Brian Norris

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming entitlement to an orthopaedic assessment and a chiropractic treatment plan.

The Licence Appeal Tribunal dismissed the application, finding that the orthopaedic assessment was a duplication of previous services and not reasonable or necessary.

The Tribunal also found that the chiropractic treatment plan addressed injuries that were not accident-related and that the applicant had already achieved several of the plan's goals.

As no benefits were payable, the claims for interest and an award for unreasonable delay were also dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for chiropractic treatment plans and a functional cognitive assessment.

The respondent denied the claims.

The Licence Appeal Tribunal found that the chiropractic treatment plans were incurred prior to their submission to the respondent, contrary to section 38(2) of the Statutory Accident Benefits Schedule, and no exceptions applied.

The Tribunal also found that the functional cognitive assessment was not reasonable and necessary, as the medical evidence did not show significant cognitive impairment requiring further investigation.

The application was dismissed, and no interest was awarded.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including non-earner benefits and treatment beyond the Minor Injury Guideline (MIG) limit.

The respondent denied the claims, arguing the injuries were minor.

The Tribunal found that the applicant's physical and psychological injuries fell within the MIG, preferring the respondent's psychological assessment over the applicant's.

The Tribunal also dismissed the claim for non-earner benefits, finding insufficient evidence that the applicant suffered a complete inability to carry on a normal life, noting inconsistencies in the applicant's self-reporting and a lack of supporting medical evidence.

The applicant was injured in a motor vehicle accident and sought non-earner benefits and attendant care benefits from the respondent insurer.

The respondent raised preliminary issues regarding the applicant's failure to submit a disability certificate and an assessment of attendant care needs (Form 1).

The Tribunal held that under section 36(3) of the Statutory Accident Benefits Schedule, the applicant is not entitled to non-earner benefits for any period prior to the submission of a completed disability certificate.

Furthermore, under section 42, the applicant is not entitled to attendant care benefits because a Form 1 was never submitted.

The preliminary issues were resolved in favour of the respondent.

The applicant requested a reconsideration of a decision finding they suffered predominantly minor injuries subject to the Minor Injury Guideline limit.

The applicant argued the Tribunal violated procedural fairness by overlooking medical evidence of chronic pain and psychological injuries, and erred in law regarding section 38(8) notice requirements.

The Adjudicator dismissed the request, finding the medical evidence was properly considered and insufficient to remove the applicant from the MIG, and that the section 38(8) argument was an impermissible new issue.

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

The respondent denied several treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued that pre-existing conditions, psychological injuries, and ongoing pain removed her from the MIG.

The Tribunal found that the applicant's pre-existing conditions did not preclude recovery within the funding limit, preferred the respondent's psychological assessment finding no psychological impairment, and concluded there was no evidence of a chronic pain condition.

The Tribunal held that the applicant sustained predominantly minor injuries and dismissed the claims for medical benefits and interest.

The applicant insurer sought repayment of $2,400 in income replacement benefits paid to the respondent following an automobile accident, alleging the respondent wilfully misrepresented his home address when renewing his policy.

The Licence Appeal Tribunal found that the insurer failed to establish on a balance of probabilities that the respondent wilfully misrepresented his address.

The evidence, including the motor vehicle accident report and adjustor's log notes, did not support the insurer's claim.

The application for repayment was dismissed.

The applicant was injured in a motor vehicle accident and sought medical benefits for physiotherapy, massage therapy, and swim passes.

The respondent denied the treatment plan based on an insurer's examination report which opined that no further facility-based treatment was required.

The Tribunal found the treatment plan was reasonable and necessary to address the applicant's ongoing pain and functional limitations, preferring the clinical notes and records over the insurer's examination prognosis.

The Tribunal ordered the respondent to pay the treatment plan with interest, but declined to grant an award under section 10 of Regulation 664, finding the respondent did not act unreasonably in relying on the assessment report.

The applicant was injured in a rear-end motor vehicle accident and sought statutory accident benefits for a treatment plan that included massage therapy.

The respondent partially approved the plan but denied funding for massage therapy.

The Tribunal found that massage therapy was not reasonable and necessary, as the applicant's family physician and the insurer's examination physician both recommended only active therapy such as physiotherapy and home exercises.

A late-filed chiropractic report recommending massage therapy was admitted but given less weight due to its timing.

The application for benefits, interest, and costs was dismissed.

The applicant was injured in a motor vehicle accident and sought medical and rehabilitation benefits, including treatment plans for chiropractic therapy, a social work assessment, an in-home assessment, and the cost of a disability certificate.

The respondent insurer denied the benefits based on insurer's examinations indicating the applicant had recovered and the treatments were not reasonable and necessary.

The Licence Appeal Tribunal found that the medical evidence, including the applicant's family physician's records, showed the applicant was pain-free and functional.

The Tribunal dismissed the application, finding the applicant was not entitled to the disputed treatment plans or the cost of the disability certificate.

The applicant was injured in a rear-end motor vehicle accident and sought income replacement benefits (IRBs) after resigning from one job and being terminated from another.

The respondent denied the claim, arguing the applicant could perform the essential tasks of their pre-accident employment.

The Tribunal agreed with the respondent, finding that the test for IRBs is based on the essential tasks of the employment held at the time of the accident, not subsequent employment.

As there was no medical evidence demonstrating an inability to perform the pre-accident tasks, the claim for IRBs and interest was dismissed.

The applicant, a self-employed painter injured in a motor vehicle accident, sought income replacement benefits (IRBs) and the cost of an accounting report.

The Tribunal found that the applicant's IRBs should be calculated based on the last completed taxation year under section 4(3) of the Schedule, not the 52 weeks prior to the accident, and dismissed the claim for increased IRBs.

The respondent agreed to pay for the accounting report during the proceeding.

The Tribunal awarded interest on the overdue payment of the accounting report and a $500 award under Ontario Regulation 664, finding that the respondent unreasonably delayed payment for the report.

The applicant sought accident benefits for psychological injuries following a motor vehicle accident, arguing they fell outside the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found the applicant's injuries were predominantly minor and subject to the $3,500 MIG limit, preferring the respondent's neuropsychological assessment which found evidence of malingering over the applicant's psychological report.

The Tribunal dismissed the claims for a psychological assessment and treatment plan, finding the assessment costs were incurred prematurely and the treatment was not reasonable and necessary.

Claims for an award and interest were also dismissed.

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

The respondent denied claims for income replacement benefits and chiropractic treatment plans in early 2016.

The applicant commenced an application to dispute the denials nearly three years later.

The Tribunal held that the applicant was barred from proceeding with the claims because the application was commenced beyond the two-year limitation period under section 56 of the Schedule.

The Tribunal found the respondent's refusals were clear and unequivocal, and declined to exercise its discretion to extend the limitation period under section 7 of the Licence Appeal Tribunal Act.

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

The respondent denied the claims on the basis that the treatments were not reasonable and necessary.

The Tribunal dismissed the application, finding that the applicant failed to meet the burden of proof.

The Tribunal entirely rejected the applicant's occupational therapy expert report, finding the assessor was biased, partisan, and provided opinions outside the scope of their expertise.

As no benefits were payable, the claim for interest was also dismissed.

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

The respondent insurer determined the applicant's injuries fell within the Minor Injury Guideline (MIG) and refused to fund treatment plans exceeding the $3,500 limit.

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

The Tribunal found that the applicant failed to provide sufficient medical evidence to support removal from the MIG, noting that the psychological report's conclusions were unsupported by its own psychometric testing and uncorroborated by other medical records.

The application was dismissed, and the disputed treatment plans were denied as the MIG funding limit had been exhausted.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the insurer's denial of two chiropractic treatment plans, interest, and an award for unreasonable withholding.

The Tribunal found the October 2017 treatment plan reasonable and necessary based on timely medical records and psychological assessments, but dismissed the May 2018 plan due to a lack of persuasive evidence and an uncontested insurer examination finding symptom magnification.

The applicant was awarded interest on the approved plan but denied a special award, as the insurer had responded to the plans within the required timelines and provided valid medical reasons.

The applicant sought statutory accident benefits after slipping and falling in a parking lot shortly after retrieving items from the trunk of their vehicle.

The respondent insurer denied the claim, arguing the incident did not meet the definition of an 'accident' under the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal applied the purpose and direct cause tests, finding that the applicant's use of the vehicle had ended when the trunk was closed and the fall occurred during a new task of walking away.

The application was dismissed.

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

The respondent insurer denied funding for a psychological assessment and treatment plan, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant suffered from accident-related psychological injuries, including post-traumatic stress disorder, which removed him from the MIG.

The Tribunal ordered the respondent to pay for the disputed psychological assessment and treatment plan, along with interest, but denied the applicant's request for an award under Regulation 664, finding the insurer's initial denials were not unreasonable.

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

The respondent initially denied the treatment plans but agreed to approve and pay for them prior to the hearing.

The remaining issues were interest and costs.

The Tribunal held that the applicant was entitled to interest on the incurred goods and services from the date the application was filed until the date the respondent agreed to pay.

The Tribunal declined to award costs, finding no evidence that the respondent acted unreasonably, vexatiously, or in bad faith.