The claimant sought to add a claim for punitive damages to his LAT application. Adjudicator Mazerolle held that the Tribunal did not have jurisdiction to award punitive damages in accident benefits disputes. The Tribunal’s jurisdiction was limited to matters provided for in the Insurance Act and Regulations. The Legislature provided clear authority to the Tribunal to grant a special award. No statutory authority existed for an award of punitive damages.
The insurer sought production of the claimant’s AB file from a 2007 accident, and the LTD file relating to the same accident. The claimant argued that the materials were not relevant, as they related to an incident more than 10 years prior to the subject accident. Adjudicator Lake ordered the claimant to produce the full AB file and LTD file, subject to redaction for privilege and reserves. She reasoned that the productions were relevant because the 2007 accident caused significant orthopaedic injuries and resulted in the death of the claimant’s mother. The probative value of the AB file and LTD file outweighed any prejudicial effect. The insurer agreed to pay for the cost of producing the files.
This motion decision arose in the context of a LAT hearing relating to a catastrophic impairment determination. On the third day of the hearing during direct examination of one of the claimant’s expert witnesses, counsel for the insurer objected on the ground that the expert’s testimony was beyond the scope of her written report. The expert’s evidence in direct examination was contained in a rebuttal report, which had not been served on time and was not allowed to be admitted as hearing evidence. The insurer argued that the expert’s testimony should be limited to the expert’s original report. Adjudicator Paluch ruled that the probative value of the expert’s testimony would outweigh the prejudice suffered by the insurer and allowed the expert’s testimony relating to her updated rebuttal report as it was potentially relevant. Adjudicator Paluch also ruled that the insurer would be granted a brief adjournment for the purpose of preparing for cross examination, to prepare its expert to testify, and to call any additional witnesses required to address the claimant’s expert’s evidence.
The insurer sought reconsideration of the Tribunal’s decision that the claimant was an insured person as a dependent of his mother. Vice Chair Flude dismissed the reconsideration because the Tribunal’s decision had not finally disposed of the appeal. Rule 18.1 required that the insurer wait until the matters in dispute were finally disposed of. The preliminary decision did not finally determine the claimant’s entitlement to benefits.
The claimant applied to the LAT seeking a determination that his accident-related impairments were outside of the MIG and entitlement to two treatment plans for medical benefits. A hearing was held in August 2019. Several months later, the LAT was informed that the claimant had passed away. At a subsequent teleconference hearing, the insurer argued that the claimant’s passing rendered the LAT proceeding moot. The deceased claimant’s estate argued that it required a decision on the interest in dispute, and that a decision from the LAT would assist the claimant’s estate in pursuing a tort claim. Adjudicator Mazerolle found that the question of MIG determination was not moot as it was possible that the LAT could find that benefits in dispute were deemed incurred pursuant to s. 3(8) of the SABS. Adjudicator Mazerolle then found that the claimant was within the MIG, and the benefits in dispute were not deemed incurred. The interest in dispute was found not payable, as there was no OCF-21 detailing incurred services and no other evidence that a payable amount was overdue.
The claimant submitted a request for reconsideration arising out of a decision which found that he was not entitled to medical benefits and post-104 week IRBs because the claimant’s psychological impairments were not a result of the accident. The claimant’s reconsideration request was made on the basis that there was fresh evidence (a new IE report from the insurer) that was not before the Tribunal when rendering its decision. The IE report found that the claimant’s psychological impairments flowed from his accident-related chronic pain. Adjudicator Grieves accepted that the new report was not available at the hearing, could not have been obtain previously by the claimant given that the Tribunal’s decision was rendered three months prior to the claimant receiving the report, and that the evidence would likely have affected the result at the hearing. As such, she granted the request for reconsideration in part, finding that the claimant was entitled to post-104 week IRBs and some of the disputed medical benefits.
Vice Chair Flude released a decision in which he found the claimant’s motion moot, and requested submissions on costs from the insurer. The LAT Rules consider costs as a deterrent for a party that “has acted unreasonably, frivolously, vexatiously, or in bad faith” in a proceeding. Vice Chair Flude concluded that the claimant acted unreasonably and in bad faith in bringing a motion for relief previously denied by the Tribunal with no new grounds and, during the hearing, making a collateral attack on another Tribunal Order. Vice Chair Flude ordered the claimant to pay costs to the insurer in the amount of $1,000, which he felt would have sufficient deterrent effect.
The claimant applied to the LAT seeking a determination that her accident-related impairments were outside of the MIG and entitlement to psychological and chronic pain assessments. The insurer argued the claimant was barred from proceeding with the application for MIG determination as the issue had already been adjudicated and decided by the LAT in a previous application. Adjudicator Lake found that the doctrine of res judicata applied, and the claimant was barred from seeking a determination on whether her impairments were outside of the MIG. The application was dismissed.
The claimant filed a request for reconsideration of a LAT hearing decision, in which the adjudicator found that the claimant was entitled to pre-104 IRBs but was not entitled to post-104 IRBs. The claimant argued that the adjudicator had made errors in fact and law, including incorrectly applying the test for IRBs. In the hearing decision, the adjudicator took into consideration post-accident volunteer and work training activities when deciding that the claimant did not meet the test for post-104 IRBs. As a preliminary issue, Adjudicator Reilly agreed with the insurer that the claimant’s Reply submissions should not be considered for the Reconsideration decision, as the Reply raised new issues or facts not raised in the hearing, the Request for Reconsideration, or the Response by the insurer. Adjudicator Reilly found that the adjudicator’s decision provided well-reasoned analysis of the submissions and medical evidence of both parties, and correctly applied the test for post-104 IRBs. The request for reconsideration was dismissed.
The claimant sought entitlement to benefits following an accident that occurred on August 28, 2015. At the case conference, the insurer raised the preliminary issue that the claimant was statute-barred from proceeding with his claim under s. 56 of the Schedule because he failed to appeal its valid denial within the two-year limitation period. A written hearing was scheduled, but claimant’s counsel was removed from the record prior to the deadline for the parties’ written submissions, and the Tribunal did not receive the claimant’s responding submissions by the deadline or hear from the claimant again. The written preliminary hearing proceeded. Adjudicator Boyce found that the claimant was statute-barred from appealing the denial of his claim under s. 56, as he failed to commence his appeal within two years of a valid denial. Adjudicator Boyce found that the insurer’s notice met the Smith requirements and that the claimant failed to provide any evidence or details or any exceptional circumstances or reasons as to why the application was not commenced within the two-year limitation period. Further, he did not offer submissions as to why the Tribunal should exercise its discretion to extend the limitation period under s. 7 of the Licence Appeal Tribunal Act. Despite the lack of communication and participation from the claimant, Adjudicator Boyce was satisfied that the Tribunal facilitated a fair, open and accessible process. Any further delay would offend Rule 3.1(b), which is meant to ensure efficient, proportional and timely resolution of the merits of the proceedings.
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416.507.1850