Chloe Lester

The respondent insurer requested a reconsideration of a Tribunal decision that removed the applicant from the Minor Injury Guideline (MIG) and awarded six treatment plans.

The insurer argued the adjudicator violated procedural fairness and made significant errors of fact and law by relying on unsupported submissions, making medical conclusions not in the records, and misinterpreting various medical assessment reports.

The Vice-Chair found that while the adjudicator made two minor errors of fact, they were not significant enough to alter the outcome, as there was ample other evidence supporting the chronic pain diagnosis and the reasonableness of the treatment plans.

The request for reconsideration was dismissed.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that found she was not catastrophically impaired and denied her claims for attendant care and medical benefits.

The applicant argued the adjudicator failed to properly consider her medical evidence, including her family doctor's opinion and a psychiatric report.

The Vice-Chair dismissed the request, finding that the original adjudicator adequately weighed the competing medical reports and provided sufficient reasons for preferring the respondent's assessment.

The Vice-Chair concluded there was no significant error of law or fact, nor any breach of procedural fairness, to warrant a reconsideration.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that found their injuries fell within the Minor Injury Guideline (MIG) and denied medical benefits.

The applicant argued that the adjudicator made an error of fact, as the respondent had already removed the applicant from the MIG prior to the hearing.

The Vice-Chair agreed that the adjudicator made a factual error by deciding an issue that was no longer in dispute, which resulted in the treatment plans not being adjudicated.

The request for reconsideration was granted, and the matter was remitted to the original adjudicator to issue a new decision solely on the reasonableness and necessity of the treatment plans based on the existing evidence.

The respondent insurer sought reconsideration of a Licence Appeal Tribunal decision that found the applicant was no longer subject to the Minor Injury Guideline (MIG) limits.

The adjudicator granted the reconsideration, finding the initial decision lacked sufficient reasons and failed to address the respondent's arguments.

Re-hearing the merits, the adjudicator determined the applicant's injuries fell within the MIG, as the applicant failed to provide compelling medical evidence that pre-existing conditions or post-accident diagnoses prevented recovery within the MIG limits.

Consequently, the applicant was not entitled to the disputed treatment plans, assessments, or interest.

The respondent's request for costs was denied.

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

The insurer 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 that pre-existing conditions, chronic pain, and PTSD removed him from the MIG.

The Tribunal found no compelling evidence that pre-existing conditions prevented maximal recovery within the MIG, and no medical diagnosis of chronic pain or PTSD.

The Tribunal concluded the injuries were minor, the MIG limit applied, and the disputed treatment plan was not payable.

The applicant sought reconsideration of a Tribunal decision denying entitlement to catastrophic determination assessments on the basis that they were not reasonable and necessary.

The applicant argued that under section 25(1) of the Schedule and the FSCO decision in Henderson, the insurer is obligated to pay for the assessments without applying the reasonable and necessary test.

The adjudicator denied the request for reconsideration, finding no significant error of law or fact, and affirmed that entitlement to catastrophic assessments is subject to the reasonableness and necessity test.

The respondent insurer sought reconsideration of a Tribunal decision that found the applicant was entitled to income replacement benefits during a period of suspension for non-attendance at an insurer's examination.

The applicant had attended the examination but requested his wife be present, which the examiner refused.

While the applicant sought advice from his representative, the examiner left the facility.

The adjudicator found that although the original decision lacked sufficient reasons regarding the specific events, the ultimate finding was correct.

The applicant did not refuse to submit to the examination requests, and even if he did, he had a reasonable excuse.

The request for reconsideration was denied.

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

The adjudicator granted the reconsideration, finding multiple breaches of procedural fairness in the original decision.

Specifically, the original adjudicator failed to address costs, made a finding on the MIG when it was not an issue in dispute, misapplied the causation test by failing to analyze new post-accident injuries, and improperly relied on a previous Financial Services Commission of Ontario decision as evidence rather than case law.

The matter was ordered to be re-heard before a different adjudicator.

The applicant was involved in a motor vehicle accident and sought medical benefits and income replacement benefits (IRBs) from the respondent insurer.

The respondent denied the benefits, arguing the injuries were pre-existing and the applicant did not meet the disability tests.

The Licence Appeal Tribunal found that, but for the accident, the applicant would not have suffered the physical and psychological impairments.

The Tribunal held that all five disputed treatment plans were reasonable and necessary.

Furthermore, the Tribunal concluded the applicant suffered a substantial inability to perform her pre-accident employment as a chef, and a complete inability to engage in any suitable employment, thereby entitling her to both pre- and post-104 week IRBs, along with interest on overdue payments.

The applicant, a taxi driver, sought reconsideration of a decision finding that his assault by a passenger over an unpaid fare was not an 'accident' under the Statutory Accident Benefits Schedule.

The applicant argued the adjudicator erred in applying the purpose and causation tests and failed to consider recent case law.

The Vice-Chair dismissed the request, finding no significant error of law or fact that would have changed the outcome, as the assault, not the use or operation of the vehicle, was the direct cause of the impairment.

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

The insurer initially placed the applicant in the Minor Injury Guideline (MIG) but later removed her.

The applicant sought payment for a partially denied physiotherapy treatment plan, ongoing income replacement benefits (IRBs), and an award for unreasonable withholding of benefits.

The Tribunal found the treatment plan was reasonable and necessary, ordering payment with interest.

However, the Tribunal dismissed the claim for IRBs, finding the applicant's soft tissue injuries did not cause a substantial inability to perform the essential tasks of her sedentary employment.

The claim for an award was also dismissed.

The applicant was injured in a motor vehicle accident and subsequently deemed catastrophically impaired due to psychological impairments.

She sought statutory accident benefits for medical cannabis and attendant care.

The respondent denied the medical cannabis and approved a lower amount for attendant care, arguing the applicant's pre-existing conditions and credibility issues undermined her claims.

The Tribunal found the applicant credible and concluded that the medical cannabis was reasonable and necessary to improve functionality and decrease psychoactivity.

The Tribunal also found the applicant's Form 1 for attendant care reasonable and necessary, awarding the benefit up to the $6,000 monthly maximum for catastrophically impaired persons.

The appellant, a registered motor vehicle dealer and salesperson, sought reconsideration of a Tribunal decision that directed the Registrar to carry out a proposal to refuse and revoke his registrations.

The original decision found reasonable grounds to believe the appellant would not carry on business with law, integrity, and honesty due to his failure to notify the Registrar of a criminal charge and his conspiracy to roll back a vehicle's odometer.

On reconsideration, the appellant argued for leniency and maintained his innocence regarding the odometer tampering.

The Tribunal dismissed the request for reconsideration, finding that the appellant failed to establish any error of fact or law, or any violation of procedural fairness in the original decision.

The applicant sought reconsideration of a case conference report that closed her file on consent, purportedly due to a lack of jurisdiction because she had not filed a completed Disability Certificate and the insurer had not explicitly denied her claim for a non-earner benefit.

The Vice-Chair granted the reconsideration, finding that the applicant did not consent to the closure and that the Tribunal either erred in determining jurisdiction or violated the rules of natural justice by failing to provide sufficient notice.

A new case conference was ordered to properly address the jurisdictional issue.

The applicant withdrew their application for dispute resolution after the respondent filed its submissions, which included a request for costs.

The Tribunal closed the file without adjudicating the costs issue.

The respondent filed a Request for Reconsideration, arguing this violated procedural fairness.

The Vice-Chair granted the reconsideration, finding that closing the file without hearing the costs request breached natural justice.

However, on the merits of the costs claim, the Vice-Chair found the applicant's conduct in filing a medical report with their submissions and asking for an inference to be drawn did not meet the high threshold of being unreasonable, frivolous, vexatious, or in bad faith.

The request for costs was denied.

The respondent insurer requested a reconsideration of a Licence Appeal Tribunal decision regarding the applicant's entitlement to income replacement benefits and interest following a motor vehicle accident.

The Vice-Chair found that the original adjudicator violated Rule 18.2 by issuing an unclear order regarding the timeframe for income replacement benefits and by making an error of law in determining that interest on medical benefits was payable from the date the treatment plan was submitted rather than when the expense was incurred.

The request for reconsideration was granted in part, and the decision was referred back to the original adjudicator for amendment.

The respondent insurer requested a reconsideration of a case conference decision that denied its requests for a stay of proceedings and a preliminary issue hearing.

The insurer argued that proceeding with the Tribunal application while a related Superior Court action was pending would result in a duplicity of proceedings and violate procedural fairness.

The Vice-Chair dismissed the request, finding that the original adjudicator properly balanced the potential prejudice to the applicant, who was out of work and not receiving income replacement benefits, against the insurer's concerns about efficiency and costs.

The Tribunal concluded there was no breach of natural justice, procedural fairness, or significant error of law or fact.

The applicant requested a reconsideration of a case conference order requiring him to produce a list of relevant, non-privileged documents from his accident benefits file.

The applicant argued this breached procedural fairness and was overly burdensome given the 13-year-old file.

The Vice Chair dismissed the request, finding the applicant misunderstood the order, which did not require producing the entire file or privileged documents, and that the order was within the adjudicator's discretion to ensure procedural fairness for both parties.

The applicant was injured in a motor vehicle accident and sought payment for chiropractic and massage therapy treatment plans under the Statutory Accident Benefits Schedule.

The respondent insurer denied the plans based on insurer's examinations.

The Tribunal found the applicant credible and held that the treatment plans were reasonable and necessary as they provided temporary pain relief that allowed the applicant to maintain workplace attendance and perform daily activities.

The Tribunal placed less weight on the insurer's examinations, finding them unhelpful or taken out of context.

The applicant was awarded the cost of the treatment plans and interest on overdue payments.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits beyond the $3,500 Minor Injury Guideline (MIG) limit.

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

The Tribunal found that the applicant's injuries, which included disc bulges, central canal stenosis, and chronic pain syndrome, were not minor and removed him from the MIG.

The Tribunal approved the chronic pain assessment, chronic pain treatment program, and psychological assessment as reasonable and necessary, but denied the orthopaedic assessment.

The applicant was also awarded interest on the overdue benefits.