Brian Norris

The applicant was injured in a motor vehicle accident and sought income replacement benefits and funding for a chiropractic treatment plan from her insurer.

The insurer denied the benefits, and the applicant applied to the Licence Appeal Tribunal.

The adjudicator found that the applicant failed to prove she was substantially unable to perform the essential tasks of her pre-accident employment as a supermarket cashier.

The adjudicator also found that the proposed chiropractic treatment plan was not reasonable and necessary, as there was insufficient medical evidence supporting it.

The application was dismissed.

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

The insurer denied the benefits on November 8, 2016.

The applicant filed an application to dispute the denial on May 29, 2019, beyond the two-year limitation period.

The applicant argued that a subsequent letter from the insurer on July 28, 2017, which provided an accounting report and payment for past benefits, restarted the limitation period.

The Tribunal found that the November 2016 letter was a clear and unequivocal denial that started the limitation clock, and the July 2017 letter did not alter this denial.

The Tribunal also declined to extend the limitation period under section 7 of the Licence Appeal Tribunal Act, finding no bona fide intention to appeal within the time limit and a significant delay of six months.

The applicant was barred from proceeding with the claim.

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits from the respondent insurer under the Statutory Accident Benefits Schedule.

The respondent denied several treatment plans, leading the applicant to apply to the Licence Appeal Tribunal.

The adjudicator found that the occupational therapy, psychological, and one chiropractic treatment plan were partially or fully reasonable and necessary, subject to the applicant's $50,000 funding limit.

The optometric treatment plan and a second chiropractic treatment plan were deemed not reasonable and necessary.

The adjudicator also held that the applicant was entitled to interest on incurred expenses but declined to deem any expenses incurred due to unreasonable delay.

The applicant, a self-employed delivery driver, sought statutory accident benefits after a garage door fell on his head while he was picking up parcels at a commercial business.

He had parked his van, turned it off, opened the sliding door, and was walking through the garage door when it fell.

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

The Tribunal applied the two-part purpose and causation test.

While the purpose test was met, the Tribunal found the causation test was not satisfied.

The use of the vehicle had ended when the applicant left it to retrieve packages, and the falling garage door was an intervening act independent of the vehicle's use.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for physiotherapy and a psychological assessment.

The respondent insurer denied the claims on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and were subject to the $3,500 funding limit.

The Licence Appeal Tribunal found that the applicant sustained predominantly minor soft tissue injuries and failed to provide compelling evidence of a psychological injury that would warrant removal from the MIG.

The Tribunal preferred the respondent's psychological assessments, which reviewed the full medical file, over the applicant's assessment, which lacked a review of the family physician's clinical notes.

The application for benefits and interest was dismissed.

The applicant was injured in a motor vehicle accident and sought medical and rehabilitation benefits from the respondent insurer under the Statutory Accident Benefits Schedule.

The respondent denied several treatment plans, leading the applicant to apply to the Licence Appeal Tribunal.

The adjudicator found that the occupational therapy, psychological, and one chiropractic treatment plan were partially or fully reasonable and necessary, subject to the applicant's $50,000 funding limit.

The optometric and second chiropractic treatment plans were denied.

The adjudicator also held that previously approved but unconsumed benefits count against the funding limit unless explicitly withdrawn by the applicant.

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

The adjudicator found that the applicant's injuries fell outside the Minor Injury Guideline (MIG) due to pre-existing physical conditions and an exacerbation of psychological injuries, relying on the respondent's own Insurer's Examination reports.

However, the adjudicator dismissed the claims for various treatment plans, finding them not reasonable and necessary because they proposed block fees without specifying the provider or duration of modalities, contrary to the Professional Services Guideline.

Claims for the costs of disability certificates, interest, and costs of the proceeding were also dismissed.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that found his psychological injuries fell outside the Minor Injury Guideline (MIG) but denied funding for physical treatment plans.

The applicant argued the adjudicator erred in law and fact by omitting evidence and misinterpreting statutory requirements.

The adjudicator dismissed the reconsideration request, finding no error of law or fact.

The applicant had failed to meet his onus to prove entitlement to the physical treatment plans, as he did not identify specific components of the plans or submit them for the hearing.

The applicant requested a reconsideration of a decision finding that he sustained a minor injury under the Statutory Accident Benefits Schedule and was therefore subject to the $3,500 funding limit.

The applicant argued the adjudicator erred in law by applying an incorrect test to determine whether the disputed treatment plans were reasonable and necessary.

The adjudicator dismissed the request, finding no error of law was made.

The adjudicator confirmed that because the applicant suffered a minor injury, it was unnecessary to evaluate whether the treatment plans were reasonable and necessary, as they proposed treatment outside the Minor Injury Guideline framework.

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

The Tribunal found the applicant was statute-barred from disputing one treatment plan due to the expiry of the two-year limitation period.

For another plan, the respondent failed to provide adequate medical reasons for its denial under s. 38(8) of the Schedule, making it liable for the incurred costs.

The remaining treatment plans were found not to be reasonable and necessary, as the medical evidence did not support the requested frequency of treatment or the need for a chronic pain program.

The applicant's claim for an award for unreasonably withheld benefits was dismissed.

The applicant sought income replacement benefits and a determination that her injuries fell outside the Minor Injury Guideline following a minor parking garage collision.

The adjudicator held that the characterization of injuries cannot be a standalone issue when no medical benefits are in dispute.

The claim for income replacement benefits was dismissed because the applicant failed to provide compelling evidence of disability, while the respondent's insurer examinations persuasively indicated symptom magnification and no accident-related impairment.

The applicant sought a reconsideration of a decision that found her entitled to a treatment plan but denied her request for a special award under section 10 of Ontario Regulation 664.

The applicant argued the adjudicator erred in law and fact by finding the insurer's reliance on an unsolicited prognosis in an insurer's examination report was not unreasonable.

The adjudicator dismissed the reconsideration request, finding no significant error of law or fact that would have led to a different result, as the insurer's reliance on a regulated healthcare professional's opinion was not unreasonable.

The applicant was injured in a rear-end motor vehicle accident and sought statutory accident benefits for a psychological assessment and chiropractic treatment.

The respondent insurer denied the treatment plans following insurer's examinations.

The Licence Appeal Tribunal found that the applicant failed to prove the treatment and assessment plans were reasonable and necessary, noting a lack of compelling contemporaneous medical evidence and preferring the respondent's expert reports which indicated minimal psychological and physical impairment.

The application was dismissed and no interest was payable.

The applicant was injured in a motor vehicle accident and sought medical benefits for psychological and chiropractic treatment.

The respondent insurer denied the treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 funding limit had been exhausted.

The applicant argued that pre-existing conditions, chronic pain syndrome, and an adjustment disorder warranted removal from the MIG.

The Tribunal found insufficient evidence to support diagnoses of chronic pain or a psychological injury that would preclude recovery within the MIG, noting the applicant's return to full-time work.

The Tribunal concluded the injuries were minor and dismissed the claims for treatment plans and interest.

The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit, the cost of a psychological assessment, and a plastic surgery consultation fee.

The Licence Appeal Tribunal dismissed the claims.

The Tribunal found the applicant did not suffer a complete inability to carry on a normal life, as evidence showed he maintained independence and returned to school and work.

While the psychological assessment was deemed reasonable and necessary, it was not payable because the cost had not been incurred.

The plastic surgery consultation fee was denied because it was incurred before a treatment plan was submitted.

The applicant sought statutory accident benefits following a rear-end motor vehicle collision.

The respondent insurer determined the injuries fell within the Minor Injury Guideline (MIG) and capped treatment funding at $3,500.

The applicant applied to the Licence Appeal Tribunal, arguing that pre-existing conditions and chronic pain syndrome warranted removal from the MIG.

The Tribunal found no compelling evidence of pre-existing conditions that would preclude recovery within the MIG, preferring the respondent's medical examination over the applicant's physiatry report due to internal contradictions in the latter.

The Tribunal concluded the applicant suffered predominantly soft-tissue injuries falling within the minor injury definition.

As the $3,500 funding limit had been exhausted, the disputed treatment plans and claim for interest were dismissed.

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

The applicant filed an application with the Licence Appeal Tribunal more than two years after the denials.

The respondent raised a preliminary issue that the application was statute-barred under section 56 of the Schedule.

The Tribunal found that the denials were clear and unequivocal, triggering the limitation period.

Applying the Manuel factors under section 7 of the Licence Appeal Tribunal Act, the Tribunal declined to extend the limitation period due to the length of the delay, lack of bona fide intention to appeal within the period, and prejudice to the respondent.

The application was dismissed as statute-barred.

The applicant was injured in an automobile accident in Alberta while driving a vehicle registered and insured in Alberta.

After receiving benefits under the Alberta policy, the applicant applied to the Licence Appeal Tribunal for statutory accident benefits under the Ontario Schedule.

The respondent insurer challenged the Tribunal's jurisdiction.

The Tribunal held that under section 226(2) of the Insurance Act, the applicant's policy was excluded from the scope of the Act because the vehicle was not required to be registered in Ontario and the policy was not in an approved Ontario form.

The Tribunal further found that the Power of Attorney and Undertaking (PAU) signed by the insurer did not grant jurisdiction over an out-of-province accident involving an out-of-province policy.

The application was dismissed for lack of jurisdiction.

The applicant sought income replacement benefits following a motor vehicle accident, and the respondent insurer sought repayment of overpaid benefits.

The matter proceeded to a hearing in writing, but the applicant failed to provide any submissions or evidence despite multiple notices from the Tribunal.

The Tribunal dismissed the applicant's claim as abandoned pursuant to Rule 3.4(d) of the Common Rules of Practice & Procedure.

The Tribunal also found that the respondent had incorrectly calculated the applicant's gross weekly income, resulting in an overpayment.

The respondent was awarded repayment of $1,566.81 plus interest.

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 funding for a psychological assessment and physiotherapy treatment.

The Tribunal found that the applicant sustained predominantly minor injuries, relying on the insurer's examination reports which outweighed the applicant's chiropractic assessment.

The Tribunal dismissed the claims for treatment plans as they fell outside the MIG, denied payment for pre-screening invoices because they were incurred prior to submission, and denied interest as no payments were overdue.