The claimant sought reconsideration of the Tribunal’s decision that he was not involved in an accident. Adjudicator Grant rejected the reconsideration, holding that there was no error law regarding the purpose or causation test. The claimant had been the victim of an assault, which was an intervening act and the dominant cause of his injuries.
The claimant sought reconsideration of the Tribunal’s decision that she was not entitled to IRBs beyond the 104 week mark. Adjudicator Lake dismissed the reconsideration. The claimant’s arguments were primarily an attempt to have the Tribunal re-weigh the evidence and expert opinions in a more favourable light. This did not constitute an error in law.
The claimant sought reconsideration of the Tribunal’s decision that she was not entitled to IRBs beyond the 104 week mark. Adjudicator Lake dismissed the reconsideration. The claimant’s arguments were primarily an attempt to have the Tribunal re-weigh the evidence and expert opinions in a more favourable light. This did not constitute an error in law.
The claimant sought reconsideration of the Tribunal’s decision that his claim for ACBs and HK expenses was barred by the limitation period. Adjudicator Boyce granted the reconsideration request based on the Court of Appeal’s decision in Tomec v. Economical. The claimant’s ACBs and HK expenses had been denied in 2005. In 2015, the insurer accepted that the claimant suffered a catastrophic impairment, but refused to pay any ACBs or HK expenses based on the earlier denial. Adjudicator Boyce held on reconsideration that the claimant did not discover his claim for ACBs and HK expenses until he was determined to suffer a catastrophic impairment. He also held that the insurer’s denial in 2005 was pre-emptive and was not valid, because the claimant did not require such services at that time.
The claimant sought reconsideration of the Tribunal’s decision that the limitation period barred the claim for NEBs. Adjudicator Norris rejected the reconsideration, holding that there was no legal error made in the Tribunal’s conclusions that the claimant did not have a bona fide intention to appeal within the two year period. He also concluded that the other factors to extend the limitation period did not favour the claimant.
The claimant sought reconsideration of the Tribunal’s decision that she was barred from disputing entitlement to medical benefits because she failed to attend an IE assessment. Adjudicator Norris concluded that he did not commit an error in regard to the proper medical and other reasons for the insurer’s denial since the insurer’s letter noted that the proposed services were not consistent with the injuries report, and noted gaps in treatments without any clinical documentation to explain the same. He also found that there was no violation of procedural fairness as the claimant could attend the IE and re-apply to the LAT if the benefits remained denied.
The claimant sought reconsideration of the Tribunal’s denial of post-104 week IRBs. Adjudicator Go dismissed the reconsideration request. The claimant used the wrong test in arguing for entitlement to IRBs. Further, Adjudicator Go noted that the claimant’s own family physician did not support that she suffered a complete inability to engage in any suitable employment.
The insurer sought reconsideration of the Tribunal’s award of $6,000 per month in ACBs. The claimant was involved in an accident in 2015 and deemed catastrophically impaired three years later. The claimant’s Form 1 recommended $8,467.65 worth of ACBs per month; the insurer’s Form 1 supported $1,583.45 in ACBs per month. The insurer argued that the Tribunal erred in its decision, and that the evidence showed that the claimant was largely independent at the time the Form 1 was submitted, that the Tribunal did not properly apply the “but for” test, that the Tribunal incorrectly admitted late evidence, and failed to apply the proper law in relation to ACBs. Adjudicator Lester reiterated the exhaustive list of reasons why such a high quantum of ACBs were warranted and rejected the reconsideration request. She further commented that, although the claimant’s Form 1 was not included in the evidence brief prior to the hearing, the insurer had a chance to object to it being admitted into evidence at the hearing and did not, it was also a key piece of evidence that caused no prejudice to the insurer as it was aware of it prior to the hearing. Although the claimant and her treating therapists did not specifically elaborate on a precise breakdown of each line of the Form 1 in dispute, Adjudicator Lester was satisfied that it was reasonable on the grounds of the claimant’s psychological injuries requiring a higher level of assistance, such as cueing.
The insurer sought reconsideration of the Tribunal’s award of $6,000 per month in ACBs. The claimant was involved in an accident in 2015 and deemed catastrophically impaired three years later. The claimant’s Form 1 recommended $8,467.65 worth of ACBs per month; the insurer’s Form 1 supported $1,583.45 in ACBs per month. The insurer argued that the Tribunal erred in its decision, and that the evidence showed that the claimant was largely independent at the time the Form 1 was submitted, that the Tribunal did not properly apply the “but for” test, that the Tribunal incorrectly admitted late evidence, and failed to apply the proper law in relation to ACBs. Adjudicator Lester reiterated the exhaustive list of reasons why such a high quantum of ACBs were warranted and rejected the reconsideration request. She further commented that, although the claimant’s Form 1 was not included in the evidence brief prior to the hearing, the insurer had a chance to object to it being admitted into evidence at the hearing and did not, it was also a key piece of evidence that caused no prejudice to the insurer as it was aware of it prior to the hearing. Although the claimant and her treating therapists did not specifically elaborate on a precise breakdown of each line of the Form 1 in dispute, Adjudicator Lester was satisfied that it was reasonable on the grounds of the claimant’s psychological injuries requiring a higher level of assistance, such as cueing.
The claimant was the operator of a vac-truck that responded to a fatal tractor-trailer collision. The claimant alleged that, as a result of cleaning up the spilled substances resulting from the accident and seeing the deceased bodies, he suffered from both physical and psychological injuries. The Tribunal denied the claim on the grounds that it did not meet the definition of an “accident”. The claimant filed for Reconsideration. In her decision, Adjudicator Lester noted that the environmental spill would be considered an intervening act, and not part of the “ordinary course of things” in relation to the use or operation of a motor vehicle. Furthermore, the tractor trailer itself did not directly cause the claimant’s injuries. It collided with another vehicle causing a chemical spill and fatality, which ultimately led to the claimant’s injuries as the claimant’s job was to clean up chemical spills outside of his vehicle. The chemical spill and deceased body were not as a result of the use or operation of a vehicle, but as a result of a collision. Adjudicator Lester denied the Reconsideration request.
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150 York Street, Suite 1800
Toronto, Ontario M5H 3S5
416.507.1850
© 2020 Thomas Gold Pettingill LLP