Christopher A. Ferguson

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

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

The applicant argued that a subsequent shoulder tear, psychological injuries, and chronic pain removed her from the MIG.

The Tribunal found that the applicant failed to meet her onus to prove her injuries fell outside the MIG, noting a lack of contemporaneous medical evidence linking the shoulder tear or psychological issues to the accident, and surveillance evidence contradicting her claims of chronic pain.

The appeal was dismissed.

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

The insurer raised preliminary issues, arguing the applicant was statute-barred from appealing the denial of income replacement benefits and physiotherapy because she missed the two-year limitation period, and that she was precluded from appealing another physiotherapy claim for failing to attend an insurer's examination.

The Tribunal extended the limitation period under section 7 of the Licence Appeal Tribunal Act, finding the applicant had a bona fide intention to appeal and the insurer suffered no material prejudice.

The Tribunal also found the applicant had attended a subsequent insurer's examination, allowing that appeal to proceed.

The applicant was injured in a motor vehicle accident and sought a medical and rehabilitation benefit of $6,177.64 for a massage therapy chair, which the insurer denied.

The Licence Appeal Tribunal found that the applicant met the onus of proving the massage chair was reasonable and necessary for pain relief and to support physical activity, preferring the evidence of the applicant's occupational therapist and physiatrist over the insurer's experts.

The Tribunal ordered the insurer to pay for the massage chair and associated warranty, along with interest on the overdue payment.

The applicant sought statutory accident benefits following two motor vehicle accidents.

The insurer denied various treatment plans for chiropractic and massage therapy, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant argued for removal from the MIG based on a pre-existing condition and chronic pain.

The Tribunal found no compelling evidence of a pre-existing condition that would prevent maximal recovery within the MIG limits.

Furthermore, surveillance and employment evidence contradicted the applicant's claim of chronic pain, showing he worked 12-hour shifts and engaged in physical activities without apparent discomfort.

The Tribunal concluded the injuries were predominantly minor and dismissed the application.

The applicant sought payment for an accounting report prepared to calculate her Income Replacement Benefits (IRBs), as well as interest on overdue IRB payments and an award for unreasonable delay.

The Licence Appeal Tribunal found that the accounting report was not reasonable and necessary because the IRB calculation was simple and the dispute arose from the applicant's failure to provide accurate income information.

The Tribunal dismissed the claim for the report and the award, but allowed the claim for interest on the overdue IRB payments, noting that the interest provision is a no-fault provision.

The applicant, a passenger on a TTC bus involved in a collision, sought statutory accident benefits for physiotherapy and psychological treatments.

The Licence Appeal Tribunal denied the claims for physiotherapy, finding the applicant failed to prove the back pain was caused by the accident rather than a pre-existing knee injury.

However, the Tribunal allowed the claims for the cost of preparing an OCF-18 for a psychological assessment and the unpaid portion of a psychological treatment plan, finding them reasonable and necessary.

The respondent was ordered to pay interest on the overdue amounts.

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

The respondent denied the claims on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG), capping medical and rehabilitation benefits at $3,500.

The applicant argued that chronic pain removed him from the MIG.

The Tribunal found that the applicant failed to prove the chronic pain was caused by the accident, noting subsequent injuries and degenerative conditions that were not addressed by the applicant's medical assessors.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the insurer's denial of psychological services, chiropractic treatments, a chronic pain assessment, and a chronic pain program.

The Licence Appeal Tribunal found the psychological, chiropractic, and chronic pain program treatments to be reasonable and necessary, preferring the evidence of the applicant's treating practitioners over the insurer's assessors.

The claim for a chronic pain assessment was denied as redundant.

The applicant was awarded interest on overdue payments, but claims for a special award and costs were dismissed.

The applicant sought statutory accident benefits for dental services following a motor vehicle accident.

The insurer denied the claim, arguing the dental issues were not caused by the accident.

The Tribunal found that the applicant failed to prove causation, noting the absence of reported dental injuries in the immediate post-accident medical records and a documented history of pre-existing dental problems.

Relying on the insurer's dental examination report, the Tribunal concluded the recommended treatments likely addressed pre-existing deficiencies.

The application for benefits, interest, and a special award was dismissed.

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

The insurer denied various medical, rehabilitation, attendant care, and non-earner benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant failed to meet the burden of proving her injuries warranted removal from the MIG, noting that her medical evidence was unpersuasive and internally contradictory.

Furthermore, the applicant's claim for non-earner benefits was dismissed because her own statements to independent examiners demonstrated she had resumed a significant portion of her pre-accident activities.

The appeal was dismissed.

The applicant sought statutory accident benefits for physiotherapy and an orthopaedic assessment following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant failed to prove her left knee impairment was caused or aggravated by the accident, as medical evidence indicated pre-existing osteoarthritis.

Consequently, most of the treatment plans were deemed not reasonable and necessary.

However, the Tribunal ordered the respondent to pay for one physiotherapy treatment plan because the respondent failed to provide a sufficient explanation of benefits (notice of denial) as required by section 38 of the Schedule.

The claims for an award and interest were dismissed.

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

The insurer terminated IRBs after 104 weeks, arguing the applicant did not meet the test for complete inability to work.

The Tribunal found that while the applicant failed to prove physical impairment, he successfully established that his psychological impairments, caused by the accident, rendered him completely unable to engage in any employment for which he was reasonably suited.

The Tribunal awarded IRBs from November 15, 2015, ongoing, with interest.

The respondent's request for costs was denied.

The applicant sought a preliminary determination on whether the costs of catastrophic impairment assessments are included in the $50,000 limit on medical and rehabilitation benefits under the Statutory Accident Benefits Schedule.

The Tribunal held that catastrophic impairment assessments are not included in the $50,000 cap and are instead payable under section 25 of the Schedule.

The respondent was ordered to restore $18,434.00 to the applicant's medical and rehabilitation benefit limit.

The insurer brought a motion to bar the applicant from proceeding with her application for income replacement benefits because she failed to attend several scheduled insurer's examinations (IEs).

The Tribunal found that while the applicant failed to attend the IEs, barring her appeal would be a disproportionate response given the lack of wilful non-compliance and the fact that she provided reasonable explanations for some absences.

The Tribunal exercised its discretion under s. 55(2) of the Schedule to allow the application to proceed, subject to the condition that the applicant attend rescheduled IEs.

The Tribunal also held it had no jurisdiction to order the applicant to pay the insurer's cancellation fees for the missed IEs.

Aviva applied to the Licence Appeal Tribunal for repayment of $6,059.23 in income replacement benefits (IRBs) paid to the respondent, arguing the amount was paid in error due to a miscalculation of his pre-accident self-employment income.

The respondent disputed the recalculation and sought ongoing IRBs.

The Tribunal found that the respondent correctly designated his gross employment income from his last fiscal year prior to the accident under section 4(2)3 of the Schedule, and that corporate losses should not be deducted from his personal income.

The Tribunal dismissed Aviva's claim for repayment and ordered Aviva to pay the respondent IRBs of $400.00 per week from October 18, 2013 to date, plus interest.

The respondent's request for costs was dismissed.

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

The respondent insurer brought a preliminary motion to bar the application because the applicant failed to attend independent medical examinations (IEs) under s. 44 of the Schedule and failed to provide requested information under s. 33.

The Tribunal found the applicant was barred from proceeding with his appeal for medical benefits and examination costs due to his unexcused failure to attend the IEs.

However, the insurer was liable to pay non-earner benefits for a specific period due to its failure to provide proper notice of election of benefits, though it could withhold payments for the subsequent period of the applicant's non-compliance with s. 33.

The applicant, a taxi driver, was assaulted by a passenger after leaving his vehicle and following the passenger into a laneway to collect an unpaid fare.

He applied for statutory accident benefits, which the respondent insurer denied on the basis that the incident was not an 'accident' under the Schedule.

The Licence Appeal Tribunal applied the two-part purpose and causation test from Greenhalgh.

The Tribunal found that leaving the taxi to collect a fare was not an ordinary use or operation of the vehicle, and that the assault was a distinct and severable intervening act that broke the chain of causation.

The application was dismissed.

The applicant, who was struck by a vehicle at age six, sought non-earner benefits (NEBs) upon turning 16.

The insurer paid NEBs for seven months before terminating them following an insurer's examination.

The Licence Appeal Tribunal found that the applicant failed to prove he suffered a complete inability to carry on a normal life, as he successfully completed school, played competitive sports, and worked as a general labourer.

The application for NEBs and interest was dismissed.

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

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

The applicant argued she should be removed from the MIG due to psychological injuries, a pre-existing psychological condition, and chronic pain.

The Tribunal found the applicant's claims of psychological injury and chronic pain were not credible due to significant inconsistencies in her self-reporting to various medical assessors.

The Tribunal concluded the applicant's injuries were predominantly minor and governed by the MIG, dismissing her application for additional medical benefits and interest.

The applicant insurer sought repayment of benefits and claim adjustment costs from the respondent, alleging he wilfully misrepresented being a passenger in an insured vehicle during an accident.

The respondent did not participate in the hearing.

The Tribunal found that the respondent was not an occupant of the vehicle and that his claim was based on a wilful misrepresentation.

The Tribunal ordered the respondent to repay $200.00 in benefits plus interest.

However, the Tribunal held it lacked jurisdiction to order repayment of the insurer's claim adjustment costs, such as insurer's examination fees, and denied the insurer's request for costs of the proceeding.