Brian Norris

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

The respondent insurer raised a preliminary issue, arguing the applicant was barred from proceeding with the application for failing to attend three scheduled insurer's examinations under section 44 of the Statutory Accident Benefits Schedule.

The Tribunal found that while the request for the examinations was reasonably necessary, the notice provided by the respondent was non-compliant because it failed to include medical reasons for the examinations, citing only procedural reasons.

As the notice was defective, the applicant was not required to attend the examinations and is not barred from proceeding with the application.

The applicant was struck by a streetcar and applied for catastrophic impairment benefits.

After the respondent's initial insurer examinations (IEs) concluded the applicant was not catastrophically impaired, the applicant provided rebuttal IEs.

The respondent then sought a second round of multi-discipline IEs and requested five years of pre-accident production records.

The Tribunal applied the Travelers factors and found the proposed IEs were not reasonably necessary, noting the respondent's delay and the number of previous examinations.

The Tribunal also dismissed the motion for productions, finding the request for five years of records overly broad and an unwarranted infringement of privacy.

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

The respondent insurer requested the applicant attend an insurer's examination (IE) to determine if the injuries fell outside the Minor Injury Guideline.

The applicant refused to attend, arguing the proposed assessor's professional designation did not match the practitioner who recommended the benefits.

The Tribunal held that an insured cannot dictate the identity of the IE assessor, provided they are a regulated health professional.

Because the applicant failed to attend a properly scheduled IE, section 55(1)(2) of the Schedule precluded the applicant from proceeding with the application.

The application was dismissed.

The applicant was struck by a passenger-side door while walking and sought accident benefits.

The respondent determined the injuries fell within the Minor Injury Guideline (MIG) and denied a $1,553.76 chiropractic treatment plan because the $3,500 funding limit was exhausted.

The applicant argued they suffered from chronic pain and psychological injuries, which should remove them from the MIG.

The Tribunal found no compelling medical evidence or diagnosis of chronic pain or psychological injury, noting the respondent's physiatry assessment concluded the injuries were minor.

The application was dismissed, and the disputed treatment plan and interest were denied.

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

The respondent denied funding for several physical and psychological treatment plans and a psychological assessment.

The Tribunal found that the physical treatment plans were not reasonable and necessary, as the applicant provided no evidence of their goals or how they would address her injuries.

The Tribunal granted the balance of the psychological assessment cost, finding it did not exceed the maximum fee in the Professional Services Guideline.

The psychological treatment plan was partially approved for 8 sessions and evaluation testing.

Finally, the Tribunal ordered the applicant to repay $748.05 for benefits mistakenly paid directly to her instead of the clinic.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to income replacement benefits (IRBs), medical benefits for physiotherapy, and the cost of attendant care assessments.

The Licence Appeal Tribunal dismissed the claim for IRBs, finding no evidence of a substantial inability to perform the essential tasks of employment.

The Tribunal granted the cost of the initial physiotherapy treatment plan incurred during the acute phase of recovery, but denied subsequent plans as the applicant had reached maximum medical recovery from minor soft tissue injuries.

The Tribunal also awarded the cost of a single attendant care assessment, rejecting a retroactive assessment as meaningless and duplicative.

The applicant was injured in a rear-end motor vehicle accident and sought medical benefits under the Statutory Accident Benefits Schedule.

The respondent denied the benefits 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 diagnoses of a rotator cuff injury, chronic pain syndrome, and psychological injuries removed them from the MIG.

The Tribunal found that the applicant suffered predominantly minor soft tissue injuries and that the medical evidence did not support a diagnosis of chronic pain syndrome or a psychological injury.

As the applicant had exhausted the MIG funding limit, the claims for additional medical benefits and interest were dismissed.

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

The respondent denied ongoing income replacement benefits (IRBs) and took the position that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant was not entitled to IRBs beyond August 3, 2016, as medical evidence did not establish a substantial inability to perform the essential tasks of their pre-accident employment.

However, the Tribunal determined that the applicant suffered psychological injuries, including driver and passenger phobia and a depressive disorder, which removed them from the MIG.

Consequently, the disputed psychological assessment and the treatment plan for chiropractic, massage, and physiotherapy were deemed reasonable and necessary and were approved with interest.

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

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

The Tribunal found that the applicant's injuries were minor and subject to the MIG funding limit, preferring the evidence of the respondent's assessors over the applicant's assessor, whose opinion relied heavily on self-reporting without objective validation.

The disputed treatment plans, special award, and costs were denied due to a lack of supporting evidence.

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

The respondent insurer raised preliminary issues, arguing the applicant was statute-barred from proceeding before the Licence Appeal Tribunal due to failing to provide information requested under section 33 of the Schedule and failing to attend an insurer's examination under section 44.

The Tribunal found that failure to comply with section 33 does not preclude an applicant from disputing a refusal to pay benefits, and regardless, the applicant had complied with the reasonable requests.

Furthermore, the Tribunal held the applicant was not barred for failing to attend the insurer's examination because the respondent's notice was non-compliant, as it explicitly stated attendance was not required.

The applicant was injured in a rear-end motor vehicle collision and sought medical benefits beyond the $3,500 Minor Injury Guideline (MIG) limit, claiming a psychological injury and a partial muscle tear.

The Licence Appeal Tribunal found that the applicant's physical injuries, including the partial tear, were expressly included within the MIG.

The Tribunal also rejected the psychological injury claim, noting that the applicant's evidence predated the accident and the respondent's psychological assessment found only temporary, resolved symptoms.

The application for additional benefits was dismissed, though the applicant was permitted to use the remaining $129.81 of the MIG limit.

The applicant sought medical benefits for dental work following a motor vehicle accident.

The insurer denied the treatment plan, relying on a section 44 assessment which concluded that only some of the proposed work was reasonable and necessary.

The Tribunal found that composite restorations for teeth 1.4 and 2.2 were reasonable and necessary, rejecting the applicant's request for porcelain crowns.

The Tribunal also approved an implant replacement for tooth 4.7, finding it more appropriate than the insurer's proposed extraction.

The claims for teeth 4.4 and 4.5 were dismissed as they were related to pre-existing wear and erosion.

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

After a case conference, a written hearing was scheduled.

The applicant's counsel withdrew, and the applicant failed to provide any submissions or evidence, nor did they respond to communications from the Tribunal.

The adjudicator dismissed the application due to the applicant's failure to meet their evidentiary burden.

The respondent was awarded $125 in costs because the applicant's failure to participate or withdraw the application was deemed unreasonable and frivolous.

The applicant was injured when she fell on a city bus that accelerated before she could sit down.

The bus did not collide with anything.

The respondent denied her claim for statutory accident benefits based on the 'no crash, no claim' exception in s. 268(1.1) of the Insurance Act.

The applicant argued that because she was attempting to use priority seating, she fell under the exemption for 'special transportation facilities for persons with disabilities' in s. 224(1).

The Licence Appeal Tribunal dismissed the application, finding that priority seating is not a special transportation facility and the applicant was not receiving a special service.

Therefore, the 'no crash, no claim' exception applied.

The applicant was injured in a motor vehicle accident and sought payment for five medical assessments under the Statutory Accident Benefits Schedule.

The insurer denied the assessments.

The Licence Appeal Tribunal found that the psychological, orthopaedic, and physiatry assessments were not reasonable and necessary.

However, the Tribunal ordered the insurer to pay for the chronic pain assessment, finding it reasonable and necessary to explore treatment options, and the functional impairment assessment, as the insurer failed to provide a proper medical reason for denial within the required timeframe.

The applicant was awarded interest on overdue payments but denied a special award under section 10 of Regulation 664.

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

The respondent denied funding for chiropractic services, physiotherapy, and a psychological assessment 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 Licence Appeal Tribunal found that the applicant failed to dispute the partial denial of chiropractic services within the two-year limitation period.

Furthermore, the Tribunal concluded that the applicant's injuries were minor as defined by the Schedule, as there was no compelling medical evidence of psychological or non-minor injuries.

The application was dismissed.

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

The respondent denied the plans on the basis that they were not reasonable and necessary, not causally related to the accident, and not incurred.

The Tribunal found the physiotherapy treatment plan was reasonable and necessary, less fees for previous plans, as the medical evidence supported ongoing therapy for low back pain.

The chiropractic treatment plan was denied for lack of supporting evidence.

The Tribunal also held that the respondent is liable to pay for reasonable and necessary treatment once incurred, rejecting the argument that treatment must be incurred before it can be approved.

No interest was awarded as no payments were overdue.

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

The respondent denied a non-earner benefit and certain medical benefits, asserting the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant's accident-related injuries were minor and subject to the $3,500 funding limit, noting that pre-existing degenerative issues did not preclude recovery within the MIG.

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

The application was dismissed.

The applicant sought payment for an activities of daily living assessment and an orthopaedic assessment following a motor vehicle accident.

The respondent argued the claims were statute-barred as they were disputed more than two years after being denied.

The Tribunal found the applicant was statute-barred from claiming the activities of daily living assessment because a clear and unequivocal denial had been issued more than two years prior.

However, the denial for the orthopaedic assessment was not clear and unequivocal.

The Tribunal ordered the respondent to pay for the orthopaedic assessment, finding the applicant had incurred the cost before receiving a valid denial and was compliant with section 44 of the Schedule.

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

The respondent terminated IRBs based on insurer's examinations.

The Tribunal found that the applicant's essential tasks of employment were sedentary and that the medical evidence did not support a substantial inability to perform those tasks.

The applicant's claims of physical and psychological impairments preventing work were contradicted by medical records and her ability to complete a post-secondary program.

The application for IRBs and interest was dismissed.