The Personal Insurance Co. v. Jia (2020 ONSC 6361)

The insurer appealed the LAT’s decision that counsel acting in a priority matter could not also act in the LAT dispute, and the decision excluding the transcript from the priority EUO from the LAT hearing. The Court dismissed the appeal and concluded that the LAT’s decision was reasonable. It held that a conflict could arise if the same counsel acted in the priority dispute and at the LAT. It also reasoned that the protections of section 33 would not be followed if the priority EUO transcript was admitted without leave of the Tribunal.

C.B. v. Allstate Canada (18-009967)

The claimant sought an order for the particulars of redaction in the adjuster log notes, the complete files from IE assessors, further log notes after the date of the LAT application related to section 33 requests and further IE requests, an updated payment summary, the particulars of whether the cost claimant’s catastrophic impairment assessments were taken from his medical benefits limits, and the particular amounts paid for IEs. The claimant also sought costs of the motion. Adjudicator Chakravarti ordered the insurer to produce the full AB file including correspondence, emails, draft reports, letters of instructions, notes from IE assessors, and any documentary information the insurer possessed relating to IEs. She also ordered production of log notes and emails related to section 33 requests, and related to the requests for further IEs (subject to solicitor-client privilege and litigation privilege). Costs of $500 was awarded to the claimant because the insurer had failed to provide many records that had been ordered produced in earlier Orders, including a nine month delay in producing the IE file. She found the insurer’s actions rose to the threshold level of being unreasonable and frivolous, and even in bad faith.

K.A. v. Aviva General Insurance Company (19-002676)

The claimant sought entitlement to IRBs. The insurer argued that the claimant had failed to attend IE, and failed to comply with section 33 requests. Adjudicator Johal held that the claimant was barred from proceeding due to the IE non-attendance, reasoning that the IEs were reasonably required for determining entitlement to post-104 week IRBs even though IRBs had been terminated prior to the 104 week mark, and that the notices provided the requisite information. Adjudicator Johal rejected the insurer’s section 33 defence because section 33 did not prevent the Tribunal from adjudicating the claim. The consequences of section 33 non-compliance ultimately go to entitlement to a disputed benefit.

S.B.S. v. Wawanesa Mutual Insurance Company (17-006935)

The claimant sought entitlement to ongoing IRBs and two medical benefits. The insurer argued that the claimant was not credible, and that her impairments were caused by other health issues and second motor vehicle accident. Adjudicator Neilson found the claimant to be a poor historian who consistently exaggerated her complaints. She concluded that the claimant did not suffer a substantial inability to engage in her pre-accident employment as a result of the accident, and that her reported impairments were caused by things and events other than the subject accident (she also did not meet the complete inability test). The claim for psychological treatment was dismissed; further chiropractic treatment was awarded based on it providing pain relief at the time it was proposed. Adjudicator Neilson also dealt with a number of preliminary motions, in which she ordered: the insurer’s witnesses would not be excluded for failure to produce the full IE file; the claimant’s treating OT and psychologist could not testify as experts, but rather as treating practitioners; that the claimant could call the adjuster as a witness; and that the claimant could refer to and rely upon psychological testing data that was served late.

R.F. v. Pafco Insurance (17-008708)

On the eve of the hearing, the claimant brought various motions to add the insurer’s counsel as a witness, for production of records from the IE facilities, to hold the insurer’s counsel in contempt, and to adjourn the hearing. The motions all related to the claimant’s counsel’s position that the IE assessors had violated PIPEDA by not providing records or providing incomplete records. Vice Chair Marzinotto dismissed the motions, and noted that the claimant did have some of the requested records in her possession, that the motion was not timely as it was brought only two weeks before the hearing, that the insurer’s counsel had not acted improperly (and had, in fact, attempted to assist in obtaining the requested records), and that the insurer’s counsel was not a necessary witness at the hearing. Vice Chair Marzinotto also noted that any allegations of PIPEDA violations could not be addressed by the LAT. The hearing was adjourned as a result of the claimant’s late motion.

Khan v. Allstate Insurance Company of Canada (2020 ONSC 3578)

The claimant sought judicial review of the Tribunal’s decision that it did not have jurisdiction to award interim benefits. Before the hearing, the claimant and the insurer settled the claim on a full and final basis. The claimant argued that the Court should nevertheless make a determination on the matter. The Court dismissed the judicial review on the grounds that it was moot, but wrote that the Tribunal’s earlier decision was not binding on any other adjudicator.

J.R. v. Aviva General Insurance Company (19-007539)

The insurer filed a request for reconsideration of a motion decision extending the time for exchange of documents and the production of log notes. Pursuant to the amended rule 18.1 of the Common Rules of Practice and Procedure, Associate Chair Jovanovic dismissed the request for reconsideration as it was in regard to a decision that did not finally dispose of the appeal.

M.A. v. Travelers Insurance Company of Canada (19-008748)

The claimant sought reconsideration of the Case Conference order that an in-person hearing be held rather than a written hearing. Vice Chair Jovanovich dismissed the reconsideration as the order was not a final order disposing of an appeal.

L.D. v. Gore Mutual Insurance Company (18-011978)

The claimant sought reconsideration of the Tribunal’s Case Conference order that a preliminary issue hearing take place to address the IE non-attendance issue, and of the Case Conference adjudicator’s refusal to “strike” the issue, arguing that the adjudicator was biased. Vice Chair Jovanovich dismissed the reconsideration request because it was not a final order. Rather, it was a procedural order made under the Tribunal’s Rules.

S.S.Z. v. Certas Direct Insurance Company (18-007365)

The claimant filed a request for reconsideration arising from a decision in which the Tribunal found that his injuries fell within the MIG. Adjudicator Kaur first addressed the insurer’s motion to exclude certain documents and submissions that were included in the claimant’s request for reconsideration. Adjudicator Kaur granted the insurer’s motion. She found that the claimant was using a psychiatric report to supplement the evidence which was already before the Tribunal in an attempt to re-argue issues that had already been decided, and that the other documents and submissions did not add anything to the case substantively, were not relevant to the issues raised, or were misleading. Adjudicator Kaur dismissed the request for reconsideration on the grounds that the claimant failed to establish she acted outside of the Tribunal’s jurisdiction or violated the rules of natural justice or procedural fairness, or that the Tribunal made a significant error of law of fact such that it would have likely reached a different decision.