Tricia Jane McAvoy

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

The respondent insurer denied treatment plans for physiotherapy, a chronic pain assessment, and a neurological assessment.

The respondent also raised a preliminary issue that the applicant was barred from proceeding with the chronic pain assessment claim due to non-attendance at an insurer's examination.

The Tribunal found the insurer's request for the examination was not reasonably necessary due to its timing, over a year after the denial.

On the substantive issues, the Tribunal found the insurer's denial notices were deficient under s. 38(8) of the Schedule, making the physiotherapy and chronic pain assessments payable.

The Tribunal also found the neurological assessment was reasonable and necessary based on the medical evidence.

All disputed benefits were awarded with interest.

The applicant was injured in a motorcycle accident and sought attendant care benefits (ACBs) of $6,000 per month, claiming a need for 24-7 supervision due to physical, cognitive, and psychological impairments.

The respondent argued the applicant only required just under four hours of care per day.

The Tribunal found the applicant's evidence regarding cognitive decline unreliable and noted limitations in both parties' occupational therapy assessments.

Taking a practical approach based on the evidence, the Tribunal determined the applicant did not require 24-7 supervision but was entitled to ACBs in the amount of $2,724.28 per month.

The defendant municipality brought a motion for summary judgment to dismiss the plaintiff’s slip-and-fall action for failure to provide notice within ten days as required by the Municipal Act, 2001.

The plaintiff argued for an exception based on reasonable excuse and lack of prejudice to the municipality.

The court found that the plaintiff could rely on a late-served expert report for the motion, but that the admissibility of both parties’ expert evidence was not established.

The court concluded that the conflicting expert evidence on the plaintiff’s capacity and reasonable excuse created a genuine issue requiring a trial.

Both the defendant’s motion for summary judgment and the plaintiff’s request for reverse summary judgment were dismissed.

No costs were awarded due to divided success.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including income replacement benefits (IRB), attendant care benefits (ACB), and various treatment plans.

The Licence Appeal Tribunal found the applicant was entitled to an IRB for the pre-104 week period, as his accident-related low back pain caused a substantial inability to perform the essential tasks of his employment as an electrician.

However, the Tribunal denied the post-104 week IRB, finding the applicant failed to prove a complete inability to perform less physically demanding work for which he was reasonably suited.

The claim for ACB was dismissed because the applicant provided no evidence that the services were incurred.

The Tribunal approved treatment plans for an in-home attendant care assessment and physical therapy, but denied plans for an occupational therapy assessment and vestibular physiotherapy due to a lack of evidence connecting the symptoms to the accident.

The applicant was awarded interest on overdue benefits but denied a special award.

The applicant insurer sought repayment of $19,170.90 in attendant care benefits paid to the respondent insured.

The insurer had paid the benefits based on the respondent's mother's Employment Insurance statement, pending further proof of her economic loss.

In a prior Tribunal decision, it was determined that the respondent failed to prove his mother sustained an economic loss in providing care.

The Tribunal found that the insurer paid the benefits directly to the respondent in error, as no evidence of economic loss was ever provided.

The Tribunal ordered the respondent to repay the $19,170.90 plus interest, finding that the insurer had provided proper notice within the 12-month limitation period.

Three sets of defendants brought motions for summary judgment to dismiss the plaintiffs' claims arising from a 30-vehicle winter highway pileup.

The court granted the motion for one defendant (Seney), finding his vehicle was far removed from the main collision and did not contribute to the plaintiffs' injuries.

However, the court dismissed the motions for the other two defendants (Gill and McCallum), holding that while the case against them was not strong, granting partial summary judgment posed a significant risk of inconsistent verdicts at trial, as a jury could still apportion liability to them for allegedly blocking escape routes.

The applicant was injured in a motor vehicle accident and sought various statutory accident benefits, including non-earner, medical, attendant care, and housekeeping benefits.

The insurer suspended benefits after the applicant failed to attend an examination under oath, though a previous arbitrator found the notices defective.

The arbitrator found the applicant entitled to the disputed medical treatment plans, as well as attendant care and housekeeping benefits for a limited period due to the insurer's procedural breach in failing to provide assessment reports in a timely manner.

However, the claim for non-earner benefits was dismissed as the applicant did not meet the test of a complete inability to lead a normal life.

The request for a special award was also denied.

The applicant requested a reconsideration of a decision that found him catastrophically impaired but denied post-104 income replacement benefits, attendant care, housekeeping, and a special award.

The applicant argued the denial of these benefits was logically inconsistent with the catastrophic impairment finding.

The adjudicator dismissed the request, finding no significant errors of law or fact in the original decision.

The adjudicator held that the applicant's psychological impairments, which warranted the catastrophic designation, did not preclude him from performing his pre-accident casual work, and that the attendant care and housekeeping benefits were properly denied as they were not incurred.

The plaintiffs sought leave to amend their statement of claim to add Paragon Protection Ltd. as a defendant in a slip and fall action, after the apparent expiry of the limitation period.

The court applied discoverability principles under the Limitations Act, finding that the plaintiffs provided a reasonable explanation for the delay in discovering Paragon's potential liability.

Initial information from the owner's insurer and defendants' pleadings had directed the plaintiffs' focus solely to other parties responsible for winter maintenance.

The court granted leave to amend, noting that Paragon could still raise a limitations defence at trial.

The applicant was injured in a bicycle-motorcycle collision and sought various statutory accident benefits, including a determination of catastrophic impairment (CAT).

The Licence Appeal Tribunal found that the applicant sustained a catastrophic impairment due to a marked impairment in the adaptation domain resulting from psychological and behavioural disorders.

However, the Tribunal dismissed the applicant's claims for post-104 week income replacement benefits, finding he did not suffer a complete inability to work.

Claims for attendant care and housekeeping benefits were also dismissed because the applicant failed to prove his father, the service provider, suffered an economic loss.

A claim for a special award was denied as the insurer did not unreasonably withhold benefits.

The insurer appealed an arbitrator's decision denying repayment of accident benefits paid to the insureds.

The arbitrator had found that the motor vehicle collision was staged, but concluded the insurer was not entitled to repayment because there was no evidence of fraud or wilful misrepresentation regarding the specific injuries, treatments, and expenses claimed.

The Director's Delegate allowed the appeal, holding that where fraud or wilful misrepresentation relates to the fundamental facts of the accident itself, the insureds are required to repay all benefits paid directly to them.

The matter was returned to arbitration to determine the specific amounts repayable.

The appellant appealed an arbitrator's decision dismissing her claims for non-earner and attendant care benefits under section 55 of the SABS.

The Director's Delegate found that the arbitrator did not err in proceeding with the hearing in the absence of the appellant's written submissions, as she had been given notice and an extension.

However, the Director's Delegate held that the arbitrator erred in law by requiring the OCF-3s to confirm entitlement to the non-earner benefit and by concluding that no valid claim for attendant care benefits had been made because no Form 1 had been filed.

The appeal was granted, the arbitrator's order was rescinded, and the matter was remitted for a hearing on the merits.

The applicant sought dispute resolution for a medical benefit of $1,346.49 for psychological services following a motor vehicle accident.

The parties consented to the application being dismissed without costs, as the applicant had a similar application before FSCO and wished to pursue that application instead.

The Tribunal dismissed the application without costs.

The applicant sought dispute resolution for a medical benefit of $1,346.49 for psychological services following a motor vehicle accident.

The parties consented to the application being dismissed without costs, as the applicant had a similar application before the Financial Services Commission of Ontario (FSCO) that they wished to pursue instead.

The Tribunal ordered the application dismissed without costs.

The applicants sought various statutory accident benefits following a motor vehicle incident that was previously determined to be a staged accident.

At the arbitration hearing, the self-represented applicants attended but declined to give evidence or participate.

Consequently, their claims for benefits were dismissed.

The insurer sought repayment of over $78,000 in benefits previously paid, arguing that because the crash was fraudulent, all benefits were paid as a result of wilful misrepresentation or fraud under s. 52 of the SABS.

The arbitrator dismissed the insurer's claim for repayment, finding no evidence was provided of wilful misrepresentation or fraud regarding the legitimacy of the injuries, treatments, and expenses for the actual benefits claimed.

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

The arbitrator dismissed the claim for income replacement benefits, finding that post-accident funds provided by the applicant's company to her service provider were deductible employment income.

The claim for attendant care benefits was also dismissed because the service providers were not healthcare professionals and did not suffer an economic loss, and the expenses were not deemed incurred under s. 3(8) of the SABS.

The arbitrator granted claims for rehabilitative coaching, occupational therapy, physiotherapy, and a nutritional assessment, but denied claims for assistive devices, attendant care assessments, and a speech language assessment.

The claim for a special award was dismissed as the insurer's conduct was not unreasonable.

The appellants appealed an arbitrator's decision finding that they were not involved in a 'legitimate accident' because the collision was staged.

The Director's Delegate allowed the appeal, finding that the arbitrator erred in law by requiring an accident to be 'accidental' to meet the statutory definition under the SABS.

Relying on the Court of Appeal's decision in Vijeyekumar, the Delegate held that the statutory definition of 'accident' includes intentional incidents, such as a staged collision, and that the insurer should have relied on the wilful misrepresentation provisions (s. 53) rather than arguing the incident was not an accident.

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

Disputes arose and mediation failed.

The applicant applied for arbitration, but the insurer argued the application was filed beyond the two-year limitation period.

The arbitrator found that the application was filed more than 90 days after the mediator's report and more than two years after the insurer's refusals.

The arbitration was dismissed as time-barred, and the applicant was ordered to pay $1,500 in expenses to the insurer.

Following an arbitration where the applicant's claims for statutory accident benefits were denied and the insurer was partially successful on its claim for repayment, the insurer sought its expenses of the proceeding.

The arbitrator considered the criteria under the Expense Regulation, primarily the degree of success.

The insurer claimed $5,674.48 but the arbitrator reduced this amount, disallowing the cost of a court reporter and an unsubstantiated expert fee.

The arbitrator fixed the insurer's expenses at $2,000.00, inclusive of fees, disbursements, and GST, after applying a modest set-off because the insurer failed to attempt to resolve the expense issue prior to the hearing.

The applicant was injured in a motor vehicle accident and suffered a brain injury and conversion disorder.

During settlement discussions, the issue of her mental capacity to proceed in the dispute resolution process was raised.

The arbitrator found, based on medical evidence, that the applicant was incapable of managing her property, appointing a representative, or conducting her own case.

The arbitrator appointed the applicant's husband to act on her behalf in the arbitration process, effective nunc pro tunc to the date the Application for Mediation was filed.