Chloe Lester

The respondent requested an adjournment of the hearing due to a cyber attack that prevented access to its internal systems and files.

The applicant opposed the adjournment and brought a motion to exclude surveillance video and a report that were disclosed past the deadlines set in the case conference order.

The Tribunal granted the adjournment, finding it reasonable to allow the respondent time to prepare once systems were restored.

The Tribunal also granted the applicant's motion to exclude the surveillance evidence, finding it had little probative value, was not used by assessors, and its late disclosure caused prejudice that outweighed any relevance.

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

The respondent denied the assessment, arguing it was not recommended by the applicant's psychiatrist and was a duplication of already approved psychotherapy services.

The Tribunal found that the assessment was not reasonable or necessary, as there was no medical need for it and it duplicated ongoing psychotherapy treatments.

The application was dismissed.

The applicant sought an adjournment of the hearing pending an appeal to the Divisional Court regarding a prior preliminary decision, and to allow for the completion of ongoing section 44 insurer's examinations.

The respondent opposed the adjournment, arguing the request was untimely and the appeal vexatious.

The Tribunal granted the adjournment and stayed the application, noting that under section 25(1) of the Statutory Powers and Procedures Act, an appeal to the Divisional Court operates as an automatic stay.

The Tribunal also found that waiting for the completion of the insurer's examinations would prevent the bifurcation of issues and promote efficiency.

The applicant, who sustained a catastrophic impairment in a 2011 motor vehicle accident, sought attendant care and housekeeping benefits.

The Tribunal held that the 2014 amendments to the Statutory Accident Benefits Schedule applied, limiting attendant care benefits to the non-professional provider's economic loss.

The Tribunal found the provider's economic loss was limited to his lost wages of $2,100 per month, rejecting claims for lost opportunities and fringe benefits due to lack of evidence.

The Tribunal deemed professional attendant care expenses incurred under s. 3(8) because the insurer unreasonably delayed payment.

The applicant was also awarded housekeeping benefits and a 50% special award under O. Reg. 664 due to the insurer's repeated and unreasonable delays in paying benefits.

The applicant, who was catastrophically injured in a motor vehicle accident, applied for attendant care benefits in the amount of $3,790.38 per month.

The respondent partially approved the claim in the amount of $2,331.07 per month.

The respondent raised a preliminary issue that the Tribunal lacked jurisdiction because the applicant was not incurring expenses above the approved amount.

The Tribunal dismissed the preliminary issue, finding that a dispute exists over the quantum of the benefit regardless of whether it has been incurred.

On the merits, the Tribunal found the applicant entitled to $2,997.30 per month in attendant care benefits, concluding that he requires 8 hours of attendant care daily.

The applicant was involved in a motor vehicle accident and sought income replacement benefits (IRBs) and medical benefits beyond the Minor Injury Guideline (MIG) limit.

The Tribunal found that the applicant's injuries, including strains and sprains, did not fall outside the MIG, rejecting claims of psychological and chronic pain disorders due to inconsistencies with surveillance and medical records.

As the $3,500 MIG limit was exhausted, the treatment plans were denied.

However, the Tribunal awarded IRBs for a limited period, finding the applicant suffered a substantial inability to perform his heavy physical employment tasks during his initial recovery.

The respondent insurer requested a reconsideration of a Tribunal decision that found the applicant's Assessment of Attendant Care Needs (Form 1) to be reasonable and necessary, entitling her to attendant care benefits up to $6,000 per month.

The insurer argued the Tribunal erred by failing to apply the 'but for' test for causation, improperly admitting late evidence, failing to address whether the benefits were incurred, and misapplying the law regarding catastrophic impairment.

The Tribunal dismissed the request for reconsideration, finding that the 'but for' test was implicitly applied, the late evidence was relevant and prejudice was remedied, the issue of whether benefits were incurred was not in dispute, and the catastrophic designation was merely provided for context.

The applicant requested a reconsideration of a Tribunal decision that found his physical and psychological impairments, sustained while cleaning up a toxic spill and viewing a deceased body following a fatal tractor-trailer collision, did not result from an 'accident' under the Statutory Accident Benefits Schedule.

The applicant argued the Tribunal misinterpreted the definition of an accident and misapplied the causation test.

The Tribunal dismissed the request, finding no errors of law or fact that would have led to a different result, as the impairments were caused by the aftermath of the collision rather than the direct use or operation of a vehicle.

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

The insurer placed the applicant in the Minor Injury Guideline (MIG) and denied treatment plans beyond the $3,500 limit.

The insurer also suspended income replacement benefits after the applicant failed to attend scheduled insurer examinations.

The Tribunal found that the applicant's injuries were predominantly minor and subject to the MIG limit.

The Tribunal also held that the applicant was not entitled to income replacement benefits because she failed to attend the required insurer examinations, and the Tribunal lacked jurisdiction to consider her explanation for non-attendance until she complied.

The applicant sought income replacement benefits (IRBs) following a motor vehicle accident.

The respondent insurer terminated IRBs based on insurer's examinations concluding the applicant did not suffer a substantial inability to perform the essential tasks of his employment.

The Tribunal found that the applicant failed to provide sufficient medical evidence to prove he met the test for IRBs, as the medical documentation did not support the claimed physical and psychological impairments.

The application was dismissed.

The applicant requested a reconsideration of a Tribunal decision that denied two treatment plans for case manager services, including $600 for mileage.

The applicant argued the Tribunal erred in fact and law by not determining whether the mileage expenses were necessary and by finding the treatment plan unreasonable.

The Tribunal dismissed the request, finding that the applicant was merely re-arguing submissions from the original hearing without demonstrating any error in fact or law.

The applicant sought reconsideration of a Tribunal decision that found her injuries fell within the Minor Injury Guideline (MIG) and denied two treatment plans.

The applicant argued the adjudicator erred in fact and law by misweighing evidence regarding her psychological condition and failing to address the respondent's allegedly inadequate denial letter.

The Vice-Chair found no error in the adjudicator's weighing of the medical evidence.

While acknowledging a minor factual error regarding when the applicant first complained of psychological symptoms, the Vice-Chair concluded this did not affect the outcome as a diagnosis is required to remove an applicant from the MIG.

The reconsideration request was dismissed as an attempt to re-litigate the case.

The applicant sought reconsideration of a Tribunal decision that precluded her from proceeding to a hearing on pre-104 income replacement benefits (IRBs) due to her failure to attend insurer's examinations.

The applicant argued the Tribunal erred in law and fact, and that new evidence regarding her compliance with post-104 IRB examinations warranted reconsideration.

The Tribunal dismissed the request, finding no specific errors of law or fact in the original decision.

The Tribunal also held that the new information would not have affected the outcome, as the original decision only pertained to pre-104 IRBs.

The respondent's request for costs was denied, as the applicant's conduct was not frivolous, vexatious, or in bad faith.

The respondent insurer requested a reconsideration of a Licence Appeal Tribunal decision that upheld the suspension of the applicant's non-earner benefits but limited the suspension period and the scope of document production.

The insurer argued the Tribunal erred in law by requiring the section 33 notice to contain details not mandated by the Statutory Accident Benefits Schedule, and erred in fact by restricting the production of the applicant's CPPD and AB files.

The Vice-Chair found that the original decision was a final decision subject to reconsideration.

The Vice-Chair held that the Tribunal erred in law by obligating the insurer to include information in the section 33 notice not detailed in the Schedule, allowing the insurer to suspend benefits from the earlier date of June 20, 2018.

However, the Vice-Chair dismissed the request to reconsider the scope of the file production, finding no error in fact in the original decision's limitation to medical and rehabilitation information.

The reconsideration was granted in part.

The applicant sought entitlement to a chiropractic treatment plan and an income replacement benefit (IRB) following a motor vehicle accident.

The Licence Appeal Tribunal found the chiropractic treatment plan to be reasonable and necessary, noting improvements in the applicant's range of motion and ongoing impairments.

However, the Tribunal found it lacked jurisdiction to deal with the merits of the IRB claim because the benefit was suspended due to the applicant's failure to comply with a section 33 request for financial documents.

The applicant was awarded the treatment plan with interest.

The respondent insurer requested a reconsideration of a Tribunal decision that removed the applicant from the Minor Injury Guideline (MIG) and awarded various statutory accident benefits, including non-earner benefits (NEBs) and treatment plans.

The insurer argued the Tribunal erred in fact and law on several grounds, including the applicant's failure to attend insurer examinations, the finding of chronic pain, and the start date for NEBs.

The Vice-Chair granted the reconsideration in part, expunging an erroneously awarded expense for clinical notes and records that had been resolved prior to the hearing, and amending the start date for NEBs to six months post-accident based on the applicable pre-June 1, 2016 Schedule.

The request for reconsideration was dismissed on all other grounds, as the insurer was primarily seeking to re-weigh the evidence.

The applicant sought income replacement benefits following a motor vehicle accident.

The respondent denied the benefits and requested a preliminary issue hearing to determine whether the applicant was precluded from proceeding with his claim under s. 55 of the Schedule for failing to attend an insurer's examination.

The Tribunal found that the respondent failed to provide sufficient notice of the examination, as the medical and other reasons provided were contradictory and confusing.

The Tribunal also determined that the applicant's Disability Certificate (OCF-3) was submitted in or around November 18, 2016.

The applicant was not precluded from proceeding to a hearing on the merits.

The applicant sought income replacement benefits following a motor vehicle accident.

The respondent insurer denied the benefits and requested a preliminary issue hearing to dismiss the application because the applicant failed to submit a completed Disability Certificate (OCF-3) as required by section 36 of the Statutory Accident Benefits Schedule.

The applicant argued that the insurer should have taken a holistic approach and obtained the necessary information from his treating practitioners using signed authorizations.

The Tribunal held that section 36 places the onus on the applicant to submit a completed OCF-3 filled out by a health practitioner before entitlement to the benefit begins.

As the applicant had not submitted a completed OCF-3, the application was dismissed.

The applicant was struck by a motor vehicle while crossing the street and applied for statutory accident benefits, which were denied by the respondent insurer.

The applicant sought attendant care benefits, treatment plans for chiropractic and physiotherapy services, and various out-of-pocket expenses.

The Tribunal found that the applicant failed to prove entitlement to attendant care benefits and most of the claimed expenses, as there was insufficient medical evidence linking her reported chemical sensitivities, light sensitivity, and fibromyalgia to the accident.

However, the Tribunal found the chiropractic and physiotherapy treatment plans, as well as expenses for Tylenol, to be reasonable and necessary.

The application was allowed in part.

The applicant, an environmental clean-up worker, sought statutory accident benefits after suffering physical and psychological injuries, including a collapsed lung, following his response to a fatal tractor-trailer collision.

He was exposed to toxic fumes and viewed the deceased driver while cleaning up the accident scene.

The insurer denied benefits on the basis that the incident did not meet the definition of an 'accident' under section 3(1) of the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal dismissed the application, finding that the incident failed both the purpose and causation tests.

The vehicles involved in the collision were no longer in use or operation when the applicant arrived, and the applicant's use of a vac-truck to clean the spill was not the direct cause of his impairments.