a motion to compel production of the report.

The insurer claimed litigation privilege, arguing the report was prepared in anticipation of arbitration.

The arbitrator found that the report was commissioned during the good faith investigation phase, before litigation could be reasonably anticipated.

The insurer was ordered to produce the report.

Following a preliminary issue hearing where the insurer successfully argued the applicant was precluded from receiving statutory accident benefits due to her election under the Workplace Safety and Insurance Act, the insurer sought its expenses.

The arbitrator declined to award expenses to the insurer, finding that while the insurer was successful, the applicant faced a legitimate and novel preliminary issue concerning the interplay between the statutory accident benefits scheme and the workers' compensation scheme.

The arbitrator ordered that each party bear its own expenses.

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement, medical, and housekeeping benefits, as well as a special award.

The applicant failed to attend the pre-hearing and the arbitration hearing.

As the applicant did not appear to present evidence and meet the burden of proof, the arbitrator dismissed all claims.

The applicant was ordered to pay the insurer's reasonable arbitration expenses, fixed at $1,669.46.