Brett Todd

The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit and several physiotherapy treatment plans.

The matter proceeded to a written hearing.

The applicant failed to file any submissions or evidence by the deadlines set in a case conference report and a subsequent motion order.

Due to the applicant's failure to meet her evidentiary burden, the Licence Appeal Tribunal dismissed the application in its entirety.

The applicant was injured in a motor vehicle accident and sought payment for various treatment plans under the Statutory Accident Benefits Schedule.

The respondent insurer partially denied the plans, arguing the amounts exceeded the maximum rates established in the Professional Services Guideline.

The Licence Appeal Tribunal found that the applicant was entitled to the higher rates for document preparation and osteopathic services, as well as the recommended 1.5-hour psychological therapy sessions, ordering the respondent to pay the disputed balances plus interest.

The applicant sought statutory accident benefits for dental treatment, claiming a motor vehicle accident exacerbated prior damage to a tooth, requiring an implant or bridge.

The respondent denied the claim, arguing the treatment was not reasonable and necessary and that the tooth was already irreparably damaged before the accident.

The Tribunal found that the applicant failed to prove the dental treatment would not have been required but for the accident, as his own dentist's records did not connect the damage to the accident and the respondent's expert concluded the tooth needed replacement prior to the accident.

The application was dismissed.

The insurer brought a preliminary issue motion to bar the insured from proceeding with a claim for income replacement benefits (IRB) because he failed to submit a Disability Certificate (OCF-3) within 104 weeks of the accident.

The insured argued that O. Reg. 73/20, enacted during the COVID-19 pandemic, extended the deadline by 183 days.

The Tribunal held that O. Reg. 73/20 applies to legal proceedings and limitation periods, not to the specific document submission deadlines within the Statutory Accident Benefits Schedule.

Finding that the OCF-3 was never properly submitted to the insurer within the prescribed timeline, the Tribunal barred the insured from proceeding and dismissed the IRB claim.

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

The matter was scheduled for a written hearing, but the applicant failed to file any submissions or evidence by the deadlines.

Consequently, the Tribunal dismissed the application, finding the applicant failed to meet his evidentiary burden.

The respondent's request for costs was also dismissed, as the Tribunal found that merely failing to file submissions did not constitute unreasonable, frivolous, vexatious, or bad faith conduct.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming his injuries, including chronic pain, warranted treatment outside the Minor Injury Guideline (MIG).

The respondent denied the treatment plans, arguing the injuries were minor.

The Licence Appeal Tribunal found that the applicant failed to prove he suffered from non-minor injuries or chronic pain with functional impairment.

The Tribunal preferred the comprehensive insurer's examination report over the applicant's medical evidence.

As the applicant remained within the MIG and its $3,500 limit was exhausted, the claims for treatment plans, an award, and interest were dismissed.

The applicant sought a non-earner benefit, a chronic pain assessment, and psychological services following a motor vehicle accident.

The Tribunal found the applicant was not entitled to the non-earner benefit or psychological services, as the medical evidence indicated his cognitive decline and psychological issues were caused by a pre-existing neurological condition (brain calcifications leading to dementia) rather than the accident.

However, the Tribunal approved the chronic pain assessment, finding it reasonable and necessary given the consistent reporting of musculoskeletal pain since the accident.

The applicant was struck by a vehicle while crossing the street and sought statutory accident benefits for injuries sustained.

The insurer denied two treatment plans for chiropractic services and assistive devices.

The Licence Appeal Tribunal found both treatment plans to be reasonable and necessary, preferring the applicant's medical evidence over the insurer's examination reports, which were primarily focused on a withdrawn non-earner benefit claim.

The Tribunal awarded interest on the overdue benefits but dismissed the applicant's claim for a special award, finding the insurer had applied proper due diligence.

The Tribunal also dismissed the insurer's request for costs related to the late withdrawal of the non-earner benefit claim.

The applicant sought statutory accident benefits following a single-vehicle accident.

The Tribunal found the applicant was not entitled to a non-earner benefit, as she failed to demonstrate a complete inability to carry on a normal life, noting her pre-existing conditions and lack of evidence showing a significant post-accident functional decline.

However, the Tribunal removed the applicant from the Minor Injury Guideline (MIG), finding she met the criteria for chronic pain and suffered an exacerbation of prior psychological impairments.

The Tribunal awarded $2,460.00 for a psychological assessment but denied a $3,805.69 claim for physiotherapy because the treatment plan was not submitted into evidence.

The applicant sought statutory accident benefits for chiropractic and massage therapy treatment plans following a motor vehicle accident.

The respondent denied the benefits, arguing they were not reasonable and necessary.

The Tribunal found that the applicant failed to provide corroborating medical evidence to support the treatment plans, relying solely on the OCF-18 forms.

The Tribunal accepted the respondent's insurer examination report, which concluded the applicant had reached maximum medical improvement and exhibited no observable impairments.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming her chronic pain and psychological conditions warranted removal from the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant's medical evidence, which was not contemporaneous with the accident and lacked formal diagnoses of chronic pain or functional impairment, was insufficient to meet her burden.

The Tribunal preferred the respondent's insurer examination reports, which consistently concluded the applicant suffered only soft-tissue injuries.

Consequently, the applicant's injuries were deemed predominantly minor, and her claims for treatment plans beyond the $3,500 MIG limit and interest were dismissed.

The applicant sought statutory accident benefits for various treatment plans and assessments following a motor vehicle accident.

The respondent denied the benefits.

The Tribunal dismissed the application, finding that the applicant failed to meet her burden of proving the treatment plans were reasonable and necessary.

Crucially, the applicant failed to submit the actual treatment plans (OCF-18s) into evidence, making it impossible for the Tribunal to assess them.

Furthermore, the Tribunal preferred the respondent's medical evidence, including multiple insurer examinations, which concluded the applicant had reached maximum medical improvement and did not require the disputed treatments.

The applicant sought entitlement to various statutory accident benefits following a motor vehicle accident, including treatment plans for psychological, physiotherapy, and chiropractic services, as well as catastrophic assessments and medical expenses.

The Licence Appeal Tribunal found the psychological and physiotherapy treatment plans to be reasonable and necessary, supported by extensive medical evidence, and noted the insurer's failure to provide proper notice of denial for one plan.

However, the Tribunal denied the chiropractic plan as there was no proof it was submitted, denied the catastrophic assessments as the unapproved file reviews were not standalone assessments, and denied the medical expenses incurred in China as they were submitted late and not proven reasonable and necessary.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's determination that his injuries fell within the Minor Injury Guideline.

The matter proceeded to a written hearing, but the applicant failed to provide any submissions or evidence despite multiple opportunities and notifications that he was no longer represented by counsel.

The Tribunal dismissed the application, finding that the applicant failed to meet his evidentiary burden to establish entitlement to the claimed benefits.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming her chronic pain and psychological impairments warranted removal from the Minor Injury Guideline (MIG).

The respondent denied the treatment plans, arguing the injuries were minor and the $3,500 MIG limit was exhausted.

The Tribunal found the applicant failed to provide compelling medical evidence of a chronic pain condition or psychological impairment outside the MIG.

The application was dismissed, and claims for treatment plans, interest, and a special award were denied.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming her injuries warranted treatment outside the Minor Injury Guideline (MIG) due to chronic pain, psychological issues, and exacerbation of a pre-existing condition.

The insurer denied the disputed treatment plans, arguing the injuries were predominantly minor.

The Tribunal found the applicant failed to meet her burden of proving her injuries fell outside the MIG, preferring the insurer's medical examination reports over the applicant's unsupported treatment plans.

As the $3,500 MIG limit had been exhausted, the application for the disputed treatment plans and interest was dismissed.

The applicant failed to attend three scheduled case conferences.

The Tribunal issued a notice of intent to dismiss the application as abandoned.

The applicant provided written submissions and a medical note explaining that the third absence was due to a medical emergency.

The respondent's submissions were filed incorrectly and not considered.

The Tribunal accepted the applicant's medical explanation and declined to dismiss the application, noting the consumer protection purpose of the Schedule, but ordered peremptory attendance at the next case conference.

The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit, lost educational expenses, and various treatment plans.

The Licence Appeal Tribunal dismissed the application in its entirety.

The Tribunal found the applicant failed to prove a complete inability to carry on a normal life, preferring the respondent's multidisciplinary assessments over the applicant's self-reported evidence.

Claims for lost educational expenses were denied as academic transcripts showed the applicant continued his studies and improved his grades post-accident.

The disputed treatment plans were found not to be reasonable and necessary, and the requested hourly rate for a social worker exceeded the applicable Guideline maximum.

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

The insurer determined the applicant's injuries fell within the Minor Injury Guideline (MIG) and denied further treatment plans as the $3,500 limit was exhausted.

The applicant argued he suffered from chronic pain and psychological impairments warranting removal from the MIG.

The Tribunal found insufficient evidence of chronic pain or psychological impairment, preferring the insurer's psychological assessment over the applicant's.

The Tribunal concluded the injuries were predominantly minor, and since the MIG limit was exhausted, the disputed treatment plans were not payable.

The applicant was injured in a 1994 motor vehicle accident and sought a supervisory level of attendant care benefits (ACB) and several treatment plans after reopening her claim in 2015.

The respondent denied the benefits, arguing a lack of causation and relying on insurer's examinations that recommended minimal care.

The Tribunal found the applicant suffered from conversion disorder causing unpredictable, debilitating tremors, necessitating 24/7 supervisory care for her safety.

The Tribunal awarded the maximum $3,000 monthly ACB, past ACB, and all disputed treatment plans.

Furthermore, the Tribunal ordered a 50% special award against the respondent under s. 10 of Regulation 664, finding the insurer's prolonged reliance on a baseless causation argument to deny benefits was excessive, stubborn, and unreasonable.