Category: LAT Rules

G. I-F. v. Economical Insurance Company (19-001420)

The claimant sought reconsideration of a motion order denying the request to vary the hearing timetable. Associate Chair Batty dismissed the reconsideration because it was not related to a final order.

Applicant v. Gore Mutual Insurance Company (18-011978)

The claimant sought an order from the case conference adjudicator that his decision not to strike the insurer’s preliminary issue was biased and requested that the adjudicator recuse himself. Adjudicator Mazerolle refused the request. He explained that his decision was based on the written submissions of both parties and that a reasonable person would not view the process with a reasonable apprehension of bias.

C.B. v. Allstate Insurance Company of Canada (18-009967)

The insurer asked for an extension of time to serve a motion record in relation to the claimant’s motion to exclude certain evidence from an upcoming hearing. Adjudicator Paluch granted the extension and vacated the scheduled hearing dates in order for the motion to be heard. He wrote that the insurer inadvertently failed to serve only one of three parts of the motion record and should not be prejudiced by that mistake.

S.A. v. Guarantee Insurance (18-002962)

The claimant sought reconsideration of the Tribunal’s decision that he was not entitled to NEBs. He argued, among other things, that the Tribunal’s refusal to allow closing arguments violated the rules of natural justice. Vice Chair Jovanovic agreed that the Tribunal breached the rules of natural justice by not allowing closing submissions. The Tribunal could have easily accommodated the request to make submissions, and the claim for NEBs was of considerable importance to the claimant, who was only receiving ODSP as her other source of income.

S.A. v. Guarantee Insurance (18-002962)

The claimant sought reconsideration of the Tribunal’s decision that he was not entitled to NEBs. He argued, among other things, that the Tribunal’s refusal to allow closing arguments violated the rules of natural justice. Vice Chair Jovanovic agreed that the Tribunal breached the rules of natural justice by not allowing closing submissions. The Tribunal could have easily accommodated the request to make submissions, and the claim for NEBs was of considerable importance to the claimant, who was only receiving ODSP as her other source of income.

H.S. v. Aviva Insurance Canada (17-007384)

The claimant sought removal from the MIG and entitlement to four treatment plans for physical therapy. As a preliminary matter, the insurer sought to admit as evidence two addendum report authored after the production deadline. Adjudicator Harper refused to admit the addendum reports, reasoning that they could have been obtained much earlier, since the records reviewed were in the insurer’s possession for some time. Regarding the claimed benefits, Adjudicator Harper concluded that the claimant suffered a concussion, which fell outside of the MIG. She also concluded that the disputed physical treatment was reasonable and necessary because the claimant had long-lasting injuries and she had not achieved maximal recovery.

P.Y. v. Aviva General Insurance Company (17-003692)

The claimant sought reconsideration of the Tribunal’s decision that the claimant’s injuries fell within the MIG and the denial of three treatment plans. Following the Tribunal’s decision, the insurer removed the claimant from the MIG. The claimant argued that this was new evidence that could not have reasonably been obtained earlier. Adjudicator Grieves granted the reconsideration and ordered that the claims for three treatment plans be determined by the adjudicator originally hearing the matter.

J.Y. v. Aviva Insurance Canada (17-009034)

The claimant sought reconsideration of the Tribunal’s decision to dismiss all of his claims. Adjudicator Watt dismissed the reconsideration request. He held that the claimant had failed to provide written submissions to the Tribunal as ordered by the hearing adjudicator; that the surveillance considered by the Tribunal was not improper; that the Tribunal considered the proper test for IRBs; and that the Tribunal was not required to accept the evidence of an assessor whose report was inconsistent and contrary to other evidence.

N.A. v. Aviva General Insurance (18-006048)

The claimant sought entitlement to a TMJ assessment. The insurer argued that the Tribunal had already determined whether the claimant suffered TMJ injuries in the accident during an earlier proceeding. Adjudicator Grant agreed with the insurer that the causation of the claimant’s TMJ symptoms had already been addressed by the Tribunal, and that res judicata barred the claimant from re-litigating the issue. He also held it would be an abuse of process for the Tribunal to make a determination contrary to the Tribunal’s earlier decision.

T.H. v. Aviva Insurance Company of Canada (17-001125)

The Tribunal dismissed the claim for NEBs and the claimant sought reconsideration arguing that he had been denied natural justice because he was not permitted to call additional witnesses at the hearing, despite agreeing to the procedure in the Case Conference. He also argued that the insurer failed to send an appropriate NEB denial. Member Jovanovic dismissed the reconsideration. He held that the claimant’s legitimate expectations were met because the hearing procedure had been agreed upon during the Case Conference. He also accepted that the insurer had sent an appropriate denial of NEBs. Finally, he held that the Tribunal had applied the correct NEB test.