Brian Norris

The applicant was injured while riding a public bus and sought statutory accident benefits, including non-earner benefits, catastrophic impairment assessments, and various medical and rehabilitation benefits.

The Licence Appeal Tribunal found that the applicant did not suffer a complete inability to carry on a normal life, dismissing the claim for non-earner benefits.

However, given the applicant's significant pre-existing conditions and accident-related physical and psychological injuries, the Tribunal found the catastrophic impairment assessments reasonable and necessary, excluding a file review fee.

The Tribunal also approved a neurological assessment and a psychological treatment plan, while dismissing the remaining treatment plans.

The applicant insurer sought repayment of $12,731.87 in income replacement benefits (IRBs) paid to the respondent following a motor vehicle accident.

The insurer alleged that the respondent wilfully misrepresented her employment status by failing to disclose that she had returned to work.

The Tribunal found that the respondent failed to report her new employment and failed to produce a Record of Employment, leading to an adverse inference.

The Tribunal concluded that the respondent wilfully misrepresented her return to work date, entitling the insurer to full repayment of the IRBs plus interest.

The Tribunal also awarded $100 in costs to the insurer due to the respondent's bad faith conduct during the proceeding.

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

The insurer determined the injuries fell within the Minor Injury Guideline (MIG) and denied several treatment plans.

The Tribunal found that the applicant sustained psychological injuries, including an adjustment disorder with mixed anxiety and depressed mood, which removed him from the MIG.

The Tribunal ordered payment for a psychological assessment plan and a chiropractic treatment plan that the insurer had failed to deny within the required timelines.

A second chiropractic treatment plan was found not reasonable and necessary.

The applicant requested a reconsideration of a decision finding him statute-barred from disputing the respondent's denial of income replacement and medical benefits.

The applicant argued the adjudicator made errors of law and fact, and sought to introduce new case law.

The Tribunal dismissed the request, finding the applicant was improperly attempting to advance new arguments not raised at the initial hearing.

While the adjudicator acknowledged an error in grouping the denials together when analyzing the Manuel factors for a limitation extension, he concluded this error would not have changed the outcome.

The respondent's request for costs was also dismissed.

The applicant sought income replacement benefits (IRBs) and attendant care benefits (ACBs) following a motor vehicle accident.

The adjudicator found that while the applicant met the pre-104 week disability test for IRBs as a server, she failed to establish the quantum of her entitlement because she did not produce her 2016 Notice of Assessment or post-accident tax returns.

The adjudicator drew an adverse inference from this failure to produce material financial documents.

The claim for ACBs was also dismissed because the applicant provided no evidence that she had actually incurred the expenses.

The application was dismissed in its entirety.

The applicant sought statutory accident benefits, claiming he was injured when he hit his head while hastily exiting his vehicle after his mobile phone spontaneously exploded in his pocket.

The respondent denied the claim, alleging the accident was staged.

The Tribunal found the applicant lacked credibility due to numerous inconsistencies in his narrative, forensic evidence indicating the phone was tampered with rather than spontaneously exploding, and his failure to call his common-law partner as a corroborating witness.

Drawing an adverse inference, the Tribunal concluded the accident was staged for the applicant's benefit and dismissed the application.

The applicant sought non-earner benefits and attendant care benefits following a motor vehicle accident and subsequent knee surgery.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove a complete inability to carry on a normal life for the claimed period, as contemporaneous medical evidence indicated excellent recovery.

The Tribunal also found that the applicant no longer required attendant care services during the disputed period and failed to prove the expenses were incurred.

The applicant sought Income Replacement Benefits (IRBs) following a motor vehicle accident.

The parties disputed the weekly quantum, with the applicant claiming $989.08 based on employment income, and the respondent calculating $80.77 based on self-employment income.

The Tribunal found that the applicant reported her income to the CRA as self-employment income, and therefore her IRBs must be calculated on that basis.

The Tribunal ordered the respondent to pay $80.77 per week plus interest, but denied the applicant's request for a special award, finding the respondent's withholding of payment was not unreasonable given the inaccurate account of self-employment.

The applicants sought reconsideration of a decision finding they were not entitled to accident benefits.

They witnessed a close relative being struck by a vehicle and claimed nervous shock, arguing they were 'involved in an accident' under section 3(1) of the Statutory Accident Benefits Schedule.

The adjudicator dismissed the request, affirming that nervous shock claims are limited to the named insured and their family members under definition (a)(ii) of 'insured person', and the applicants did not fall into these categories.

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

The insurer determined her injuries fell within the Minor Injury Guideline (MIG) and denied several treatment and assessment plans.

The Tribunal found that the applicant's ongoing knee and back pain were likely due to pre-existing degenerative changes, and her psychological symptoms did not rise to a level that would remove her from the MIG.

As the applicant had already exhausted the $3,500 funding limit for minor injuries, she was not entitled to the disputed plans or interest.

The applicant sought medical benefits for chiropractic treatment, physiotherapy, an MRI, and an orthopaedic assessment following a motor vehicle accident.

The respondent denied the benefits, arguing the applicant's injuries were pre-existing.

The Licence Appeal Tribunal found that the applicant sustained a torn rotator cuff as a result of the accident.

The Tribunal held that the treatment plans for chiropractic and physiotherapy were reasonable and necessary, but the proposed MRI and orthopaedic assessment were not, as the injury had already been identified via ultrasound.

The applicant was also awarded interest on overdue payments.

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

The insurer determined her injuries fell within the Minor Injury Guideline (MIG) and refused to fund several treatment plans.

The applicant argued that pre-existing conditions, psychological injuries, and chronic pain precluded her recovery within the MIG.

The Tribunal found no evidence that the accident exacerbated her pre-existing conditions or caused psychological injuries or chronic pain.

The Tribunal concluded the applicant sustained minor soft-tissue injuries, was subject to the $3,500 MIG limit, and dismissed the application as the funding limit had been exhausted.

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

The respondent scheduled insurer's examinations (IEs), which the applicant failed to attend.

The respondent raised a preliminary issue arguing the applicant was barred from proceeding under section 55 of the Statutory Accident Benefits Schedule.

The Tribunal found that the applicant failed to attend properly scheduled IEs without a reasonable excuse.

The Tribunal declined to exercise its discretion to permit the application to proceed, noting the respondent was prejudiced by the inability to obtain a contemporaneous medical opinion.

The application was dismissed.

The applicant sought to dispute the denial of a chiropractic treatment plan, income replacement benefits (IRBs), and attendant care benefits (ACBs) more than two years after the initial denials.

The Licence Appeal Tribunal found the applicant was statute-barred from disputing the chiropractic treatment plan under section 56 of the Schedule.

However, applying the Manuel factors, the Tribunal exercised its discretion under section 7 of the LAT Act to extend the limitation period for the IRBs.

For the ACBs, the Tribunal found the limitation clock had not started because there was no formal refusal to pay, and directed the parties to address whether section 55 of the Schedule barred the claim at a subsequent case conference.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including income replacement benefits (IRBs) and various medical treatment plans.

The insurer initially placed the applicant in the Minor Injury Guideline (MIG) and denied several treatment plans, later removing her from the MIG for psychological impairments but terminating IRBs based on insurer examinations.

The Licence Appeal Tribunal found that the applicant was not entitled to further IRBs, as she did not suffer a substantial inability to perform her essential tasks as an Uber driver, noting she was enrolled in a full-time massage therapy program.

The Tribunal upheld the insurer's denial of most treatment plans under s. 38(5) of the Schedule, but approved one physiotherapy plan and the balance of a psychological assessment.

Claims for an award for unreasonable delay were dismissed.

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

The insurer initially denied funding for a psychological assessment and physiotherapy, relying on the Minor Injury Guideline.

After an insurer's examination confirmed a psychological injury, the insurer approved the assessment and later approved the physiotherapy plan.

The applicant sought an award for unreasonable delay and interest on overdue payments.

The Tribunal dismissed the claims, finding the insurer's initial refusal was reasonable given the lack of medical evidence provided by the applicant, and there was no basis to order interest.

The applicant sought non-earner benefits following a motor vehicle accident.

The insurer raised a preliminary issue, arguing the applicant was barred from proceeding because the submitted Disability Certificate (OCF-3) indicated he did not suffer a complete inability to carry on a normal life, and was therefore not 'completed' under the Schedule.

The Tribunal found that an OCF-3 is 'completed' if it is filled out, dated, and signed by a regulated healthcare professional, even if it does not support the claim for the specified benefit.

The applicant was permitted to proceed with his application on the merits.

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

The respondent denied the plans, arguing they were not reasonable and necessary and that the applicant's injuries fell within the Minor Injury Guideline.

The Tribunal found that the applicant's medical evidence, which included unreliable clinical notes and inconsistent subjective reports, failed to support the need for ongoing treatment or assessments.

All claims for treatment plans and interest were dismissed.

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs) from the respondent insurer.

The adjudicator found that the applicant had returned to work on a full-time basis with unmodified duties prior to the start of her claim for IRBs.

The medical evidence, including the insurer's examinations, did not support a finding that the applicant suffered a substantial inability to perform the essential tasks of her employment.

The application for IRBs and interest was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident but failed to submit her application within the 30-day timeline prescribed by section 32 of the Statutory Accident Benefits Schedule, submitting it over a year and a half late.

The respondent denied the claim due to the delay.

The Licence Appeal Tribunal found that the applicant failed to provide a reasonable explanation for the delay under section 34, as her claim of latent injuries was contradicted by her examination under oath where she admitted to experiencing extreme back pain months before applying.

Consequently, the applicant was barred from proceeding with her claim pursuant to section 55(1)1 of the Schedule.