Robert Douglas Jeffrey Rogers

The appellant was injured in a motor vehicle accident and applied for income replacement benefits.

The arbitrator determined the appellant was self-employed and attributed 50% of his closely held family company's profits to him, with the remainder attributed to his wife and children who also worked in the business.

The appellant appealed, arguing that 100% of the profits should be attributed to him as the sole voting shareholder and key person.

The Director's Delegate dismissed the appeal, finding the arbitrator properly considered the share structure, expectation of profit, relative contributions, and degree of risk of all family members.

The appeal regarding the applicable claim code was also dismissed.

The moving party, a party under disability represented by the Public Guardian and Trustee as litigation guardian, sought leave to appeal an order approving a $1 million settlement of her motor vehicle accident claims.

The moving party was previously made subject to an order under Rule 37.16 prohibiting her from bringing further motions or appeals without leave due to a history of frivolous proceedings.

The Court of Appeal dismissed the motion, holding that the moving party lacked standing to act independently of her litigation guardian, and that the proposed appeal lacked reasonable grounds and would be an abuse of process.

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

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

The applicant argued that her pre-existing lymphadenopathy, psychological impairments, and chronic pain took her out of the MIG.

The Tribunal found no evidence that the pre-existing condition prevented maximal recovery.

It also found that the applicant's psychological symptoms did not constitute a severe or extreme impairment.

Finally, the Tribunal rejected the applicant's chronic pain evidence, placing little weight on her expert's report due to recent disciplinary findings against him, and preferred the respondent's medical assessment.

The application was dismissed.

The applicant sought a determination that HST paid for attendant care services should be paid outside the attendant care benefit limit under the Statutory Accident Benefits Schedule, and claimed an award for unreasonable delay.

The Tribunal found that the Schedule's silence on HST, combined with FSCO Guidelines, should be interpreted in favour of the insured, meaning HST is a tax payable outside the benefit limit.

However, the Tribunal denied the claim for an award, finding the insurer's withholding of payment was based on its own interpretation of the Schedule and did not constitute unreasonable behaviour.

The applicant sought interest and a special award under Regulation 664, alleging that the respondent unreasonably delayed the payment of a $6,000 funeral benefit following the death of her son in a motor vehicle accident.

The respondent argued that the 30-day timeline for payment did not commence until the applicant provided confirmation that no WSIB claim had been filed, as the accident occurred during the course of employment.

The Tribunal found that the application was not complete until the WSIB confirmation was received, and the respondent paid the benefit within 30 days of that date.

The claims for interest and a special award were dismissed.

The court apportioned costs between the defendants following a 39-day trial where the plaintiffs were awarded approximately $12 million in damages.

The Jantzi defendants were found 80% at fault for a motor vehicle accident, and All Star Tap & Grill 20% at fault for over-serving alcohol, with the plaintiff Wesley Hummel 25% contributorily negligent.

The Jantzi defendants argued All Star should bear 80% of post-offer costs due to their refusal to settle, while All Star argued costs should follow the trial's liability apportionment (75% Jantzi, 25% All Star after contributory negligence).

The court considered factors under Rule 57.01 and Section 131(1) of the Courts of Justice Act, including offers to settle and policy limits.

Ultimately, the court ordered the Jantzi defendants to pay one-third of the plaintiffs' costs and All Star Tap & Grill to pay two-thirds, based on their respective insurance policy limits ($1 million for Jantzi, $2 million for All Star).

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

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

The Tribunal found that the applicant's injuries were predominantly minor and did not meet the threshold for chronic pain that would remove him from the MIG.

However, because the respondent failed to provide proper notice under s. 38(8) of the Schedule for a chiropractic treatment plan, it was ordered to pay any incurred expenses for that plan.

The respondent also conceded payment for a chronic pain assessment due to late notice.

The applicant's claim for a special award under O. Reg. 664 was dismissed.

The respondent insurer sought reconsideration of a Tribunal decision which held that the cost of a catastrophic impairment assessment is not deducted from the $50,000 monetary limit for medical and rehabilitation benefits under the Statutory Accident Benefits Schedule.

The insurer argued that the Tribunal made a significant error of law.

The Vice-Chair dismissed the request for reconsideration, finding no significant error of law.

The Vice-Chair confirmed that a catastrophic impairment is a designation, not a benefit, and therefore an assessment for it is not 'in connection with any benefit or payment' under section 18(5) of the Schedule.

Consequently, the cost of the assessment is payable over and above the $50,000 limit.

The applicant sought approval for three treatment plans for chiropractic and massage therapy, and payment of the balance of a partially paid treatment plan, following a motor vehicle accident.

The insurer denied the plans on the basis that the applicant had reached maximum medical recovery.

The Licence Appeal Tribunal ordered the insurer to pay the outstanding balance on the partially paid invoices, finding that the clinical notes and records provided sufficient evidence that the services were rendered.

The Tribunal also approved the massage therapy portions of the denied plans for pain control, but denied the multiple body site therapy portions, accepting the insurer's medical examination evidence that the appellant had plateaued and the proposed therapy was not reasonable and necessary.

The appellant appealed a Divisional Court decision dismissing his application for judicial review of a Director Delegate's decision.

The Court of Appeal found no error in the Divisional Court's application of the appropriate standard of review.

The appeal was dismissed with costs awarded to the respondent.

The applicant sought judicial review of a decision by the Director's Delegate at the Financial Services Commission of Ontario, which upheld an arbitrator's decision dismissing his claim for accident benefits.

The applicant had settled his claim in 2003 after eight years of litigation but purported to rescind the settlement in 2014, arguing the settlement disclosure notice did not comply with the Settlement Regulation.

The Divisional Court dismissed the application, finding that the Director's Delegate reasonably and correctly applied binding Court of Appeal precedent establishing that the regulation's strict disclosure requirements do not apply to settlements reached after a court action has commenced.

The appellant appealed a Licence Appeal Tribunal decision finding her claim for attendant care benefits was statute-barred.

Following a 2005 motor vehicle accident, the insurer denied her claim for attendant care benefits without requiring a Form 1 assessment.

The appellant did not dispute the denial until 2015, after her condition deteriorated and she was deemed catastrophically impaired.

The Divisional Court dismissed the appeal, holding that the adjudicator reasonably concluded the 2005 denial was clear and unequivocal, thereby triggering the two-year limitation period under the Insurance Act.

The applicant sought a preliminary determination on whether the costs of catastrophic impairment assessments are included in the $50,000 limit on medical and rehabilitation benefits under the Statutory Accident Benefits Schedule.

The Tribunal held that catastrophic impairment assessments are not included in the $50,000 cap and are instead payable under section 25 of the Schedule.

The respondent was ordered to restore $18,434.00 to the applicant's medical and rehabilitation benefit limit.

The applicant was involved in a motor vehicle accident in 2005.

The respondent insurer denied attendant care benefits in April 2005 based on an occupational therapy assessment, even though the applicant had not expressly claimed them.

In 2015, after being deemed catastrophically impaired, the applicant applied for attendant care benefits.

The respondent denied the claim, arguing it was barred by the two-year limitation period triggered by the 2005 denial.

The Tribunal found that the 2005 denial was clear and unequivocal, and following the Court of Appeal's decision in Sietzema, a premature denial is sufficient to trigger the limitation period.

The applicant's claim was therefore statute-barred.

The Applicant sought non-earner benefits following a 2013 motor vehicle accident where he was struck as a pedestrian, aggravating a severe pre-existing right knee injury from a 2012 accident.

The insurer denied the claim based on independent medical assessments.

The arbitrator rejected the insurer's medical assessments as flawed for failing to properly consider the pre-existing injury.

However, the arbitrator dismissed the application because the Applicant failed to provide sufficient corroborating evidence of his pre- and post-accident activities of daily living, complicated by his post-accident cocaine addiction and inconsistent living arrangements, to prove he suffered a complete inability to carry on a normal life.

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs).

At the time of the accident, the applicant was receiving Long Term Disability (LTD) benefits.

The parties disputed how the LTD benefits should be deducted from the IRB quantum under the Statutory Accident Benefits Schedule.

The applicant argued for a net deduction, while the insurer argued for a gross deduction.

The arbitrator determined that, based on the language of the Schedule and the treatment of LTD benefits as gross employment income, the insurer may deduct 70% of the gross income received for LTD benefits when calculating the weekly IRB quantum.

The applicant brought a motion for a stay of an arbitrator's order which held that an arbitration arising from a 1990 motor vehicle accident could not proceed because the applicant had signed a full and final release.

The applicant sought the stay pending an application for judicial review.

The Divisional Court applied the RJR MacDonald test and found that while there was a serious issue to be tried, the applicant failed to establish irreparable harm or that the balance of convenience favoured a stay.

The court noted that the delay was largely attributable to the applicant and that financial compensation would ultimately be available if successful.

The motion for a stay was dismissed.

The appellant sought to rescind a 2003 settlement of his accident benefits claim and proceed to arbitration for further income replacement benefits.

The Arbitrator found that the Full and Final Release precluded arbitration because the Settlement Regulation's cooling-off and disclosure provisions do not apply to settlements reached after a court action has commenced.

On appeal, the Director's Delegate upheld the Arbitrator's decision, finding that binding Court of Appeal precedent established that the Settlement Regulation does not apply in the context of litigation, and subsequent regulatory amendments did not alter this principle.

The applicant was injured in a motor vehicle accident and sought a determination that he was catastrophically impaired under the Statutory Accident Benefits Schedule.

The arbitrator considered whether the applicant suffered a marked or extreme impairment due to a mental or behavioural disorder, or a whole person impairment of 55 percent or more.

The arbitrator preferred the evidence of the insurer's experts, finding that the applicant's mental and behavioural impairments were mild to moderate.

Combining the physical and psychological impairments, the arbitrator determined the applicant's whole person impairment was 31 percent.

The application for a catastrophic impairment determination was dismissed.

The Applicant sought accident benefits for two separate motor vehicle accidents (1990 and 1996).

In a preliminary issue hearing, the Arbitrator determined whether the arbitrations could proceed.

For the 1990 accident, the Arbitrator found that the arbitration was barred because the Applicant had signed a Full and Final Release in 2003 to settle a related civil action, and the right to rescind under the Settlement Regulation did not apply to settlements reached in court proceedings.

For the 1996 accident, the Arbitrator found that the claim for income replacement benefits was not time-barred because the Insurer's termination notice failed to clearly and unequivocally inform the Applicant of the dispute resolution process and time limits, as required by the Smith v. Co-operators test.