Thomas Hughes

The applicant sought non-earner benefits following a motor vehicle accident, claiming physical and psychological impairments prevented her from carrying on a normal life.

The adjudicator applied the Heath framework and found that while the applicant experienced some changes in her post-accident life, she could still perform many of her pre-accident activities, including childcare and self-care, without significant restrictions.

The application for non-earner benefits, along with claims for an award and interest, was dismissed.

The applicant sought payment for a physiatry assessment following a motor vehicle accident that resulted in a traumatic brain injury.

The respondent insurer denied the cost, relying on an assessment by a general practitioner.

The Licence Appeal Tribunal found the physiatry assessment was reasonable and necessary, preferring the evidence of the applicant and her treating professionals.

The Tribunal also found the insurer unreasonably withheld benefits due to multiple errors in handling the file, and ordered a 25% special award under Regulation 664, along with interest on the overdue payment.

The applicant sought statutory accident benefits for medical marijuana and related assessment costs following a motor vehicle accident that exacerbated pre-existing workplace injuries.

The insurer denied the treatment plans based on an insurer's examination report which concluded that cannabis was not recommended for treating depression or anxiety.

The Licence Appeal Tribunal found the treatment plans reasonable and necessary, noting that traditional prescription medications and psychotherapy had proven ineffective for the applicant's chronic pain, insomnia, and anxiety, whereas medical marijuana provided marked improvement.

The Tribunal awarded the benefits and interest but declined to make an award for unreasonable delay, finding the insurer had reasonably relied on its assessor's report.

The applicant sought a non-earner benefit and a medical benefit for chiropractic services following a motor vehicle accident.

The adjudicator found that the applicant did not meet the test for a non-earner benefit, as video surveillance and medical assessments demonstrated she had resumed most of her pre-accident activities, including caring for her children, driving, and household chores.

The adjudicator also denied the medical benefit for chiropractic services, finding it was not reasonable and necessary because the applicant had reached a plateau in her recovery and was successfully participating in an independent exercise program.

Claims for an award under Ontario Regulation 664 and interest were consequently dismissed.

The applicant sought payment for an activities of daily living assessment and an orthopaedic assessment following a motor vehicle accident.

The respondent argued the claims were statute-barred as they were disputed more than two years after being denied.

The Tribunal found the applicant was statute-barred from claiming the activities of daily living assessment because a clear and unequivocal denial had been issued more than two years prior.

However, the denial for the orthopaedic assessment was not clear and unequivocal.

The Tribunal ordered the respondent to pay for the orthopaedic assessment, finding the applicant had incurred the cost before receiving a valid denial and was compliant with section 44 of the Schedule.

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

The respondent insurer denied the claims, arguing the applicant had reached maximal medical recovery.

The Licence Appeal Tribunal found the physiotherapy treatment plan reasonable and necessary, noting the applicant had not pursued surgery due to age-related risks and had not reached maximal medical recovery.

However, the Tribunal denied the request for an orthopaedic assessment, finding it duplicative of a recent examination by an orthopaedic consultant and lacking compelling evidence of a need for further assessment.

The applicant sought a $10,000 death benefit following her mother's death in a motor vehicle accident, claiming she was principally dependent on her mother for financial support and care.

The Licence Appeal Tribunal found that the applicant, who was employed and earning over $44,000 annually, was capable of meeting her own financial needs and was not financially dependent on her mother.

The application for the death benefit and associated interest was dismissed.

The applicant applied for a $10,000 death benefit following her mother's death in a motor vehicle accident.

The insurer denied the claim on the basis that the applicant, an adult child living at home and working full-time, was not principally dependent on her mother for financial support or care.

The Tribunal found that the applicant earned sufficient income to be self-supporting and failed to prove that her mother provided more than 50% of her financial needs.

The application for death benefits and interest was dismissed.

The applicant was injured in a motor vehicle accident and sought payment for an orthopaedic assessment.

The insurer denied the claim, arguing the assessment should be funded through OHIP and that the applicant fell within the Minor Injury Guideline.

The Tribunal found that the insurer failed to provide valid medical reasons for the denial within the required timeframe under s. 38(8) of the Schedule, triggering automatic payment under s. 38(11).

The Tribunal also rejected the insurer's broad interpretation of s. 47(2) regarding OHIP coverage.

The applicant was awarded the cost of the assessment and interest, but denied costs.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits from the insurer.

After mediation failed, the applicant applied for arbitration.

The applicant's counsel was previously removed from the record due to a breakdown in the professional relationship.

The applicant failed to attend the scheduled arbitration hearing despite receiving proper notice.

The arbitrator dismissed the application for arbitration and ordered the applicant to pay the insurer's expenses fixed at $1,500.

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

After his legal counsel was removed from the record, the applicant failed to retain new counsel or attend the scheduled arbitration hearing despite receiving adequate notice.

The arbitrator dismissed the application for arbitration due to the applicant's non-attendance and awarded the insurer $1,500 in expenses for defending the claim.

The applicant sought statutory accident benefits following an incident where he alleged a tractor-trailer backed into his vehicle.

The insurer denied the claim, arguing no collision occurred, relying on dash-cam video gaps and an accident reconstruction expert.

The arbitrator held a preliminary issue hearing to determine if the incident met the definition of an 'accident' under s. 3(1) of the Schedule.

Applying the purpose and causation tests, the arbitrator found that self-reporting collision reports from both drivers confirmed contact between the vehicles.

The arbitrator concluded the applicant was involved in an accident and deferred the issue of expenses to the main hearing.

The plaintiff was involved in a rear-end motor vehicle collision after an unidentified school bus spun out of control on the highway.

The plaintiff sued the unidentified driver and his own insurer under the unidentified motorist coverage.

The insurer brought a motion for summary judgment to dismiss the action, arguing the plaintiff was solely responsible for the collision.

The court dismissed the motion, finding the plaintiff established a prima facie case of negligence against the bus driver that required a trial.

The court also declined to use its expanded fact-finding powers under Rule 20.04(2.1) because the plaintiff had served a jury notice, and it was in the interests of justice to preserve the right to a jury trial.

Following a successful arbitration where the insurer prevailed on all issues, the insurer sought its expenses.

The arbitrator considered the criteria under Rule 75.2 of the Dispute Resolution Practice Code.

Finding that the insurer was fully successful, no settlement offers were exchanged, and the applicant caused some delay, the arbitrator awarded expenses to the insurer.

The requested legal fees were reduced as excessive given the brevity and simplicity of the hearing.

The applicant was ordered to pay the insurer $3,437.80 in arbitration expenses.

The applicant was injured in a motor vehicle accident and applied for statutory accident benefits.

After the applicant withdrew his application, the insurer sought its expenses for the arbitration proceeding.

The arbitrator awarded the insurer its expenses fixed at $1,292.72, finding the quantum reasonable and proportionate to the degree of success and complexity of the matter.

The applicant was injured when struck by a piece of airborne scrap metal while waiting in his truck.

He applied for statutory accident benefits.

The insurer initially investigated whether the incident met the definition of an 'accident' under the Schedule.

After several months, the insurer issued an OCF-9 stating its investigation was complete and it was accepting the claim.

A year later, the insurer attempted to terminate benefits, arguing the incident was not an accident.

The arbitrator held that the insurer had expressly and unequivocally waived its right to dispute the 'accident' issue when it confirmed the completion of its investigation and accepted the claim.

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

After productions revealed the applicant had been involved in a subsequent accident and received income replacement benefits from another insurer—inconsistent with his claims in this arbitration—his representatives, Pace Law Firm, brought a motion to be removed from the record.

The applicant failed to attend the hearing.

The arbitrator granted the motion to remove Pace Law Firm due to a breakdown in the solicitor-client relationship.

As the applicant presented no evidence to support his claims, the arbitration was dismissed.

The insurer was awarded $1,500 in expenses.

The applicant sought statutory accident benefits, including medical, attendant care, and housekeeping benefits, following a motor vehicle accident.

The insurer denied the benefits, arguing the treatments were not reasonable, necessary, or actually incurred.

The arbitrator dismissed the applicant's claims in their entirety, finding her testimony lacked credibility and was inconsistent with the clinical notes of her regular treating physicians.

The arbitrator drew adverse inferences from the applicant's failure to call treating practitioners or her son, who allegedly provided care, and concluded the claimed services were either not provided or not reasonably required.

The applicant sought attendant care and medical benefits following a motor vehicle accident.

The arbitrator dismissed the claims, finding that the applicant failed to provide sufficient evidence of significant injuries or a need for attendant care.

The applicant's own prior statements contradicted his claim for attendant care, and he failed to introduce a valid Form 1 or the disputed treatment plan into evidence.

The Insurer sought expenses following its complete success in an arbitration proceeding where the Applicant's claims were dismissed.

The Applicant objected to the Insurer's disclosure of settlement negotiations regarding the expense issue.

The Arbitrator found the disclosure inappropriate but did not penalize the Insurer by denying expenses entirely.

Applying the Expense Regulation, the Arbitrator reduced the claimed fees and disbursements due to lack of supporting documentation and fixed the Insurer's expenses at $12,000.00.