Amanda Fricot

The applicant sought statutory accident benefits following a rear-end motor vehicle collision, claiming entitlement to income replacement benefits (IRBs), medical benefits, and the cost of a psychological assessment.

The respondent argued the applicant suffered only minor injuries subject to the Minor Injury Guideline (MIG).

The Tribunal found that the applicant sustained a mild concussion, removing him from the MIG.

However, the Tribunal dismissed the claim for IRBs, finding insufficient evidence that the applicant's soft tissue injuries or concussion caused a substantial inability to perform the essential tasks of his pre-accident employment as a cabinet-maker.

Claims for physiotherapy, chiropractic treatment, and assistive devices were denied as not reasonable and necessary.

The Tribunal granted the cost of a psychological assessment, finding it reasonable based on an initial screening.

The Tribunal also awarded $150 in costs to the respondent due to the applicant's breach of a direction not to communicate with a witness during the hearing.

The applicant sought an award under O. Reg. 664, alleging the respondent unreasonably withheld or delayed payment of statutory accident benefits following a motor vehicle accident.

The respondent had denied several treatment plans for occupational therapy, psychological assessments, and chiropractic services, maintaining the denials even after determining the applicant's injuries fell outside the Minor Injury Guideline.

The Tribunal found the respondent's continued denial of these benefits for over six months without reasonable explanation constituted an unreasonable delay.

The Tribunal ordered the respondent to pay an award of $1,500 plus interest.

The applicant filed a Request for Reconsideration of a decision that dismissed his application for statutory accident benefits following a motor vehicle accident in Quebec.

The applicant alleged errors of law and fact and breaches of procedural fairness.

The adjudicator found that the applicant had a full opportunity to be heard and that no errors of law or fact were made in the original decision.

The request for reconsideration was dismissed.

The applicant, a pedestrian struck by a vehicle, sought statutory accident benefits including income replacement benefits (IRBs), physical rehabilitation therapy, and a physiatry assessment.

The Licence Appeal Tribunal found that the applicant failed to prove a substantial inability to perform the essential tasks of his pre-accident employment, noting he returned to work with increased hours shortly after the accident.

The Tribunal dismissed the claims for IRBs and physical therapy, but granted the cost of a physiatry assessment to determine if a herniated disc was accident-related.

Claims for interest, a special award, and adding a new issue were dismissed.

The applicant requested a reconsideration of a Tribunal decision that dismissed her claim for statutory accident benefits.

The applicant had slipped and fallen on ice while opening her car door.

The adjudicator originally found that the incident was not an 'accident' under the Schedule because the ice was the intervening and dominant cause of the fall, breaking the chain of causation.

On reconsideration, the applicant argued this finding was an error of fact and law.

The adjudicator dismissed the request, finding no error in the application of the causation test, the intervening causes analysis, or the dominant feature analysis.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the insurer's denial of several treatment plans and medical expenses.

The Licence Appeal Tribunal found that the insurer's denial complied with s. 38(8) of the Schedule by adequately relying on an Insurer's Examination report.

The Tribunal partially allowed the claim for an aqua therapy program, limiting recovery to pool sessions incurred after the treatment plan was submitted and at the rate for an unregulated provider.

Claims for chiropractic laser therapy and orthotics were dismissed for lack of evidence, while a prescription expense for migraine medication was allowed.

The applicant's request for a special award under Ontario Regulation 664 was dismissed as the insurer's reliance on the medical assessment was not unreasonable.

The applicant sought reconsideration of a decision denying her claim for accident benefits after she slipped and fell at a gas station.

The adjudicator had previously found that the incident did not meet the definition of an 'accident' under the Statutory Accident Benefits Schedule.

On reconsideration, the applicant argued that the adjudicator erred in applying the two-part test for an accident.

The adjudicator dismissed the request, finding no error of law or fact in the application of the purpose and causation tests, as the applicant had completed refuelling and was walking away from her vehicle when she fell.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits.

After withdrawing his claim for a non-earner benefit, the applicant requested that the Tribunal proceed with a written hearing solely to determine whether his injuries were subject to the Minor Injury Guideline (MIG).

The Tribunal held that it does not have jurisdiction to determine whether the MIG applies as a stand-alone issue in the absence of an underlying dispute relating to entitlement to a specific benefit under the Schedule.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming chronic pain, post-traumatic fibromyalgia, and sleep disorder to escape the Minor Injury Guideline (MIG).

The adjudicator found the applicant's evidence of functional limitations and pain severity to be vague, inconsistent, and contradicted by his family doctor's records.

The adjudicator rejected the applicant's expert opinion and concluded the injuries were predominantly minor soft tissue injuries subject to the MIG.

As the $3,500 MIG limit was exhausted, the claimed medical and assessment benefits were denied.

The respondent's request for costs was also dismissed.

The applicant sought production of the respondent's adjuster's log notes from the date of a prior FSCO application to the date the current application was filed with the Tribunal.

The respondent claimed the notes were protected by litigation privilege.

The Tribunal found that while litigation was contemplated for some claims as of the FSCO application date, the respondent failed to establish that all subsequent log notes were created for the dominant purpose of litigation.

The Tribunal ordered the respondent to produce the log notes, subject to redactions for irrelevancy, solicitor-client privilege, and reserves, and to provide particulars for each redaction.

The applicant, who was catastrophically injured in a motor vehicle accident, sought payment of legal fees incurred in obtaining a guardianship order as a rehabilitative benefit under the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to submit a treatment and assessment plan in advance of incurring the expense, as required by section 38(2) of the Schedule.

The Tribunal also dismissed the claims for interest, costs, and a special award.

The applicant sought production of all surveillance evidence from the respondent insurer, regardless of whether the insurer intended to rely on it at the hearing.

The adjudicator found that surveillance evidence is relevant to the catastrophic impairment determination.

However, litigation privilege arose on September 4, 2014, when the applicant filed a prior related application for a non-earner benefit.

Applying the Supreme Court's decision in Blank, the adjudicator held that the litigation privilege from the 2014 application continued for the current application because both proceedings shared a common factual issue regarding the applicant's level of impairment.

The respondent was ordered to disclose and produce surveillance conducted prior to September 4, 2014, but surveillance conducted after that date was protected by litigation privilege and did not need to be produced unless the respondent intended to rely on it.

The applicant sought statutory accident benefits after slipping and falling on ice while attempting to open the door of her parked car.

The respondent denied the claim on the basis that the incident was not an 'accident' under the Schedule.

The Licence Appeal Tribunal applied the two-part test for an accident.

While the purpose test was met because opening a car door is an ordinary use of a vehicle, the causation test failed.

The Tribunal found that the icy parking lot was an intervening cause and the dominant feature of the fall, breaking the chain of causation.

The application was dismissed.

The applicant was struck by a minivan and sought statutory accident benefits for physiotherapy, an in-home assessment, and an orthopaedic assessment.

The respondent initially denied the treatment plans with defective notices under s. 38(8) of the Schedule, but later provided proper notice with IE reports.

The Tribunal found that none of the treatment plans were reasonable and necessary, relying on the applicant's family doctor's records and the respondent's IE physician.

However, because of the initially defective notice, the respondent was ordered to pay for any physiotherapy costs incurred between the 11th business day after the plan was submitted and the date proper notice was given.

The claims for the assessments and a special award were dismissed.

The applicant sought statutory accident benefits after slipping and falling at a gas station after refuelling her vehicle.

The respondent denied the claim on the basis that the incident was not an 'accident' under section 3(1) of the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal held a preliminary issue hearing to determine if the incident met the definition of an accident.

The Tribunal applied the two-part purpose and causation test and found that the applicant was walking away from her car when she fell, meaning the ordinary use of the vehicle had ended.

Furthermore, the fall was an intervening act and the direct cause of her injuries, not the use or operation of the vehicle.

The Tribunal also dismissed the applicant's motion to compel and exclude evidence.

The application was dismissed.

The applicant was injured in a rear-end motor vehicle accident and sought statutory accident benefits for chronic pain and psychological impairments, arguing his injuries fell outside the Minor Injury Guideline (MIG).

The respondent denied the claims, asserting the injuries were predominantly minor.

The Licence Appeal Tribunal found that the applicant's soft tissue injuries and associated chronic back pain were predominantly minor, as there was insufficient evidence of functional impairment or disability.

The Tribunal also found no evidence of psychological injury.

Consequently, the MIG applied, and since the $3,500 limit had been exhausted, the claims for further assessments and treatment were dismissed.

The applicant was struck by a vehicle while riding his electric bike, sustaining two fractured ribs.

He sought income replacement benefits (IRBs), medical benefits, and the cost of various assessments from his insurer.

The Licence Appeal Tribunal found that the applicant was not entitled to IRBs because he was not employed, self-employed, or receiving Employment Insurance at the time of the accident, nor had he worked 26 of the 52 weeks prior.

The Tribunal also dismissed the claims for medical benefits and assessments, finding that the applicant's accident-related injuries had substantially resolved by July 2017 and the proposed treatments and assessments were not reasonable and necessary.

Claims for an award under O. Reg. 664 and interest were consequently dismissed.

The applicant was injured in a motor vehicle accident and sought medical benefits for chiropractic, massage, and physiotherapy treatments under the Statutory Accident Benefits Schedule.

The insurer denied the claims.

The Licence Appeal Tribunal found that the applicant failed to prove on a balance of probabilities that the proposed treatment plans were reasonable and necessary.

Medical evidence indicated the applicant's physical injuries were minor and improving, and the treatment plans did not adequately explain how further treatment would assist with accident-related injuries.

The application was dismissed.

The applicant sought a medical benefit of $1,300.00 for chiropractic services following a motor vehicle accident.

The respondent denied the claim.

The Licence Appeal Tribunal found that the applicant failed to prove the treatment plan was reasonable and necessary, noting it was inconsistent with a recent physiotherapy discharge report indicating the applicant had returned to her pre-injury level of function.

The application was dismissed and no interest was awarded.

The applicant was injured in a motorcycle accident and sought payment for neurological, chronic pain, and orthopaedic assessments under the Statutory Accident Benefits Schedule.

The respondent denied the treatment plans.

The Licence Appeal Tribunal found that the chronic pain assessment was reasonable and necessary given the applicant's ongoing complaints of pain and stiffness.

However, the Tribunal dismissed the claims for neurological and orthopaedic assessments, finding insufficient medical evidence to support their necessity.

Claims for interest and costs were also dismissed.