Peter Yoo

The applicant, who suffered a catastrophic impairment including a leg amputation in a motor vehicle accident, sought $607,445 for home modifications to his mother's residence.

The insurer denied the benefit.

The Licence Appeal Tribunal found that the mother's residence did not qualify as the applicant's "existing home" under s. 16 of the Schedule, as evidence showed he lived with his stepfather prior to the accident.

Furthermore, the Tribunal held there is no authority under the Schedule to redirect home modification funds into a trust for a future home purchase.

The Tribunal also dismissed the insurer's preliminary motion to dismiss the application for the applicant's failure to attend an Examination Under Oath, noting the Schedule does not prescribe dismissal as a penalty for such non-compliance.

The claims for an award and interest were dismissed.

The appellant RSA appealed a motion judge's decision regarding insurance policy priority following a motor vehicle accident.

The plaintiff was struck by a vehicle owned by D'Souza and driven by Lamoureux.

The central issue was whether the plaintiff's OPCF 44R underinsured motorist endorsement or D'Souza's personal umbrella liability policy (PLUP) would respond after the primary automobile policy limits were exhausted.

The motion judge determined that the OPCF 44R took priority over the PLUP, that RSA could not deduct the PLUP limits from its OPCF 44R payments, and that RSA could not issue a third-party claim against Certas or subrogate against the defendants.

The Court of Appeal upheld all of these determinations.

The court considered a motion by the Crown in Right of Ontario (on behalf of the OPP) to dismiss all claims against it for lack of notice under the Crown Liability and Proceedings Act, and a cross-motion by Certas Home and Auto Insurance to compel further discovery.

The court struck the plaintiff’s claim against the Crown for lack of notice but allowed Certas’ crossclaim to continue, holding that the statutory notice requirement does not apply to crossclaims.

The court also ordered Constable Khabra to re-attend for discovery to answer questions arising from undertakings, and addressed the requirements for Crown witness designation.

Costs were fixed in favour of Certas.

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

The applicant failed to attend the scheduled videoconference hearing.

The Tribunal proceeded in the applicant's absence pursuant to section 7(3) of the Statutory Powers Procedure Act.

Because the applicant presented no evidence to support his claims for income replacement benefits, attendant care benefits, and various treatment plans, he failed to meet his evidentiary burden.

The application was dismissed.

The applicant sought non-earner benefits following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to submit a completed disability certificate (OCF-3) prior to the end of the claimed entitlement period, contrary to s. 36(2) of the Schedule.

Furthermore, the applicant failed to meet her evidentiary burden to demonstrate a complete inability to carry on a normal life, as she did not provide specific arguments or references to the evidence connecting her impairments to her pre- and post-accident activities.

The applicant was involved in a rear-end motor vehicle accident and sought statutory accident benefits, including income replacement benefits (IRBs) and various medical and rehabilitation benefits.

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

The Tribunal found that the applicant sustained predominantly minor injuries (soft tissue sprains/strains) and failed to prove that pre-existing conditions, neurological issues, psychological injuries, or chronic pain warranted removal from the MIG.

The Tribunal also found the applicant failed to demonstrate a substantial inability to perform the essential tasks of his pre-accident employment, denying the claim for IRBs.

The application was dismissed in its entirety.

The applicant sought statutory accident benefits following a reported hit-and-run rear-end collision.

The respondent insurer denied benefits and sought repayment of $13,947.45, alleging the applicant staged the collision or wilfully misrepresented the facts, relying on an engineering report suggesting the vehicle reversed into a pole.

The Tribunal preferred the applicant's engineering experts, who found her account plausible based on real-world collision data.

The Tribunal also drew an adverse inference against the respondent for selling the vehicle before it could be inspected.

The Tribunal concluded the applicant was involved in an accident, did not wilfully misrepresent material facts, and the respondent was not entitled to repayment.

The appellant appealed a Licence Appeal Tribunal (LAT) decision denying his claim for catastrophic impairment benefits following a motor vehicle accident.

The LAT found that a subsequent fall and seizure was an intervening event not caused by the accident.

On appeal, the appellant argued the LAT breached procedural fairness by allowing the insurer to raise causation late, and erred by applying the 'but for' causation test instead of the 'material contribution' test.

The Divisional Court dismissed the appeal, holding that the procedural fairness issue could not be raised for the first time on appeal, and that the LAT correctly applied the 'but for' test as this was not an exceptional case involving multiple tortfeasors.

The applicant was injured in a motor vehicle accident and sought medical benefits for chiropractic treatment and massage therapy under the Statutory Accident Benefits Schedule.

The respondent denied the treatment plans based on insurer's examinations and surveillance evidence.

The applicant applied to the Licence Appeal Tribunal to dispute the denials and sought an award for unreasonable delay.

The Tribunal found that the applicant failed to prove the proposed treatment plans were reasonable and necessary, noting that the applicant had recovered much of his pre-accident functional abilities and that there were more effective alternatives for pain relief.

The Tribunal also found that the respondent provided sufficient medical reasons for its denials in compliance with section 38(8) of the Schedule.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits (IRBs) and medical benefits for chiropractic treatment.

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

The Licence Appeal Tribunal found that the applicant suffered predominantly minor injuries and failed to provide compelling medical evidence to warrant removal from the MIG.

The Tribunal also dismissed the claims for IRBs, finding no evidence of a substantial inability to perform the essential tasks of employment, and concluded the disputed treatment plans were not reasonable and necessary.

The applicant requested a reconsideration of a decision denying medical and attendant care benefits on the basis that he did not sustain a catastrophic impairment from a motor vehicle accident.

The applicant argued the Tribunal violated procedural fairness by deciding on causation without proper notice and erred in law by applying the 'but for' test instead of the 'material contribution' test.

The Adjudicator dismissed the request, finding the applicant was aware of the causation issue, failed to raise procedural concerns during the hearing, and that applying the material contribution test would not have changed the outcome.

The applicant sought enhanced statutory accident benefits, claiming he sustained a catastrophic impairment from a motor vehicle accident.

He argued the accident caused or exacerbated conditions leading to a fall and seizure weeks later.

The Tribunal found the applicant failed to prove on a balance of probabilities that his present impairments, including a traumatic brain injury and psychological issues, were caused by the accident rather than his extensive pre-existing medical conditions, such as diabetic neuropathy and a history of syncope.

As the applicant did not meet the catastrophic impairment threshold and his standard policy limits were exhausted, all claims for medical, rehabilitation, attendant care, and housekeeping benefits were dismissed, along with claims for interest and a special award.

The appellant appealed a Licence Appeal Tribunal decision refusing to extend the limitation period for her non-earner benefits claim.

The application was filed five days after the two-year limitation period expired.

The Divisional Court found the Tribunal made three errors of law: it incorrectly measured the length of delay and prejudice from the date of the insurer's denial rather than the expiry of the limitation period, and it failed to consider new evidence regarding the appellant's bona fide intention to appeal.

The appeal was allowed and the matter remitted for a new hearing.

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

The respondent denied medical benefits beyond the $3,500 Minor Injury Guideline limit.

The applicant argued his injuries, including chronic pain, exceeded the minor injury definition and that pre-existing conditions warranted removal from the guideline.

The Tribunal found the applicant's injuries were predominantly minor soft tissue injuries and rejected the evidence of his chiropractor regarding chronic pain.

The Tribunal also found the respondent's denial notices complied with the statutory timelines.

The application was dismissed.

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

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

The adjudicator found that the applicant failed to establish that her injuries warranted removal from the MIG, noting a lack of corroborative medical evidence, functional disability, or psychological impairment.

As the MIG limits were exhausted, the disputed treatment plans were not reasonable and necessary.

The application was dismissed, and claims for an award and interest were denied.

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

The respondent denied income replacement benefits (IRB) and various medical and rehabilitation benefits, arguing the applicant failed to comply with requests for information under s. 33 of the Schedule.

The Tribunal found the applicant adequately complied with the s. 33 requests and was procedurally entitled to the IRB.

The Tribunal also found that a proposed mattress and chiropractic treatment were reasonable and necessary, preferring the evidence of the applicant's treating practitioners over the respondent's assessors.

The applicant was awarded the disputed benefits with interest.

The applicant in a statutory accident benefits dispute brought motions to state a case for contempt, add the respondent's counsel and adjuster as witnesses, seek third-party productions, and adjourn the hearing.

The applicant alleged that the respondent's counsel interfered with her attempts to obtain personal information from independent medical examiners under PIPEDA.

The Tribunal denied the motion to add witnesses, finding no evidence that counsel or the adjuster were necessary witnesses and noting that the applicant's communications with the examiners were inappropriate attempts to cross-examine them outside the hearing.

The production motion was denied as untimely.

The adjournment motion was granted, and a case conference was ordered to address the contempt motion.

The appellant appealed a Licence Appeal Tribunal (LAT) decision that found it lacked jurisdiction to grant interim statutory accident benefits.

Before the appeal could be heard, the appellant's underlying claim was settled, rendering the appeal moot.

The appellant argued the court should still hear the appeal because the issue was evasive of review and of public importance.

Applying the Borowski factors, the Divisional Court declined to exercise its discretion to hear the moot appeal, finding that the issue was not evasive of review and that a future, non-moot case would provide a better factual foundation.

The appeal was dismissed.

The applicant requested a reconsideration of a decision finding her statute-barred from disputing entitlement to non-earner benefits due to failing to apply within the two-year limitation period.

The applicant argued the adjudicator erred in fact and law by not finding a bona fide intention to appeal and by failing to consider the respondent's delay in providing her accident benefit file.

The adjudicator dismissed the request, finding no error of law or fact, as the applicant failed to demonstrate a bona fide intention to appeal within the limitation period and the respondent's delay did not relieve the applicant of her obligation to file on time.

The applicant insurer sought judicial review of a FSCO Director's Delegate decision which held that the insurer's notice letters seeking repayment of income replacement benefits were invalid.

The insurer had attempted to claw back overpayments after the respondent became eligible for CPP benefits.

The Divisional Court dismissed the application, finding it was reasonable for the Delegate to conclude the notices were defective for claiming beyond the 12-month statutory cap and for failing to be substantially correct.

The insurer was ordered to refund the clawed-back monies with interest.