Category: Reconsideration

M.J. v. TD Home and Auto Insurance Company (18-004395)

The claimant had filed two LAT applications: one addressing NEBs and five treatment plans; the second addressing a catastrophic impairment determination. The claimant had exhausted her medical benefits and would only be entitled to the disputed treatment plans if she suffered a catastrophic impairment. A hearing was scheduled on the first application, while the second application had not yet gone through the Case Conference. The insurer sought an order that the treatment plans be removed from the first application because they could not be awarded until the catastrophic impairment determination was made. The Case Conference adjudicator denied the request. The insurer requested reconsideration, and Vice Chair Trojek also denied the request. Instead, she ordered that the scheduled hearing be adjourned and that the two LAT applications be combined so that all issues could be determined at once. She reasoned that approach was the most cost effective and just determination of all issues.

M.K. v. Waterloo Insurance (17-001265)

The claimant sought reconsideration of the Tribunal’s decision that his injuries fell within the MIG. Associate Chair Batty held that the Tribunal did not make an error in its factual conclusions regarding the claimant’s alleged psychological injuries or pre-existing conditions. The reconsideration was dismissed.

Applicant v. Security National Insurance Company (18-001613)

The insurer sought an adjournment of the scheduled Case Conference to allow time for CAT assessment to be completed. The Tribunal refused the requested. Associate Chair Batty also refused the adjournment request, stating that the assessments need to be completed by the time of the Case Conference for the insurer to participate. The insurer’s defence did not need to be finalized by the Case Conference, and the claim was not being adjudicated during the Case Conference.

Z.P. v. Guarantee Insurance (18-003753)

The claimant had requested an adjournment of a written hearing due to her counsel’s unanticipated medical leave. The LAT refused the adjournment. On reconsideration, Vice Chair Trojek granted the adjournment and set new dates for the written hearing. She wrote that the Tribunal relied too heavily on a strict adherence with its rules and failed to take into consideration the unforeseen and uncontrollable circumstances which were supported by documentary evidence.

Applicant v. The Guarantee Company of North America (17-006956)

The claimant sought reconsideration of the Tribunal’s decision that she was not entitled to payment for catastrophic impairment assessments. Vice Chair Shapiro upheld the decision. He wrote that the Tribunal accurately considered whether there was some objective evidence to suggest that the claimant may suffer a 55 percent WPI. The Tribunal found that further investigation for catastrophic impairment status was not reasonable and necessary.

Applicant v. Intact Insurance Company (17-004109)

The insurer sought reconsideration of the Tribunal’s order that the claimant was required to attend two Ies before the matter could proceed, in accordance with section 55. However, the Tribunal’s decision included terms regarding the IEs; Intact disputed those terms. Vice Chair Shapiro upheld the terms imposed by the Tribunal. He concluded that the Tribunal properly performed a “balancing act,” and that the Tribunal did not make an error. There was no evidence that a paper review rather than an in-person review would be impossible or meaningless.

Applicant v. Intact Insurance Company (17-004109)

The insurer sought reconsideration of the Tribunal’s order that the claimant was required to attend two Ies before the matter could proceed, in accordance with section 55. However, the Tribunal’s decision included terms regarding the IEs; Intact disputed those terms. Vice Chair Shapiro upheld the terms imposed by the Tribunal. He concluded that the Tribunal properly performed a “balancing act,” and that the Tribunal did not make an error. There was no evidence that a paper review rather than an in-person review would be impossible or meaningless.

M.Y. v. Aviva Insurance Company (17-007683)

The Insurer filed a Request for Reconsideration of a hearing decision that allowed the claimant to proceed with her application despite non-attendance at insurer examinations requested under s. 44 of the SABS. The hearing adjudicator had ordered the respondent to attend the insurer examinations as a condition to allowing the claimant to proceed. The insurer had been ordered to provide the claimant with new examination dates within 35 business days of receiving the hearing decision. The insurer argued in the Request for Reconsideration that due to the prejudice it suffered as a result of the claimant’s failure to attend numerous examinations over a period of years, the claimant should be barred from proceeding with her application. Vice Chair Trojek dismissed the insurer’s request that the claimant be completely barred from proceeding with the LAT application. Vice Chair Trojek found that the hearing decision did not violate the rules of natural justice or make a significant error in law or fact.

Applicant v. The Guarantee Company of North America (18-002753)

The claimant sought the raw test data from the insurer’s psychologist. The request was denied during the Case Conference. On reconsideration, Vice Chair Marzinotto also dismissed the request. She wrote that the claimant failed to provide any basis for reconsideration, and there were no supporting facts for the reconsideration.

P.J. v. Aviva Insurance Company (18-001418)

The insurer sought reconsideration of the order that it produce unredacted log notes and that the claimant was not required to provide the particular of the special award claim until after receipt of the log notes. Vice Chair Trojek held that the insurer was to provide the log notes up to the date the LAT application was filed, with redactions for reserves, litigation privilege, and solicitor-client privilege. She dismissed the request that the claimant be required to particularize the special award claim prior to receipt of the log notes and ordered that the claimant had 30 days to provide particulars.