W.E. v. Aviva Insurance Company (19-003285 and 19-009617)

This decision relates to two LAT files. The issues in dispute were whether the claimant’s initial LAT application should be dismissed as abandoned for the claimant’s failure to make written hearing submissions pursuant to a LAT Order, whether the claimant was entitled to ongoing IRBs, and whether the insurer was entitled to a repayment of IRBs. The hearing was heard in writing. The claimant made no submissions. Adjudicator Norris found that the claimant’s initial LAT application was dismissed as abandoned, and the insurer was entitled to a repayment of IRBs made as a result of error.

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.

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.

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.

R.T. v Coseco Insurance Company (18-004783)

The claimant filed a motion to withdraw some of the issues listed for an upcoming LAT hearing on a without-prejudice basis. The insurer submitted that the issues not identified for withdrawal (namely attendant care benefits) were still in dispute, while the claimant submitted that the issue of attendant care benefits was previously determined in a preliminary issue decision that was upheld on reconsideration. Adjudicator Punyarthi concluded that the claimant was permitted to withdraw issues without prejudice, noting that there was no basis for imposing a generalized “with prejudice” withdrawal of issues in this case. If an issue is brought back, the claimant would have a right to have that issue considered and decided on the merits. Adjudicator Punyarthi also determined that attendant care benefits were not an issue in dispute because the issue had already been decided and upheld on reconsideration, and the Tribunal could not re-hear the issue at this stage.

J.K. v Aviva Insurance Company of Canada (18-008054)

The insurer submitted a request for reconsideration following a decision in which the Tribunal found that the claimant was entitled to various medical benefits. In making its decision, the Tribunal addressed a procedural issue that arose as a result of the parties not filing the OCF-18s in dispute with their written submissions and evidence. As a result, the Tribunal issued an Order directing the parties to serve on each other and file with the Tribunal a copy of the missing OCF-18s along with written submissions on whether the claimant should be permitted to file the missing OCF-18s as evidence for the written hearing. Ultimately, the Tribunal allowed the missing OCF-18s into evidence and proceeded to determine that the claimant was entitled to the treatment set out in those OCF-18s. The insurer argued that the Tribunal made significant errors of fact and law such that the Tribunal would likely have reached a different decision by finding that the missing OCF-18s were submitted by the claimant (when they were in fact submitted by the insurer), by accepting the missing OCF-18s into evidence, and by making the claimant’s case for her on arguments that were never made by the claimant. Adjudicator Lake dismissed the insurer’s request for reconsideration, noting that the Tribunal did not err in admitting the missing OCF-18s into evidence, and that while it erred in stating that the treatment plans were submitted by the claimant when they were in fact submitted by the insurer, this error would not have led the Tribunal to a different decision. Adjudicator Lake further noted that the Tribunal correctly placed the onus on the claimant to prove entitlement, and did not act as an advocate for the claimant. Rather, the Tribunal reviewed all of the evidence in the matter, which included the missing OCF-18s.