Avvy Go

The applicant, a 10-year-old passenger injured in a motor vehicle accident, sought a medical benefit of $1,840.00 for optometric services (vision therapy) under the Statutory Accident Benefits Schedule.

The respondent insurer denied the claim, arguing the visual issues were not caused by the accident.

The Licence Appeal Tribunal found that, on a balance of probabilities, the applicant's post-accident visual challenges were a result of the accident and could not be mitigated by prescription glasses alone.

The Tribunal ordered the respondent to pay the medical benefit and interest on the overdue payment.

The applicant sought payment for several medical benefits and assessments following a motor vehicle accident, which the respondent insurer denied.

The Licence Appeal Tribunal found that the proposed physiotherapy and laser spinal decompression treatments were reasonable and necessary, rejecting the insurer's argument that they were merely passive therapies.

The Tribunal also approved a psycho-vocational and functional abilities evaluation, capping the cost at the statutory limit of $2,000 per assessment, and allowed an in-home assessment for attendant care needs despite the 104-week mark having passed, as the applicant might be entitled to future benefits if deemed catastrophically impaired.

The applicant was injured in a motor vehicle accident and sought attendant care benefits under the Statutory Accident Benefits Schedule.

The applicant hired a Personal Support Worker (PSW) who shared his cultural and linguistic background, but who was not employed as a PSW at the time of the accident.

The respondent insurer refused to pay the benefits, arguing the service provider was not acting in the course of her employment and had not sustained an economic loss.

The Tribunal found that the service provider, who had a PSW certificate and subsequently worked as a PSW, was providing care in her professional capacity.

The Tribunal held that the applicant was entitled to the attendant care benefits and interest, and declined to award costs to the respondent.

The applicant was injured in a motor vehicle accident and sought approval for a psychiatric assessment.

The respondent insurer denied the treatment plan and requested the applicant attend an independent psychiatric examination under s. 44 of the Statutory Accident Benefits Schedule.

The applicant refused to attend, arguing the insurer failed to provide adequate medical reasons.

On a preliminary issue, the Tribunal found the insurer's notice complied with s. 44.

While the applicant could be precluded from proceeding under s. 55 for non-attendance, the Tribunal exercised its discretion to adjourn the application for 60 days to allow the applicant to attend the examination, noting it would be unfair to bar the claim entirely when both parties agreed a psychiatric assessment was necessary.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including a non-earner benefit, chiropractic services, and a psychological assessment.

The respondent denied the medical and assessment benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant's injuries were predominantly soft tissue injuries falling within the MIG, and that he failed to prove pre-existing conditions or chronic pain that would warrant an exception.

The Tribunal also dismissed the claim for a non-earner benefit, finding insufficient evidence that the applicant suffered a complete inability to carry on a normal life.

The claims for chiropractic services and a psychological assessment were dismissed as not reasonable and necessary.

The applicant sought statutory accident benefits following a motor vehicle accident.

The respondent insurer scheduled a section 44 psychological assessment, which the applicant refused to attend.

The respondent argued the applicant was precluded from proceeding with the application due to this refusal.

The Tribunal found that the respondent's notice for the section 44 assessment failed to include medical or other reasons for the examination, rendering it non-compliant with the Schedule.

Consequently, the applicant was not precluded from proceeding with the application.

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

The respondent insurer denied the claims, arguing the injuries fell within the Minor Injury Guideline (MIG) and that a claim for $1,165.00 in physiotherapy services was statute-barred.

The Tribunal found that the applicant's injuries were predominantly minor, as there was no compelling medical evidence of a pre-existing condition that would prevent maximal recovery within the MIG cap.

Furthermore, the Tribunal dismissed the claim for physiotherapy services because the applicant failed to file the application within the two-year limitation period.

The applicant sought statutory accident benefits for chiropractic, psychological, and occupational therapy services following a 2006 motor vehicle accident.

The insurer denied the treatment plans and raised a preliminary issue that the plans were initially unsigned.

The Tribunal held that the insurer waived the signature requirement by failing to raise it in the initial denial letters.

On the merits, the Tribunal found the chiropractic and occupational therapy plans were reasonable and necessary to address the applicant's chronic pain, though mileage expenses for the occupational therapist were excluded.

The psychological treatment plans were denied due to insufficient evidence of ongoing psychological distress and the applicant's failure to attend previously approved sessions.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, which the respondent insurer denied.

The applicant filed for mediation at FSCO, but the mediation did not take place and the file was closed.

The applicant subsequently filed an application with the Licence Appeal Tribunal after the transition of dispute resolution from FSCO to the Tribunal.

The Tribunal held that the application was statute-barred because it was filed beyond the two-year limitation period and outside the 90-day extension period following the closure of the FSCO mediation file.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, which the respondent insurer denied.

The applicant filed for mediation at FSCO, but the mediation did not take place and the file was closed.

The applicant subsequently applied to the Licence Appeal Tribunal.

The respondent argued the application was statute-barred as it was filed beyond the two-year limitation period and the 90-day extension following a failed mediation.

The Tribunal found that while the 90-day extension applied, the applicant filed his application approximately a week after the extension expired.

As the applicant failed to provide authority to extend the limitation period further, the application was dismissed as statute-barred.

The applicant insurer sought repayment of $5,085.71 in income replacement benefits (IRB) paid to the respondent, alleging the respondent had returned to work without notifying the insurer.

The respondent did not participate in the hearing.

The Tribunal found insufficient evidence to establish the respondent returned to work on the date alleged by the insurer, but accepted an OCF-3 form indicating a return to work by May 1, 2014.

The Tribunal concluded the insurer provided proper notice of the overpayment and ordered the respondent to repay $1,257.14 for the period between May 1 and May 22, 2014, plus 1% simple interest.