Brian Norris

The applicant insurer sought repayment of $60,984.73 in income replacement benefits (IRBs) paid to the respondent following a motor vehicle accident.

The insurer alleged the respondent wilfully misrepresented his employment status by claiming he was unable to work while his tax documents showed he earned full-time income.

The respondent did not participate in the hearing.

The Tribunal found the respondent committed wilful misrepresentation and ordered him to repay the full amount of IRBs, plus interest.

The applicant requested a reconsideration of a decision finding he sustained a minor injury and was not entitled to certain treatment plans.

The applicant argued the adjudicator failed to consider the report of an orthopaedic surgeon.

The adjudicator dismissed the request, finding the applicant improperly raised new arguments in reply and failed to demonstrate an error of law or fact.

The adjudicator also noted the expert was not properly qualified at the initial hearing and his report was unpersuasive as the applicant maintained full-time employment.

The respondent's request for costs was dismissed.

The applicant sought reconsideration of a decision finding she sustained a minor injury and was not entitled to certain treatment plans.

She argued the adjudicator failed to consider the report of an orthopaedic surgeon.

The adjudicator dismissed the request, noting the applicant improperly raised new arguments in her reply submissions and had failed to identify the allegedly ignored evidence in her initial request.

Furthermore, the adjudicator had already addressed the surgeon's report in the initial decision, finding it unpersuasive.

The respondent's request for costs was also dismissed.

The applicant was injured in a rear-end motor vehicle accident and sought non-earner benefits (NEBs) and various medical benefits from the respondent insurer.

The Tribunal found the applicant did not meet the test for a complete inability to carry on a normal life, as medical evidence and independent examinations showed she remained generally functional.

The Tribunal denied NEBs and several treatment plans, but granted entitlement to one chiropractic treatment plan and the full cost of a psychological assessment, finding them reasonable and necessary.

Interest was awarded on the overdue payments for the approved plans.

The applicant sought statutory accident benefits, including non-earner benefits and medical benefits for physiotherapy, following a motor vehicle accident.

The insurer denied the claims based on insurer's examinations and surveillance evidence showing the applicant working at a nail salon, which contradicted her self-reported limitations.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove a complete inability to carry on a normal life and that further physiotherapy was not reasonable and necessary.

Claims for an award and interest were also dismissed.

The applicant was injured in a rear-end motor vehicle collision and sought non-earner benefits and medical benefits beyond the Minor Injury Guideline (MIG) limit.

The adjudicator found that the applicant did not suffer a complete inability to carry on a normal life, as she returned to work and maintained independence in daily activities.

Furthermore, the applicant's injuries were predominantly soft-tissue sprains and strains falling within the MIG, and she failed to demonstrate a pre-existing condition or chronic pain that would warrant removal from the MIG framework.

The application was dismissed.

Aviva General Insurance applied to the Licence Appeal Tribunal for repayment of income replacement benefits (IRBs) paid to the respondent following a motor vehicle accident.

Aviva alleged the respondent misrepresented his employment status by returning to work as a truck driver without notifying the insurer.

The adjudicator found that the respondent had indeed returned to work and misrepresented his status, disentitling him to the IRBs.

However, because Aviva's unequivocal notice of repayment only specified $8,800.00, the adjudicator limited the repayment order to that amount, rather than the $18,000.00 sought.

The respondent was also ordered to pay $250.00 in costs for unreasonable conduct during the proceeding.

The applicant was injured in a rear-end motor vehicle accident and sought statutory accident benefits for various treatment and assessment plans, including chiropractic treatment, attendant care, chronic pain, social work, and neurological assessments.

The respondent insurer denied the plans.

The Licence Appeal Tribunal found that the applicant failed to prove the plans were reasonable and necessary, noting that the applicant had already received adequate facility-based treatment, exhibited functional independence, and lacked medical evidence supporting the need for the proposed assessments.

The application was dismissed in its entirety.

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 was scheduled for a written hearing.

Neither party filed written submissions or evidence by the deadlines ordered by the Tribunal.

The adjudicator proceeded with the written hearing in the parties' absence pursuant to section 7(2) of the Statutory Powers Procedure Act.

The application was dismissed because the applicant failed to meet his evidentiary burden to demonstrate entitlement to the claimed benefits.

The applicant was involved in a single-vehicle rollover accident and sought various statutory accident benefits from the respondent insurer.

The applicant's claim for a non-earner benefit was dismissed because she failed to submit a disability certificate within the 104-week time limit, and there was no evidence the respondent was aware of the accident to provide forms earlier.

The Tribunal found a proposed psychological assessment to be reasonable and necessary, as the respondent had already approved a psychological treatment plan based on it.

Claims for plastic surgery, orthopaedic, and driving rehabilitation assessments were dismissed as not reasonable and necessary.

The Tribunal awarded the applicant $220 under s. 10 of O. Reg. 664, finding the respondent unreasonably withheld approval of the psychological assessment while approving the treatment plan derived from it.

The applicant was injured in a motor vehicle accident and sought a determination of catastrophic impairment.

The tribunal held a preliminary issue hearing to determine which version of the Statutory Accident Benefits Schedule applied to the applicant's transitional policy, and whether her claims were statute-barred.

The adjudicator found that the 2016 Schedule's definition of catastrophic impairment applied.

Applying section 7 of the Licence Appeal Tribunal Act, the adjudicator declined to extend the limitation period for the applicant's income replacement benefits claim due to incurable prejudice to the insurer, but extended the limitation period for her medical and rehabilitation benefits claims.

The applicant sought medical, income replacement, and attendant care benefits following a rear-end motor vehicle accident.

The insurer denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant sustained predominantly soft tissue injuries, which are defined as minor injuries under the Schedule.

Consequently, the applicant was not entitled to the disputed medical benefits or attendant care benefits.

The claim for income replacement benefits was also dismissed, as the applicant failed to prove a substantial inability to perform his pre-accident employment tasks, and his tax returns showed his income increased after the accident.

The Applicant sought medical benefits and the Respondent sought repayment of overpaid income replacement benefits (IRBs) following a motor vehicle accident.

The Tribunal found that the Applicant's injuries fell within the Minor Injury Guideline (MIG), as he failed to prove that his pre-existing conditions, alleged psychological injuries, or chronic pain warranted removal from the MIG.

Consequently, the claims for medical benefits beyond the $3,500 limit were denied.

The Tribunal also dismissed the Respondent's claim for a $6,400 IRB repayment, finding that the Respondent's notice of overpayment was equivocal and failed to comply with the strict 12-month notice requirement under section 52 of the Schedule.

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

The matter proceeded to a written hearing, but neither party filed written submissions or evidence.

The adjudicator dismissed the application, finding that the applicant failed to meet her evidentiary burden to demonstrate entitlement to the benefits claimed.

The applicant sought a determination that he sustained a catastrophic impairment due to a traumatic brain injury following a motor vehicle accident.

The Tribunal found that the applicant's medical reports, which relied on a GOS-E assessment conducted by an occupational therapist and a psychiatrist, failed to comply with the Statutory Accident Benefits Schedule.

The Tribunal preferred the respondent's neuropsychological assessment, which concluded the applicant's ability to drive negated a finding of Lower Moderate Disability.

The application was dismissed.

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

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

The Tribunal found that the applicant sustained predominantly soft-tissue injuries and failed to establish a pre-existing condition or chronic pain syndrome that would warrant removal from the MIG.

However, the Tribunal ordered the insurer to pay for goods and services incurred under one treatment plan because the insurer failed to provide a compliant denial notice within the required 10-business-day period under section 38 of the Schedule.

The applicant sought reconsideration of a decision finding he made a material misrepresentation on his automobile insurance application, which excluded him from income replacement benefits and required him to repay $72,881.74 to the insurer.

The applicant argued the Tribunal lacked jurisdiction, violated procedural fairness, made factual errors, and that new evidence was available.

The adjudicator dismissed the request, finding no procedural unfairness, confirming the Tribunal's jurisdiction over the dispute, and concluding the applicant was improperly attempting to relitigate the initial findings.

The adjudicator also held that the alleged new evidence could have been obtained prior to the initial hearing with due diligence.

The applicant sought statutory accident benefits but withdrew his application after the respondent filed its submissions.

The respondent sought costs, arguing the applicant acted unreasonably and withheld information.

The Tribunal denied the costs request because it failed to specify the amount requested or the number of days of attendance, as required by Rule 19.3 of the Common Rules of Practice and Procedure.

The application was dismissed and the file closed.

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

The Respondent denied the claims, arguing the Applicant's injuries fell within the Minor Injury Guideline (MIG) and that his claim for income replacement benefits (IRBs) was procedurally barred.

The Tribunal found the Applicant was barred from pursuing IRBs because he failed to provide timely notice of his intention to claim the benefit after previously withdrawing it, violating section 32(1) of the Schedule.

Furthermore, the Tribunal concluded the Applicant sustained predominantly minor injuries, finding insufficient evidence of an accident-related chronic pain condition or psychological injury.

Consequently, the disputed treatment plans were denied as they exceeded the MIG funding limit, and the application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident in November 2014.

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

The applicant argued that pre-existing ankle issues, psychological injuries, and chronic pain removed him from the MIG.

The Tribunal found that the applicant's injuries were predominantly minor and that his ongoing symptoms were likely attributable to several subsequent, more severe accidents rather than the subject accident.

The Tribunal also found that while the respondent failed to provide proper notice under section 38(9) of the Schedule, the applicant had not incurred the disputed expenses.

The application was dismissed.