Steven Sieger

The applicant requested a reconsideration of a Licence Appeal Tribunal decision which found her accident-related injuries fell within the Minor Injury Guideline (MIG).

The applicant argued the Tribunal breached procedural fairness and made errors of law and fact by failing to properly consider the medical evidence of her neurologist and chiropractor regarding her chronic pain.

The Adjudicator dismissed the request, finding that the original Tribunal properly weighed the evidence, provided adequate reasons for rejecting the uncontradicted medical reports, and made no errors of law or fact in its application of the MIG.

The applicant and respondent both requested reconsideration of a previous Licence Appeal Tribunal decision.

The applicant sought reconsideration regarding the denial of income replacement benefits and treatment plans, while the respondent challenged the finding that the applicant was involved in an 'accident' and not subject to the Minor Injury Guideline.

The adjudicator found that neither party met the high threshold for reconsideration under Rule 18.2, as both were attempting to re-litigate issues and re-weigh evidence already considered.

Both requests for reconsideration were dismissed.

The applicant sought statutory accident benefits after slipping and falling on ice while closing his car door.

The respondent denied the claim, arguing the incident did not meet the definition of an 'accident' under the Schedule.

The Tribunal found that the incident was an accident, as the applicant was actively using his vehicle and the ice was not an intervening event.

The Tribunal also determined that the applicant's fractured elbow removed him from the Minor Injury Guideline.

However, the Tribunal dismissed the claims for an income replacement benefit and specific treatment plans because the applicant failed to provide sufficient medical evidence or copies of the treatment plans to prove entitlement.

The applicant, who was 12 years old at the time of the motor vehicle accident, sought statutory accident benefits for physical and psychological impairments.

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

The Tribunal found that the applicant failed to provide sufficient objective medical evidence to establish that he sustained physical or psychological impairments outside the MIG.

Furthermore, the applicant did not prove that his pre-existing cognitive and psychological conditions prevented him from achieving maximal recovery within the MIG limits.

Consequently, the disputed treatment plans for physiotherapy and psychological services were deemed not reasonable and necessary, and no interest was payable.

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 conditions, including back pain, headaches, and congenital deafness, prevented her from achieving maximal recovery within the MIG limits.

The Tribunal found that the applicant failed to provide compelling medical evidence that her pre-existing conditions prevented maximal recovery.

The Tribunal also found that the applicant's injuries were predominantly minor in nature.

As the applicant had already exhausted the $3,500 limit under the MIG, her application for further medical benefits was dismissed.

The appellant insurer appealed a decision of the Licence Appeal Tribunal finding that the respondent was involved in an 'accident' under the Statutory Accident Benefits Schedule.

The respondent was injured while 'car surfing' on the rear bumper of a moving vehicle.

The Divisional Court dismissed the appeal, upholding the adjudicator's application of the purpose test.

The court found that while reckless, the vehicle was being used for its normal purpose of transportation, and thus the incident constituted an accident.

The parties sought expenses following a motion hearing where the insurer successfully moved to remove the applicant's counsel due to the inadvertent disclosure of privileged documents.

The arbitrator found that the insurer was wholly successful on the motions and was entitled to its expenses.

However, the arbitrator declined to order the applicant's former counsel to pay the expenses personally, finding that contesting the removal motion was justified given that removal of counsel is a drastic remedy.

The insurer's expenses were fixed at $3,684.76 based on a global approach to preparation time.

The applicant sought statutory accident benefits after sustaining injuries when she fell off the rear bumper of a moving vehicle while 'car surfing'.

The respondent insurer denied benefits, arguing the incident did not meet the definition of an 'accident' under section 3(1) of the Statutory Accident Benefits Schedule.

The Tribunal applied the two-part Amos test and found that the vehicle was being used for transportation, an ordinary and well-known activity, despite the applicant's dangerous and illegal use of it.

The Tribunal concluded that the applicant was involved in an accident and is entitled to proceed with her claim for benefits.

The appellant was injured in an altercation outside a bar where he was assaulted and subsequently struck by the assailants' departing vehicle.

He appealed an arbitrator's decision denying his claims for income replacement benefits and further medical benefits beyond the Minor Injury Guideline (MIG) cap.

The Director's Delegate upheld the arbitrator's findings that only the vehicle strike constituted an 'accident' under the Statutory Accident Benefits Schedule, that the appellant failed to prove pre-accident employment, and that his soft tissue injuries fell within the MIG.

The appeal was dismissed, save for a correction to the arbitrator's costs order.

The Applicant sought accident benefits following an incident where he was assaulted by individuals who threw a rock at him from a vehicle, punched and kicked him, and then struck him with the vehicle as they drove away.

The Arbitrator found that the injuries from the assault (rock, punches, kicks) did not arise from an 'accident' as defined in the Schedule, but the soft tissue injuries from being struck by the retreating vehicle did.

However, the Applicant's claims for Income Replacement Benefits were denied due to a lack of credible evidence regarding his employment status at the time of the accident.

The Arbitrator also concluded that the injuries sustained from the vehicle contact fell within the Minor Injury Guideline, restricting his entitlement to Medical and Rehabilitation Benefits.

During a dispute over statutory accident benefits, the insurer inadvertently disclosed privileged documents to the applicant's counsel.

The applicant's counsel reviewed the documents and subsequently brought a motion to amend the claim to include a Special Award based on the privileged information.

The insurer brought a cross-motion to remove the applicant's counsel from the record.

The arbitrator granted the insurer's motion, finding that the applicant's counsel had reviewed the privileged documents in detail and attempted to use the information to the insurer's detriment.

The applicant's motion to amend the claim was denied as an abuse of process, and the applicant's counsel was removed from the record.

The applicant was injured in a motor vehicle accident while riding his bicycle and sought a determination of catastrophic impairment.

The arbitrator found that the applicant suffered a marked impairment due to a mental or behavioural disorder, satisfying the criteria under section 2(1.2)(g) of the Statutory Accident Benefits Schedule.

However, the arbitrator concluded that the applicant did not meet the 55% whole person impairment threshold under section 2(1.2)(f), as the combined physical and psychological impairments amounted to 48%.

The applicant sought statutory accident benefits following an alleged motor vehicle accident.

The insurer terminated benefits and sought repayment, arguing the applicant was not involved in the accident.

At a preliminary issue hearing, the arbitrator found the applicant's evidence lacked credibility due to inconsistencies with medical records and contradictory testimony from his mother and the occupants of the other vehicle, who testified he was not in the car.

The arbitrator concluded the applicant was not involved in an accident under section 2(1) of the Schedule and held that the insurer was entitled to pursue repayment of benefits paid.

The applicant was injured in a motor vehicle accident and sought income replacement benefits, housekeeping benefits, and payment for treatment.

The insurer terminated benefits based on medical assessments indicating full recovery.

The arbitrator dismissed the application, finding the applicant failed to prove she was substantially unable to perform her pre-accident employment or housekeeping duties.

The arbitrator preferred the insurer's medical evidence, noting the applicant's lack of supporting medical records, inconsistent testimony, and surveillance evidence showing her working.

The applicant was injured in a motor vehicle accident as a pedestrian and claimed statutory accident benefits.

The sole issue in dispute was the quantum of attendant care benefits for the period of June to September 2005.

The applicant sought $1,777.56 per month based on an initial assessment, while the insurer relied on subsequent assessments indicating independence in self-care.

The arbitrator found the applicant's evidence regarding specific attendant care needs during the disputed period to be vague and insufficient to support the full amount claimed.

However, relying on an occupational therapy assessment, the arbitrator determined the applicant required assistance with bathing due to shower door limitations and awarded $168.92 per month for the disputed period.

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

The insurer denied various benefits, leading to arbitration.

On a preliminary motion, the arbitrator ruled that the applicant's claims for certain examination costs were barred because she failed to seek prior approval under s. 24(1.1) of the Schedule.

However, the arbitrator allowed the applicant to proceed with claims for treatment expenses incurred before the insurer first raised the lack of treatment plans, as the insurer had breached its duty to assist the applicant.

The arbitrator also ordered the insurer to produce portions of its accident benefits file up to the date of the second mediation application, but denied the applicant's request for the insurer's internal policies on lumping out claims.

The insurer brought a motion for leave to amend its Response to an Application for Arbitration to include new issues, specifically whether the applicant was actually involved in the motor vehicle accident, whether the applicant must repay benefits received, and the quantum of income replacement benefits.

The motion was prompted by unsolicited witness statements suggesting the applicant was not in the accident.

The arbitrator granted the motion, finding that the issue of involvement goes to the heart of entitlement, the amendment was sought in a timely manner after the evidence surfaced, and the delay and prejudice did not outweigh the need to determine the core issue of entitlement.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including income replacement and medical benefits.

The arbitrator found that the applicant was substantially disabled from his pre-accident employment as a vacuum installer due to an exacerbation of a pre-existing back condition, entitling him to income replacement benefits for the 104-week period.

However, he did not meet the test for a complete inability to engage in any employment thereafter.

The arbitrator also awarded partial medical benefits, noting the insurer failed to comply with the Schedule's procedures for denying treatment plans, but denied other medical benefits as not reasonable or necessary.

Interest and arbitration expenses were awarded to the applicant.

The applicant, a 65-year-old pedestrian, was struck by a motor vehicle and claimed statutory accident benefits for caregiver, housekeeping, and medical/rehabilitation expenses.

The insurer denied the benefits based on in-home and DAC assessments.

The arbitrator preferred the evidence of the applicant and her expert physiatrist over the insurer's assessors, finding that the applicant was the primary caregiver for her grandchildren and suffered a substantial inability to perform her pre-accident tasks.

The arbitrator awarded the claimed caregiver and housekeeping benefits, as well as the costs of ongoing chiropractic, massage, and physiotherapy treatments, medication, a medical report, and interest on overdue payments.

The insured, a real estate agent, was involved in two motor vehicle accidents in close succession.

The insurer terminated his income replacement benefits, and the insured appealed.

The Director's Delegate held that the insured's essential tasks should be defined by his usual job duties prior to the first accident, not the modified duties he was performing at the time of the second accident.

The Delegate also found that while the insured was an employee rather than self-employed, his employment expenses were still deductible in calculating his gross income for benefit purposes.

The insurer's request for repayment of overpaid benefits was dismissed because it failed to show the insured withheld necessary information.