Category: LAT Rules

The claimant sought entitlement to NEBs and various medical benefits. The insurer raised a preliminary issue regarding the admissibility of the claimant’s chronic pain assessment, which was served two months after the production date set at the Case Conference. Adjudicator Kepman found the claimant’s chronic pain assessment inadmissible, as the claimant consented to the production date and prevented the insurer from commissioning its own assessment of the claimant. The insurer raised a further preliminary issue regarding the admissibility of the claimant’s affidavit. Adjudicator Kepman also found that the claimant’s affidavit was inadmissible, as the Case Conference Order specified that no affidavits would be submitted into evidence and the claimant failed to ask permission to include the affidavit as part of her written submissions. With respect to entitlement, Adjudicator Kepman determined that the claimant was not entitled to the occupational therapy assessment, physiotherapy, or NEBs. However, the claimant was entitled to the assistive devices treatment plan, in part because the insurer’s IE assessor did not comment directly on the appropriateness of the assistive devices in question.

The claimant brought a motion to: (1) compel the insurer to provide particulars clarifying a statement made by a claims representative in an email regarding a job site analysis; and (2) excluding the claims representative from representing the insurer before the Tribunal. Vice Chair Maedel dismissed both motions. Whether the claims representative stated something different in her email as compared to the job site analysis went to the issue in dispute before the Tribunal. The motion to exclude the claims representative was rendered moot because the insurer appointed counsel to deal with the matter. However, Vice Chair Maedel wrote that in future cases a claims representative could be excluded if he or she was not licensed with the Law Society if the Tribunal proceeding involved legal submissions.

The claimant sought reconsideration of a decision that his claims for ACBs were barred due to the limitation period. He made no submissions on the original decision because his counsel at the time unilaterally removed himself as counsel without notice. Four months after the decision was issued, the claimant retained new counsel, who filed a Notice of Motion to extend the time limit to seek reconsideration. Vice Chair Maedel granted the motion and extended the deadline to provide a Request for Reconsideration. The claimant was 74 years old and relied on his former counsel to file the written preliminary submissions. Vice Chair Maedel accepted that the claimant was unaware of the preliminary issue decision and the seriousness of the decision until he retained new counsel in July 2021. He also accepted that the claimant had bona fide intention to appeal the denial of benefits between February to July 2021. Vice Chair Maedel rejected the insurer’s argument that the motion should be dismissed because the claimant failed to show a bona fide intention to reconsider within the 21 day period prescribed by the Rules. He found that the Tribunal was mandated to ensure a fair process to permit effective participation by all parties and to ensure that decisions are based on the merits of the dispute as per Rule 3.1 (a). In this case, the claimant had provided no preliminary submissions through no fault of his own and a preliminary decision was rendered without his participation. Vice Chair Maedel indicated that other than a delay of the application between April and December 2021 as well as the cost of responding to the Request for Reconsideration, there was little prejudice to the insurer. Notwithstanding the extension of time granted to the claimant, Vice Chair Maedel indicated the claimant would be required to address the specific criteria for reconsideration pursuant to Rule 18.2 in seeking to reverse the Tribunal’s initial decision.