Vismay Merja

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

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and that the applicant failed to comply with section 33 of the Schedule by not providing requested documents.

The Tribunal found that the applicant's pre-existing and accident-related psychological conditions removed him from the MIG.

However, because the applicant failed to comply with the respondent's section 33 requests for nearly three years without a reasonable explanation, he was barred from receiving the disputed medical and rehabilitation benefits.

The claims for an award and interest were also dismissed.

A law firm sought assessment of its legal fees under a contingency fee retainer agreement with former clients.

The clients terminated the retainer and retained new counsel.

The law firm claimed fees totaling approximately $158,920.38 based on hourly rates, arguing the retainer agreement provided for such compensation upon termination.

The court conducted a quantum meruit analysis and found the accounts unreasonable due to vague time entries, disputed meetings that did not occur, apparent double billing, and work that did not demonstrate value to the clients.

The court reduced the fees substantially, assessing Mr. Hopkins' account at $57,424.82 (including HST) and Mrs. Hopkins' account at $27,687.35 (including HST).

This costs endorsement addresses the appropriate quantum of costs following a motor vehicle accident trial in which the plaintiff was awarded damages by the jury, but the award was reduced to zero by operation of the Insurance Act.

The defendant sought $269,264.87 in costs, later reducing the request to $230,000.

The plaintiff argued for a much lower award, citing financial hardship and litigation conduct.

The court fixed costs at $185,000, finding the defendant entitled to costs but reducing the amount for duplication, lack of particulars, and proportionality.

The insurer applied to the Licence Appeal Tribunal for repayment of $5,142.86 in Income Replacement Benefits (IRBs) paid to the insured, alleging wilful misrepresentation regarding pre- and post-accident employment.

The insured failed to participate in the written hearing.

The Tribunal found that the insurer met its notice obligations and proceeded in the insured's absence.

The Tribunal concluded that the insured wilfully misrepresented her employment and income, and failed to comply with production requests.

The insurer was awarded repayment of the full amount of IRBs plus interest.

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

The respondent insurer denied several physiotherapy treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant suffered from accident-related chronic pain syndrome with functional impairment, justifying removal from the MIG.

The Tribunal ordered the respondent to pay for the disputed physiotherapy treatment plans with interest, but denied the applicant's request for a special award under s. 10 of Regulation 664.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming catastrophic impairment due to a subdural hematoma, as well as entitlement to attendant care benefits, non-earner benefits, and various treatment plans outside the Minor Injury Guideline (MIG).

The Tribunal found that the subdural hematoma was a spontaneous occurrence unrelated to the accident.

The Tribunal further held that the applicant's injuries were predominantly minor, keeping her subject to the MIG limits.

Consequently, the claims for attendant care benefits, non-earner benefits, and treatment plans exceeding the MIG were dismissed.

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

The respondent insurer denied benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and later moved to bar the application under s. 55(1)2 of the Schedule for failure to attend insurer's examinations.

The Tribunal found the application was not barred because the insurer's notice lacked adequate reasons.

On the merits, the Tribunal concluded the applicant's psychological issues, including severe depression, pre-dated the accident and that the accident itself was a suicide attempt.

Consequently, the applicant failed to prove he sustained a psychological impairment caused by the accident or that a pre-existing condition prevented his recovery under the MIG.

The application for psychological benefits, an award, and interest was dismissed.

The applicant sought income replacement benefits following a motor vehicle accident, which the respondent insurer denied.

The applicant applied to the Licence Appeal Tribunal.

Subsequently, the respondent requested section 44 insurer's examinations, which the applicant failed to attend.

The respondent argued the application should be barred under section 55(1)2 of the Schedule.

The Tribunal held that section 55(1)2 prohibits making an application, not continuing one already in progress.

However, because the applicant failed to attend rescheduled examinations without a reasonable explanation, the scope of the hearing was limited to determining entitlement up to the date of non-compliance.

The applicant sought payment for four physiotherapy treatment plans following a motor vehicle accident.

The respondent denied the plans, arguing that further facility-based treatment was not reasonable and necessary.

The Tribunal found that the applicant failed to meet his burden of proving the treatment was reasonable and necessary, as there was insufficient evidence that the goals of treatment, particularly pain relief, were being met to a reasonable degree despite years of consistent physiotherapy.

The application was dismissed.

The applicant sought statutory accident benefits following a 2016 motor vehicle accident.

The respondent denied several treatment plans for physiotherapy, a psychological assessment, and a chronic pain assessment.

The Tribunal first considered whether the applicant was statute-barred from disputing two physiotherapy denials from 2017.

Applying the four-part test under section 7 of the Licence Appeal Tribunal Act, the Tribunal declined to extend the limitation period, finding no bona fide intention to appeal and an unexplained delay.

On the substantive issues, the Tribunal found the psychological assessment was reasonable and necessary given conflicting section 44 assessments regarding causation of the applicant's psychological condition.

However, the Tribunal denied the chronic pain assessment and further physical therapy, finding insufficient evidence that the applicant's current physical complaints were causally related to the accident.

Claims for an award under section 10 of O. Reg. 664 were also dismissed.

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

The parties disputed the quantum of the IRB for the periods pre- and post-104 weeks.

Both parties submitted accounting reports, but the adjudicator found both reports flawed as neither correctly attributed the loss of self-employment income to the accident versus a separate fire at the applicant's rental property.

As the applicant bore the burden of proof and failed to provide accurate evidence of the quantum owed, the application for IRBs, interest, and a special award was dismissed.

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

The respondent denied a treatment plan for a neurological assessment on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.

The applicant argued that chronic back pain, disc bulges, and carpal tunnel syndrome warranted removal from the MIG.

The Tribunal found the applicant's evidence regarding the onset of back pain to be inconsistent and failed to establish a causal link to the accident.

The Tribunal concluded the injuries were predominantly minor, and because the MIG limit was exhausted, the disputed treatment plan and interest were denied.

The appellant law firm, UL Lawyers Professional Corporation, appealed a Superior Court decision denying their request for a solicitor's lien against settlement proceeds.

The firm had represented the respondent client in motor vehicle litigation before being discharged.

The application judge found two of the three criteria for a charging order met but concluded there was no evidence the client would not pay.

The Court of Appeal found that the application judge erred in relying on an ambiguous undertaking and that a subsequent $5,000,000 lawsuit filed by the client against the firm provided sufficient "some evidence" that the client would not pay.

The appeal was allowed, and the firm was granted a solicitor's lien for $73,195.75 plus costs.

The applicant sought income replacement benefits following a motor vehicle accident, which the respondent insurer denied.

The applicant filed an appeal with the Licence Appeal Tribunal 20 days after the expiry of the two-year limitation period under section 56 of the Statutory Accident Benefits Schedule.

The applicant sought an extension of time under section 7 of the Licence Appeal Tribunal Act, 1999.

The Tribunal applied the four-factor test from Manuel and found that the applicant failed to demonstrate a bona fide intention to appeal within the limitation period, did not adequately explain the delay, and lacked strong merits for the appeal.

The Tribunal concluded that the justice of the case did not warrant an extension of time, and the applicant was statute-barred from proceeding with her claim.

The applicant, who was involved in a motor vehicle accident, sought payment for various treatment plans including a neurological assessment, physiotherapy, chiropractic treatment, and psychological services under the Statutory Accident Benefits Schedule.

The respondent insurer denied the benefits.

The Licence Appeal Tribunal found that the applicant failed to prove on a balance of probabilities that the disputed treatment plans were reasonable and necessary.

The adjudicator noted inconsistencies in the applicant's self-reporting to assessors compared to her family doctor's records, and found the expert reports provided by both parties to be problematic or unpersuasive.

The application was dismissed in its entirety.