Robert Bowman

The applicant sought medical and rehabilitation benefits under the Statutory Accident Benefits Schedule following a motor vehicle accident, specifically claiming expenses for dog walking services and a laptop for an online college course.

The Tribunal found that dog walking services were replacement services for the dog's benefit rather than essential rehabilitation for the applicant, and thus not compensable under s. 16(3)(l).

The Tribunal also denied the claim for the laptop and course due to insufficient details in the treatment plan to assess reasonableness and necessity.

The application was dismissed.

The applicant sought a catastrophic impairment determination at the Licence Appeal Tribunal following a 2010 motor vehicle accident.

The respondent raised a preliminary issue, arguing the parties had entered into a valid full and final settlement in 2013 for $90,000, and that the applicant was prohibited from applying to the Tribunal because he had not returned the settlement funds as required by section 9.1(8) of Regulation 664.

The applicant argued the settlement was invalid due to technical defects in the Settlement Disclosure Notice.

The Tribunal found that the requirement to return settlement funds under section 9.1(8) is mandatory before the Tribunal can adjudicate the validity of a settlement.

As the applicant had not returned the funds, the application was dismissed for lack of jurisdiction.

The applicant requested a reconsideration of a preliminary issue decision which found her application statute-barred for failing to dispute a denial within the two-year limitation period.

The applicant argued the Tribunal erred in finding the denial notice was valid and triggered the limitation period.

The adjudicator dismissed the request, finding no error in the original decision that the denial was clear, unequivocal, and sufficient to trigger the limitation period, and that the applicant was merely attempting to re-litigate the issues.

The appellant appealed a Licence Appeal Tribunal decision finding he did not suffer a 'catastrophic impairment' under the Statutory Accident Benefits Schedule.

The appellant argued the tribunal applied the wrong legal test and violated procedural fairness in assessing his functional impairments.

The Divisional Court dismissed the appeal, finding the tribunal applied the correct legal standards and the appellant's arguments were impermissible attempts to re-weigh factual evidence on an appeal limited to questions of law.

The applicant sought a determination that she sustained a catastrophic impairment due to psychological injuries following a motor vehicle accident, along with payment for assessment costs.

The Tribunal found the applicant to be an unreliable historian, noting significant inconsistencies between her testimony and her pre-accident psychiatric records which documented pre-existing depression, poor memory, and suicidal thoughts.

The Tribunal placed little weight on the applicant's expert reports because they relied on her incomplete self-reporting.

The application was dismissed as the applicant failed to prove she suffered marked impairments in three domains of functioning as a result of the accident.

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

The applicant filed an application with the Tribunal more than two years after the denial.

The insurer raised a preliminary issue that the application was statute-barred under section 56 of the Schedule.

The Tribunal found that the insurer's denial letter was clear, unequivocal, and provided valid reasons, thereby triggering the two-year limitation period.

As the applicant filed her application 260 days late and provided no submissions to justify an extension under section 7 of the Licence Appeal Tribunal Act, the application was dismissed as statute-barred.

The applicant sought statutory accident benefits following a motor vehicle accident, including a determination of catastrophic impairment, income replacement benefits, and medical benefits.

At the outset of the scheduled five-day videoconference hearing, the parties advised that the issues in dispute had been settled.

The Tribunal closed the file.

This appeal arose from a civil jury trial concerning a collision between a motorist and a pedestrian, Jasmine Jarvis, who suffered severe brain injuries.

The jury at trial found the motorist not liable.

The appellants (plaintiffs) appealed, arguing the trial was unfair due to the admission of irrelevant and prejudicial bad character evidence (Ms. Jarvis fleeing a taxi without paying fare) and inflammatory remarks by respondent counsel.

The Court of Appeal found the taxi fare evidence inadmissible and its prejudicial impact outweighed its probative value.

The court also found respondent counsel's jury address inflammatory and the trial judge's instructions inadequate to cure the prejudice.

The appeal was allowed, the cross-appeal (on costs) was dismissed, and a new trial was ordered.

The applicant sought reimbursement for massage therapy services provided by an unlicensed service provider who was not registered with HCAI.

The respondent denied the OCF-6 expense claims because the invoices were not submitted through HCAI via an OCF-21, as required by s. 49.1 of the Schedule.

The Tribunal found that the applicant failed to comply with s. 49.1 and the applicable Guideline, which require an OCF-21 to be submitted by a Participating Facility even when services are provided by an unlicensed provider.

The application for benefits, interest, and an award was dismissed.

The applicant requested a reconsideration of a decision finding he was not catastrophically impaired under the Statutory Accident Benefits Schedule.

The applicant argued the adjudicator violated procedural fairness and made errors of law and fact in weighing expert evidence regarding activities of daily living and concentration, persistence, and pace.

The adjudicator dismissed the request, finding no misapprehension of the legal tests, no failure to address deficiencies in the respondent's evidence, and no error in the weighing of the situational assessments and expert testimony.

The applicant sought a catastrophic impairment designation and approval for various treatment plans following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant did not meet the threshold for catastrophic impairment, as he only demonstrated marked impairment in two of the required three areas of function (social functioning and adaptation).

The Tribunal approved several treatment plans, including occupational therapy, psychological therapy, and a mobile phone, finding them reasonable and necessary to address the applicant's accident-related impairments.

Other treatment plans, including those for optometric services and a computer, were denied.

The applicant was injured in a motor vehicle accident and sought various treatment plans for physiotherapy and assessments under the Statutory Accident Benefits Schedule.

The respondent denied the plans.

The Tribunal found the applicant was entitled to a physiotherapy treatment plan of $2,418.00, a functional impairment assessment of $1,988.80, and a physiatry assessment of $2,000.00, noting the respondent failed to provide proper medical reasons for denying the assessments under s. 38(8) of the Schedule.

The Tribunal denied the remaining physiotherapy treatment plans, finding them not reasonable and necessary based on the insurer's examination reports.

The claim for an award under Regulation 664 was dismissed, but interest was awarded on overdue benefits.

The applicant sought statutory accident benefits following a 2016 motor vehicle accident.

At the commencement of the hearing, the applicant brought a preliminary motion arguing that the respondent failed to provide denial letters for five treatment plans in accordance with s. 38 of the Schedule, and therefore the hearing should proceed only on the issue of a special award.

The Tribunal dismissed the motion, finding that whether the denial letters were sent was a fundamental factual dispute requiring evidence from both parties.

During the hearing, the parties reached a settlement in principle, and the Tribunal adjourned the matter to allow the parties to finalize the settlement and file a Notice of Withdrawal.

The applicant sought statutory accident benefits for a psychological examination and treatment following a motor vehicle accident.

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

The Licence Appeal Tribunal found the applicant suffered a psychological impairment outside the MIG, preferring the evidence of the applicant's psychologist over the insurer's expert.

The Tribunal ordered the respondent to pay for the psychological examination and treatment, plus interest, but denied the applicant's claim for a special award for unreasonably delayed payments.

The applicant sought statutory accident benefits for physiotherapy and an orthopaedic assessment following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant failed to prove her left knee impairment was caused or aggravated by the accident, as medical evidence indicated pre-existing osteoarthritis.

Consequently, most of the treatment plans were deemed not reasonable and necessary.

However, the Tribunal ordered the respondent to pay for one physiotherapy treatment plan because the respondent failed to provide a sufficient explanation of benefits (notice of denial) as required by section 38 of the Schedule.

The claims for an award and interest were dismissed.

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

The insurer denied funding for additional chiropractic treatments and assessments beyond the $3,500 Minor Injury Guideline (MIG) limit.

The Licence Appeal Tribunal found that the applicant's physical and psychological injuries fell within the MIG.

The Tribunal preferred the evidence of the insurer's medical experts, who provided extensive reports based on testing, over the applicant's practitioners, who failed to provide details of testing or lacked appropriate accreditation.

As the applicant had already exhausted the MIG funding limit, the claims for additional medical benefits and interest were dismissed.

The appellant was injured while riding a TTC bus that swerved to avoid a collision but did not strike any object.

She sought statutory accident benefits from the insurer of the other vehicle involved in the incident.

The Arbitrator held that section 268(1.1) of the Insurance Act acts as a complete bar to claiming statutory accident benefits from any source for occupants of a public transit vehicle involved in a non-collision incident.

On appeal, the Director's Delegate affirmed the decision, finding the statutory language clear and unambiguous.

The Applicant sought payment for various home repairs, cleaning services, and the cost difference for a dishwasher as rehabilitation benefits under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The Tribunal found that home repairs can qualify as 'home modifications' under section 16(3)(i) if they serve a rehabilitative purpose.

The Tribunal ordered payment for the repair of a basement step, installation of a handrail, and repair of loose tiles, as these addressed hazards exacerbated by the Applicant's accident-related impairments.

Claims for cleaning services, powder room repairs, and the dishwasher cost difference were dismissed.

Following a preliminary issue hearing where the insurer successfully argued that the applicant's claim for statutory accident benefits was barred by s. 268(1.1) of the Insurance Act, the parties made written submissions on expenses.

The insurer sought its legal expenses of $6,939.02, arguing it was wholly successful and had made a Rule 76 offer to settle.

The arbitrator found that the offer to settle was not a firm, binding offer and that the preliminary issue involved a novel interpretation of s. 268(1.1) with no direct precedent.

Balancing the insurer's success against the novelty of the issue and the modest amount in dispute, the arbitrator ordered that each party bear its own expenses.

The applicant was a passenger on a public transit bus that made a sudden stop to avoid a collision with another vehicle.

The bus did not collide with any object.

The applicant claimed statutory accident benefits from the insurer of the other vehicle.

The insurer denied the claim, arguing that s. 268(1.1) of the Insurance Act bars accident benefits for occupants of a public transit vehicle involved in a no-collision incident.

The arbitrator agreed, finding that the provision acts as a complete bar to statutory accident benefits from any source for such passengers.

The application for arbitration was barred.