T. T. v. Aviva Insurance Canada (17-002535)

The claimant sought entitlement to a number of medical treatment plans. The insurer denied the treatment and asserted a MIG position. The insurer also tendered surveillance in support of its position, to which the claimant sought to exclude on the basis of bad faith. Adjudicator Avvy Go determined that the surveillance was in contravention of Rule 9.2 and was not served 10 days prior to the hearing. Moreover, a case conference Order stipulated timelines that the insurer was in contravention of without any explanation. Accordingly, the materials were excluded. Additionally, the insurer was ordered to pay costs on the motion to exclude. However, on the substantive merits of the claim, Adjudicator Go determined that the claimant had not tendered compelling evidence to demonstrate that recovery within the MIG was unavailable; as a result, none of the treatment plans were found payable.

J.R. v. Coachman Insurance Company (17-001154, 17-001337)

This is a reconsideration decision concerning procedural issues with respect to the submission of supplementary written submissions. Following an oral hearing, the parties were invited to submit supplementary written submissions. Due to a clerical error at the LAT’s office, Adjudicator Shapiro ordered that the insurer file its submissions prior to the deadline that was ordered for the claimant’s submissions. Both parties requested reconsideration of Adjudicator Shapiro’s preliminary order on the length and deadlines for filing supplementary submissions. The claimant requested that only his filed supplementary written submissions be put before the adjudicator. The insurer requested a reconsideration on the timing, content, length and sequencing of the written submissions. The insurer raised arguments with respect to the legislative scheme governing the LAT and complained about claimant’s counsel behaviour. Associate Chair Batty denied the claimant’s application for reconsideration and granted the insurer’s relief, in part. Associate Chair Bhatty held that the fact that the insurer was ordered to submit its supplementary submissions before the claimant’s submissions were due violated the rules of procedural justice. To cure this error, Associate Chair Batty ordered that the parties file new written submissions with the claimant’s submissions due first.

Pagcaliwagan v. Aviva Insurance Company (17-003500)

The claimant sought to exclude addendum reports completed by the insurer’s IE assessors, which were served three days after the ordered due date. Adjudicator Paluch held that the late addendum reports would be admissible at the hearing. He reasoned that the insurer had kept that claimant apprised of its intention to obtain the addendum reports, and kept the claimant well-informed of the status of the reports. He also wrote that it would not be in the interest of fairness to exclude addendum reports that were two days late – the best available evidence should be available to inform the Tribunal’s decision.

P.K. v. Unica Insurance Inc. (17-005397)

The insurer sought an order for a number of documents (which the claimant undertook to provide during the Case Conference) and the particulars of the special award claim. Adjudicator Ferguson granted the insurer’s motion, and ordered the claimant to produce the requested documentation within seven days, and to provide the particulars of the special award claim.

Applicant v. Unica Insurance Company (17-002059)

The insurer sought to have the application dismissed on the basis of the claimant’s failure to attend the hearing. Adjudicator Maedel held that the claimant had abandoned his application, and had failed to substantiate his claims. The matter was dismissed.

Applicant v The Guarantee Company of North America (17-002558)

The applicant sought medical benefits for physiotherapy services. The respondent brought a motion to strike the applicant’s reply. The applicant filed a response to the motion to strike a day after the deadline. Adjudicator Goela held that despite being late, she would consider the applicant’s response as it did not prejudice the respondent. Adjudicator Goela further held that the applicant’s reply was struck because the applicant used the reply to introduce new information and arguments that should have been addressed in her initial submissions. The adjudicator also held that the applicant was also not entitled to the medical benefits sought as the treatment plans were related to injuries from a previous accident.

Mirzaie v. Wawanesa Mutual Insurance Company (17-004584)

The insurer brought a motion seeking the production of items listed in a case conference Order, as well as additional items. The claimant indicated that best efforts were made to fulfill the production requests of the case conference Order and was able to produce some of the items. Adjudicator Ian Maedel denied the request of the insurer to seek additional items citing further productions close to a hearing date would only complicate matters and add delay. However, any items not produced but subsequently tendered at the hearing would be excluded pursuant to Rule 9.4.

S.M. v. Motor Vehicle Accident Fund (17-001681)

The claimant brought a motion to add costs and a special award as issues in dispute. The motion also sought to compel the claims handler to submit to cross-examination as well as production of the entire accident benefits file and IE assessors records, inclusive of correspondence between the vendor and assessor. The insurer eventually consented to the production of the AB file and much of the records sought from the IE assessors. The insurer also indicated that it would request the correspondence between the IE vendor and its assessor. However, Adjudicator Rebecca Hines held that should the IE vendor fail to produce the records, a summons of the vendor would follow. Of note, since the insurer was the Fund, it initially sought exemption from being compelled to provide documentary and oral evidence under section 71 of the Legislation Act and section 8 of the Proceedings Against the Crown Act; this was rejected.

M.J. v. Aviva General Insurance (17-002229)

After the commencement of the hearing, the claimant withdrew the application. The Tribunal closed its file and no costs were awarded.

M.C. v. Aviva General Insurance (17-002614)

The insurer sought reconsideration of an order made by the Tribunal allowing the claimant to summons the adjuster who had handled his matter. The insurer argued that it should have been given a copy of the claimant’s summons request, and should have had the opportunity to respond to that request. Executive Chair Lamoureux rejected the reconsideration. She held that Rules 8 and 4.3, when read together, allowed the claimant to request a summons without notifying the insurer.