Shannon Kelly

The applicant sought a catastrophic impairment determination under Criterion 8 (mental and behavioural disorders) following a 2018 motor vehicle accident, along with attendant care benefits and funding for assessments.

The Tribunal found the applicant did not sustain a marked impairment in activities of daily living or social functioning, preferring the respondent's expert evidence over the applicant's due to a more robust, in-person assessment.

As the applicant was not catastrophically impaired, the claims for attendant care benefits and assessments submitted beyond the 260-week limit were denied.

The application was dismissed.

The applicant sought statutory accident benefits following a 2022 motor vehicle accident, claiming catastrophic impairment under Criterion 8, income replacement benefits, attendant care benefits, and various treatment plans.

The Licence Appeal Tribunal dismissed the majority of the claims, finding the applicant's self-reports of pre-accident functioning were inaccurate, as he was receiving long-term disability and Canada Pension Plan disability benefits prior to the accident.

Surveillance evidence and testimony contradicted the applicant's claims of severe social and functional isolation.

The Tribunal found the applicant did not sustain a catastrophic impairment, was not entitled to an IRB, and was only entitled to a minor portion of one treatment plan due to a late denial by the insurer.

The applicant sought payment for the outstanding balances of seven partially approved treatment plans, specifically the 'PR' charges for document support activity.

The respondent had reduced these charges to a one-hour 'HR' rate without providing medical or other reasons, citing only section 25 of the Schedule.

The Tribunal found the respondent failed to comply with the notice requirements under section 38(8) of the Schedule and ordered payment of the outstanding balances with interest.

The applicant's request for a section 10 award was dismissed, as the respondent's conduct did not rise to the level of being excessive or imprudent.

The applicant, TTC Insurance Company Limited (TTCICL), sought an order extending the time to commence their appeal of a Licence Appeal Tribunal (LAT) decision and an order joining this appeal with an existing application for judicial review.

Concurrently, the LAT and the Attorney General of Ontario sought leave to intervene in the appeal.

The court granted both motions, finding that the extension of time was justified given the recent Supreme Court decision in Yatar, the short delay, lack of prejudice to the respondent, and the overall interests of justice.

Intervenor status was granted to LAT and the Attorney General, with LAT's submissions restricted to procedural and jurisdictional issues, not the merits of its decision.

The appellant appealed a Licence Appeal Tribunal (LAT) decision finding it lacked jurisdiction to award punitive damages for statutory accident benefits claims.

The appellant argued the LAT had jurisdiction or, alternatively, that section 280 of the Insurance Act was unconstitutional for eliminating punitive damages claims.

The Divisional Court dismissed the appeal, holding that the LAT's jurisdiction is strictly statutory and does not include punitive damages, as established by binding Court of Appeal precedent.

The court also rejected the constitutional challenge, finding the legislature clearly and validly removed jurisdiction over these claims from the courts to the LAT.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision which found she was not an 'insured person' under section 3(1) of the Statutory Accident Benefits Schedule.

The applicant argued the Tribunal made errors of law and fact, violated procedural fairness, and failed to consider priority dispute rules under O. Reg. 283/95.

The adjudicator dismissed the request, finding it was an attempt to re-litigate the case and that the priority dispute issue was outside the Tribunal's jurisdiction for this hearing.

The applicant sought statutory accident benefits following a 2012 motor vehicle accident, claiming she sustained a catastrophic impairment due to mental and behavioural disorders.

The Licence Appeal Tribunal found that the applicant suffered a Marked impairment in both adaptation and concentration, persistence, and pace, satisfying Criterion 8 of the Schedule.

The Tribunal relied on the evidence of the applicant's treating professionals and experts, preferring them over the insurer's assessors who provided insufficient analysis.

The applicant was awarded attendant care benefits and a treatment plan for psychotherapy.

However, the Tribunal declined to order a special award under s. 10 of O. Reg. 664, finding the insurer's reliance on its medical assessments was not unreasonable.

The applicant sought statutory accident benefits for psychological injuries sustained following the death of her common law spouse, who was killed while riding an uninsured e-bike.

The respondent denied the benefits on the basis that the applicant was not an 'insured person' under section 3(1) of the Statutory Accident Benefits Schedule.

The Tribunal found that the applicant did not meet any of the criteria under section 3(1), as she was not a named insured, a specified driver, a spouse or dependant of a named insured, nor was she involved in the accident or an occupant of the vehicle.

The application was dismissed.

The applicant requested a reconsideration of a preliminary issue decision which found she was statutorily entitled to income replacement benefits (IRBs) for a limited period due to the respondent's delayed response, but was otherwise barred from claiming IRBs because her impairments arose more than 104 weeks after the accident.

The applicant argued the adjudicator acted outside his jurisdiction, violated procedural fairness, and made an error of law.

The Tribunal dismissed the request, finding the adjudicator had jurisdiction to determine the remedy for the respondent's non-compliance, procedural fairness was maintained as the applicant had the opportunity to make submissions, and no error of law occurred regarding the application of section 36 of the Schedule.

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

The respondent argued the applicant was barred from proceeding because she failed to submit a complete disability certificate (OCF-3) as required by section 36 of the Statutory Accident Benefits Schedule, and disputed receiving a second OCF-3 by fax.

The Tribunal found that the first OCF-3 was complete for the purposes of the Schedule, noting the respondent failed to notify the applicant of any deficiencies as required by section 32(6).

The Tribunal also found, based on a split onus and fax confirmation evidence, that the second OCF-3 was successfully faxed to the respondent.

The applicant was permitted to proceed with her claim.

The applicant sought income replacement benefits (IRBs) for psychological injuries sustained while caring for her spouse, who was catastrophically injured in a motor vehicle accident.

The insurer raised a preliminary issue that the claim was barred because the applicant failed to apply within 104 weeks of the accident.

The Tribunal found that while the applicant was generally barred from claiming IRBs because her impairment arose more than 104 weeks after the accident, the insurer's failure to respond to her application within the mandatory 10-day period under section 36 of the Schedule entitled her to IRBs for the period between her application and the insurer's eventual response.

The applicant sought reconsideration of a Licence Appeal Tribunal decision that denied his claims for treatment plans, interest, and an award under O. Reg 664 following a motor vehicle accident.

The applicant argued the Tribunal erred by not addressing the respondent's delay in removing him from the Minor Injury Guideline and by finding no objective evidence of a traumatic brain injury.

The Vice-Chair dismissed the request for reconsideration, finding that the applicant failed to identify a material error of fact or law and was merely attempting to reweigh the evidence.

The Applicant was struck by a vehicle in a parking lot, sustaining a right knee sprain and psychological injuries.

She also had a pre-existing hip condition that required surgery.

The Tribunal found that the accident did not cause or accelerate the need for hip surgery, but did cause chronic knee pain that prevented her from working.

The Applicant was awarded income replacement benefits, physiotherapy, and psychological treatment.

Claims for attendant care benefits and occupational therapy related to her hip surgery were dismissed, as was her claim for a special award.

The applicant was injured in a motor vehicle accident and submitted an application for accident benefits indicating potential entitlement to both an income replacement benefit and a non-earner benefit.

The insurer requested that the applicant complete an election of benefits form (OCF-10) and attend an insurer's examination before initiating payments.

The applicant argued this was not in accordance with s. 36 of the Statutory Accident Benefits Schedule.

The Tribunal held that because the application indicated possible entitlement to more than one specified benefit, s. 35 required an election, making the application incomplete until the OCF-10 was submitted.

Therefore, the insurer's requests were in accordance with the Schedule.

The applicant sought a special award under section 10 of Regulation 664, alleging the respondent unreasonably withheld or delayed payment of income replacement benefits (IRBs) following a motor vehicle accident.

The Tribunal found that the initial delay was due to the applicant's failure to provide necessary financial documentation, particularly given her self-employment status.

The Tribunal also found that the respondent's subsequent error in calculating the IRBs based on net rather than gross income, which was later corrected with interest, did not amount to excessive, imprudent, or stubborn conduct.

Both parties' requests for costs were dismissed.

The applicant sought entitlement to the costs of three examinations (a Neurology Assessment, an E.E.G., and an MRI) following a motor vehicle accident, claiming he suffered a head injury causing headaches and pain.

The respondent denied the benefits, arguing the applicant's headaches were cervicogenic and related to a soft-tissue injury.

The Tribunal found no objective medical evidence of a neurological disability or impairment resulting from the accident.

Relying on the reports of the insurer's examiner and other specialists, which aligned with the family doctor's findings, the Tribunal concluded the examinations were not reasonable and necessary.

The application was dismissed.

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 applicant sought interest and an award under O. Reg. 664 for a $2,486.00 treatment plan that the respondent insurer failed to respond to for over two and a half years.

The Tribunal found the insurer breached s. 38(8) of the Schedule and unreasonably withheld and delayed payment.

The Tribunal ordered the insurer to pay interest on the overdue benefit and a 40% award, noting the insurer's stubborn and unyielding conduct in failing to correct its error once discovered.

The applicant sought statutory accident benefits following an incident in a gym parking lot where he was involved in a physical altercation with the gym manager.

The applicant alleged he was pushed into his vehicle and sustained injuries.

The Tribunal held a preliminary issue hearing to determine if the incident met the definition of an 'accident' under section 3(1) of the Statutory Accident Benefits Schedule.

Applying the two-part purpose and causation test, the Tribunal found that the assault was an intervening act that broke the chain of causation.

The incident did not arise out of the ordinary use or operation of an automobile, and the vehicle was not the direct cause of the injuries.

The application was dismissed.