Sherilyn J. Pickering

The applicant, who sustained a catastrophic impairment (traumatic brain injury) in a 2012 motor vehicle accident, sought $97,398.08 for home modifications.

The Licence Appeal Tribunal found the applicant was partially entitled to the modifications, specifically bilateral handrails on stairs and releveling of front steps, to address his ongoing intermittent dizziness and fall risk.

Requests for a curb-less shower, deck, and private therapy room were denied as not reasonable or necessary.

The Tribunal awarded interest on overdue benefits but dismissed the applicant's claims for a special award under s. 10 of Reg. 664 and costs under Rule 19.

The applicant was injured in a severe motor vehicle accident and sought various statutory accident benefits, including attendant care benefits (ACB) and medical expenses, which the respondent insurer denied.

The Licence Appeal Tribunal found the applicant was entitled to ACB at the non-catastrophic maximum of $3,000 per month for a closed period, deeming the expenses incurred because the insurer unreasonably withheld payment during that time.

The Tribunal also approved a treatment plan for optometric services to investigate ongoing vision impairments and awarded partial reimbursement for prescription medications, an ambulance bill, and replacement glasses submitted on various OCF-6 forms.

Claims for an award under s. 10 of Regulation 664 were dismissed, but interest was awarded on all overdue benefits.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied various statutory accident benefits, including attendant care benefits, treatment plans, and medical cannabis.

The respondent brought a motion to strike new evidence filed in the applicant's reply submissions, which the Tribunal dismissed, finding the evidence was properly submitted in response to the respondent's arguments.

On the merits of the reconsideration, the Tribunal found that it had made errors of fact regarding an occupational therapy treatment plan, travel costs, and a psychological assessment, as it had failed to address the applicant's submissions and evidence on these issues.

The Tribunal granted the reconsideration in part, cancelling the decisions on those specific issues and ordering a re-hearing in writing.

The reconsideration was dismissed with respect to attendant care benefits, assistive devices, and medical cannabis, as the applicant failed to establish errors that would have changed the outcome.

The applicant sought medical and rehabilitation benefits following a motor vehicle accident, including osteopathic, chiropractic, and occupational therapy services.

The Tribunal found the applicant was entitled to osteopathic services at a rate of $80.00 per hour, as osteopaths are not relegated to the lowest rate under the Professional Services Guideline.

However, the claims for chiropractic services and an occupational therapy assessment were dismissed, as the insurer's section 44 assessments demonstrated the applicant had reached maximum medical improvement and did not suffer from functional impairments warranting further treatment.

The claim for a section 10 award was dismissed, but interest was awarded on the overdue osteopathic benefits.

The applicant, who was catastrophically impaired after being struck by a vehicle as a pedestrian, sought attendant care benefits of $6,000 per month.

The adjudicator determined the applicant was entitled to attendant care benefits at a rate of $1,529.96 per month, finding that she required assistance with routine personal care and complex hygiene but did not require around-the-clock supervisory care.

However, the adjudicator held that the benefits were not payable because the applicant had not actually incurred the expenses, and the insurer had not unreasonably withheld or delayed payment to justify deeming the expenses incurred.

Claims for an award and interest were dismissed.

The applicant, who was struck by a school bus as a pedestrian in 2006 at age six, sought statutory accident benefits including psychological and occupational therapy assessments over 15 years later.

The respondent denied the benefits.

The Licence Appeal Tribunal found that the applicant was not barred from proceeding to a hearing, but dismissed the claims for benefits.

The Tribunal concluded that the proposed treatment plans were not reasonable and necessary, as there was no medical evidence linking the applicant's current psychological and physical issues to the 2006 accident.

Claims for interest and an award for unreasonable delay were also dismissed.

The appellant was injured when the public transit bus she was riding stopped abruptly, throwing her forward.

She sought statutory accident benefits, which were denied by the Licence Appeal Tribunal under s. 268(1.1) of the Insurance Act because the bus did not collide with another vehicle or object.

On appeal, the appellant argued she constituted 'any other object' under the statute.

The Divisional Court dismissed the appeal, holding that the plain wording and context of the provision require the object to be outside the vehicle, and a bus does not collide with a person inside it.

The plaintiffs brought a motion to amend their statement of claim to correct the misnomer of several John Doe defendants, identifying them as specific treating physicians and a wound care provider (ParaMed).

The underlying action involved allegations of medical malpractice relating to the development and failure to treat the deceased's bedsores at various care facilities.

The proposed defendants opposed the motion, arguing it was an attempt to add parties after the expiry of the strict two-year limitation period under the Trustee Act.

The court granted the motion, finding that the pleadings were drafted with sufficient particularity such that the 'litigation finger' pointed squarely at the proposed defendants, and that a properly informed defendant would have recognized they were the target of the allegations.

The court also found no non-compensable prejudice to the proposed defendants.

The applicant sought a non-earner benefit and interest following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to meet her onus of proving a complete inability to carry on a normal life.

The applicant's submissions regarding her pre- and post-accident activities were brief and unsupported by persuasive evidence, and the medical evidence, including an OCF-3 and clinical notes, was insufficient to establish the requisite impairment.

An adverse inference was also drawn from the applicant's failure to comply with a production order.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied certain treatment plans and a claim for a special award following a motor vehicle accident.

The applicant argued the Tribunal erred in its assessment of the evidence regarding psychological, medical, and occupational therapy services.

The Vice-Chair dismissed the request, finding that the applicant was attempting to re-litigate the original decision and re-weigh the evidence rather than demonstrating a material error of law or fact under Rule 18.2.

The request for a special award was also dismissed as there was no evidence of excessive or imprudent conduct by the insurer.

The applicant sought statutory accident benefits following a motor vehicle accident, including attendant care benefits, occupational therapy, psychological counselling, kinesiology, and psychotherapy.

The Tribunal found the applicant was not entitled to attendant care benefits as they were not incurred.

However, the Tribunal approved the treatment plans for occupational therapy, psychological counselling, and virtual kinesiology, finding them reasonable and necessary based on the recommendations of various assessors and treatment providers.

The plan for psychotherapy by a registered nurse was denied as redundant.

The claim for a special award was dismissed, but interest was awarded on overdue benefits.

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

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

The Tribunal found the applicant was removed from the MIG due to accident-related chronic pain that impaired her function, relying on treating practitioner records and the insurer's own physiatry assessments.

The Tribunal awarded partial entitlement to attendant care benefits, but found them not payable as they had not been incurred.

Various treatment plans for occupational therapy, assistive devices, a psychological assessment, and physiotherapy were partially or fully approved as reasonable and necessary.

The applicant's claim for a special award was dismissed due to procedural non-compliance in her submissions.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's denial of several treatment plans for physiotherapy and occupational therapy, as well as attendant care benefits.

The Tribunal found the applicant partially entitled to one physiotherapy treatment plan and one occupational therapy plan, noting that a compression fracture was linked to the accident and justified further treatment.

The Tribunal also found the applicant entitled to attendant care benefits of $1,034.58 per month due to chronic pain limitations, but held they were not yet payable because the applicant failed to prove the expenses had been incurred.

The claim for a special award was dismissed.

The applicant sought various statutory accident benefits following a motor vehicle accident, including attendant care benefits, assistive devices, medical cannabis, and a psychovocational assessment.

The Tribunal denied the attendant care benefits because the applicant failed to prove the expenses were incurred after she dismissed her personal support worker.

Claims for a new mattress and medical cannabis were also dismissed for lack of medical evidence establishing them as reasonable and necessary.

However, the Tribunal granted the request for a psychovocational assessment, finding that the respondent's assessors had not adequately evaluated the applicant's ability to perform the heavy physical and mental demands of her pre-accident employment as a personal support worker.

The Tribunal also approved a prescription for Metformin, accepting that the applicant's accident-related inactivity exacerbated her pre-existing diabetes.

The claim for a special award was dismissed.

The applicant requested reconsideration of a preliminary issue decision that denied her accident benefits under s. 268(1.1) of the Insurance Act.

The applicant was injured when the public transit vehicle she was occupying made a sudden stop, but did not collide with another vehicle or object.

The Tribunal found that the adjudicator did not err in interpreting 'any other object' to mean something external to the vehicle, and that the applicant herself could not be the object.

The request for reconsideration was dismissed.

The applicant sought entitlement to statutory accident benefits following a motor vehicle accident, disputing the insurer's denial of several treatment plans and expenses.

The Licence Appeal Tribunal found the applicant was entitled to a $2,000 medical services plan for a stress assessment and $15.24 for Swiffer refills, as these were proven reasonable and necessary.

The Tribunal dismissed the claims for the remaining psychological, occupational therapy, and medical services plans, finding the applicant failed to demonstrate how the goals of those plans would be met or why the costs were reasonable.

The applicant was awarded interest on overdue payments, but the claim for a section 10 award was dismissed as the insurer's conduct was not unreasonable.

The appellant, who was injured in a motor vehicle accident, appealed and sought judicial review of a Licence Appeal Tribunal decision denying her catastrophic impairment benefits.

The Divisional Court found that while there was no breach of procedural fairness, the Adjudicator's findings regarding the appellant's whole person impairment under Criterion 6 of the AMA Guides were unreasonable.

Specifically, the Adjudicator unreasonably dismissed evidence of double vision, peripheral neuropathy, and medication side effects.

The court quashed the decision and remitted the matter to the LAT for a new hearing before a different adjudicator.

The appellant sought judicial review and appealed a Licence Appeal Tribunal (LAT) decision dismissing his application for Income Replacement Benefits (IRBs) as statute-barred.

The LAT found that the insurer's May 3, 2021 letter constituted a clear and unequivocal denial of benefits, triggering the two-year limitation period under the Statutory Accident Benefits Schedule.

The Divisional Court upheld the LAT's decision, finding no error in its application of the limitation period or its refusal to extend the time to appeal.

The court also rejected the appellant's arguments regarding discoverability and the impact of subsequent correspondence from the insurer.

The respondent insurer requested a reconsideration of a preliminary issue decision which found that the applicant was an 'insured person' under the Schedule because she and the catastrophically injured person were sisters.

The respondent argued the Tribunal erred in fact and law, asserting the evidence supported a finding that they were cousins.

The Tribunal dismissed the request, finding that the respondent improperly attempted to re-weigh evidence and raise new case law that was not presented at the initial hearing.

The applicant was injured when the TTC bus she was riding made a sudden stop, causing her to strike the interior of the bus.

The bus did not collide with any external object.

The applicant sought statutory accident benefits, arguing that she herself constituted 'any other object' with which the bus collided under s. 268(1.1) of the Insurance Act.

The Tribunal rejected this argument, finding that the ordinary meaning of the provision requires the public transit vehicle to collide with an object external to it.

As the bus did not collide with an external object, the applicant is barred from claiming accident benefits.