Executive Summary: Key Legal and Evidentiary Issues

• Assessed whether the Licence Appeal Tribunal properly denied catastrophic impairment and income replacement benefits.

• Evaluated claims of procedural unfairness during the seven-day hearing and reconsideration process.

• Addressed allegations that the Vice-Chair relied on findings of malingering not disclosed in insurer’s denial letters.

• Considered the sufficiency of reasons and whether factual findings were supported by the record.

• Applied the Vavilov standard of review for both statutory appeal (correctness) and judicial review (reasonableness).

• Concluded that the Tribunal's decision was legally sound, procedurally fair, and justified in light of the evidence.

Factual background and procedural history

Rogiar Jamali was injured in a motor vehicle accident in May 2015 and applied for benefits under Ontario’s Statutory Accident Benefits Schedule (SABS), claiming she was catastrophically impaired and entitled to income replacement benefits. Economical Insurance Company denied her claim. Ms. Jamali brought her case before the Licence Appeal Tribunal (LAT), where a seven-day hearing took place in February 2024. In May 2024, Vice-Chair Jeremy Roberts issued a decision dismissing both of her claims. Ms. Jamali then requested reconsideration, which was also denied.

Following these outcomes, she brought two proceedings before the Divisional Court: a statutory appeal under the Licence Appeal Tribunal Act and an application for judicial review. She alleged legal errors, procedural unfairness, and unreasonable findings of fact in both the original LAT decision and the reconsideration ruling.

Issues raised and the Tribunal's findings

At the Tribunal, Ms. Jamali was required to show she met the definition of catastrophic impairment under “criterion 8,” requiring evidence of a marked or extreme mental or behavioral impairment directly linked to the accident. The Vice-Chair found that her evidence lacked credibility, the objective medical evidence was inconsistent with her claims, and that suspected malingering or symptom exaggeration undermined her case. The Tribunal further found that her reported impairments did not meet the legal threshold for “marked” impairment in any functional domain.

On the issue of income replacement benefits, the Tribunal reviewed her eligibility beyond the two-year post-accident mark. Although she initially received benefits based on one doctor’s report, the insurer later terminated them after a new assessment. The Vice-Chair concluded that Ms. Jamali had not demonstrated a complete inability to engage in suitable employment, referencing her post-accident work with her father’s company and her active lifestyle, including international travel and personal tasks requiring cognitive function.

Ms. Jamali claimed that her procedural rights were violated, particularly when the Vice-Chair limited cross-examinations and denied her request to call certain witnesses. She also objected to how the Tribunal addressed allegations of malingering, which she argued were not disclosed in the insurer’s denial letters.

Divisional Court’s analysis and ruling

Justice Ryan Bell, writing for a unanimous Divisional Court panel, dismissed both the appeal and the judicial review. The court held that the LAT properly exercised its discretion throughout the hearing and that no procedural unfairness occurred. The Tribunal provided detailed and coherent reasons, applied the correct legal test for causation using the “but for” standard, and had sufficient evidentiary basis for its conclusions.

The court rejected the argument that the Vice-Chair’s reference to malingering constituted a medical diagnosis or created unfair surprise. Instead, the Tribunal had relied on psychometric testing in the record, and even without that finding, the Vice-Chair independently concluded that the impairments did not meet the catastrophic threshold.

As for the income replacement benefits, the Tribunal reasonably determined that Ms. Jamali did not suffer a complete inability to work. The Vice-Chair’s analysis considered multiple factors, including inconsistent medical evidence and her own reported activities.

Conclusion and outcome

The Divisional Court dismissed both the appeal and the judicial review application. It found no legal errors, no breach of procedural fairness, and no unreasonable findings of fact. The court ordered Ms. Jamali to pay Economical Insurance $10,000 in costs, as previously agreed by the parties. The decision affirms the deference owed to specialized tribunals in the context of accident benefits adjudication and underscores the importance of credibility, consistency, and objective evidence in personal injury claims.