D. Gregory Flude

The applicant sought statutory accident benefits for a neurological assessment and two physiotherapy treatment plans following a motor vehicle accident.

The respondent denied the claims.

The Tribunal found that the claim for the neurological assessment was barred by the two-year limitation period under s. 56 of the Schedule, and the applicant failed to establish reasonable grounds for an extension under s. 7 of the LAT Act.

The Tribunal also dismissed the claims for physiotherapy, finding that the applicant had reached maximum medical recovery from facility-based treatment and that further sessions were not reasonable and necessary, preferring the respondent's medical evidence recommending a home-based exercise program.

The applicant was injured in a rear-end motor vehicle collision and sought medical benefits for chiropractic and psychological treatment under the Statutory Accident Benefits Schedule.

The respondent insurer denied the treatment plans, arguing the applicant had reached maximum medical improvement and that his ongoing symptoms were related to extensive pre-existing degenerative conditions.

The Tribunal applied a two-step causation test and found the applicant failed to prove his current impairments were caused by the accident, preferring the insurer's medical examination evidence over the applicant's chiropractor.

The application for further benefits was dismissed.

The applicant sought reconsideration of a decision finding he did not suffer a catastrophic impairment following a motor vehicle accident.

The applicant argued he was denied procedural fairness when his expert was prevented from expanding on answers during cross-examination and re-examination, and that the adjudicator misunderstood the expert's evidence regarding cauda equina-like syndrome.

The Vice Chair dismissed the request, finding that limiting re-examination correctly prevented the applicant from splitting his case.

Furthermore, while the adjudicator acknowledged a minor factual error regarding the AMA Guides, it was not material, as the expert's diagnosis was suspect due to his unawareness of the applicant's pre-existing severe degenerative disc disease.

The applicant sought to dispute the respondent insurer's denial of a non-earner benefit.

The Tribunal previously found that the application was filed beyond the two-year limitation period under s. 56 of the Statutory Accident Benefits Schedule.

The applicant argued that the Tribunal had discretion to extend the limitation period under s. 7 of the Licence Appeal Tribunal Act, 1999.

The Tribunal held that s. 7 applies only to limitation periods fixed by an Act, not those in regulations like the Schedule.

In the alternative, applying the Manuel test, the Tribunal found that the justice of the case did not favour extending the limitation period due to the lack of a bona fide intention to appeal, the length of the delay, and prejudice to the insurer.

The application was dismissed as time-barred.

The applicant brought a motion requesting the Vice-Chair recuse himself due to a reasonable apprehension of bias arising from a remark made two years prior, and a motion to reconsider a previous interlocutory decision.

The Tribunal dismissed the recusal motion, finding no reasonable apprehension of bias given the context and an unreserved apology, and noting the motion was brought after an unexplained seven-month delay following an adverse decision.

The request for reconsideration was also dismissed as the Tribunal's rules do not permit reconsideration of interlocutory orders, and there was no denial of procedural fairness.

The applicant sought a determination that he sustained a catastrophic impairment as a result of a motor vehicle accident, along with claims for income replacement benefits, medical benefits for physiotherapy, housekeeping benefits, and cost of examinations.

The Tribunal found that the applicant's shoulder impairments were largely due to pre-existing conditions and natural degeneration, not the accident.

The Tribunal rejected the applicant's whole person impairment rating of 55%, finding that the assessors improperly included a 3% rating for medication use related to a pre-existing heart condition and an 18% rating for speculative future surgery.

The Tribunal also dismissed the claim for income replacement benefits, finding the applicant was not actively self-employed at the time of the accident due to a recent heart attack.

All claims were dismissed.

The insurer requested a reconsideration of a decision finding that the applicant was insured under a newly acquired automobile provision when he crashed his motorcycle 11 days after purchase.

The insurer argued the Tribunal erred in law by misapplying case law regarding the 14-day automatic coverage extension and the applicant's subjective knowledge of coverage.

The Tribunal found no significant error of law or fact in the original decision, confirming that the 14-day extension applied automatically and the applicant's subjective belief was irrelevant to the coverage analysis.

The request for reconsideration was denied.

The appellant appealed a decision denying his claim for compensation from the Motor Vehicle Dealers Compensation Fund following a dealership's receivership.

The Fund provides compensation only to consumers, not for business transactions.

The appellant argued he purchased the vehicle for personal use, despite having purchased 14 other vehicles for export to Ecuador.

The Tribunal found the evidence, including the involvement of a global shipping company and the timing of the purchases, indicated the vehicle was purchased as part of a business venture.

The appeal was dismissed.

The respondent insurer brought a motion to dismiss the applicant's claim for statutory accident benefits due to her failure to attend two scheduled insurer medical examinations under section 44 of the Schedule.

The applicant claimed scheduling conflicts and the need for an interpreter, but the Tribunal found these explanations lacked credibility and were unsupported by the evidence.

The Tribunal declined to exercise its discretion to allow the application to proceed and dismissed the application pursuant to section 55 of the Schedule.

The applicant sought statutory accident benefits after injuring his back while changing his vehicle's winter tires to summer tires in his driveway.

The respondent insurer denied the claim 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 Tribunal held that performing planned seasonal maintenance, such as changing tires on a parked and disabled vehicle, does not constitute the 'use or operation' of an automobile.

The Tribunal found that it was not within the reasonable expectations of the insured to have coverage while performing such maintenance.

The preliminary issue was resolved in favour of the respondent.

The applicant, a pedestrian struck by a vehicle, sought a determination that she sustained a catastrophic impairment due to psychological and emotional damage.

The Tribunal reviewed extensive medical and occupational therapy evidence, finding that the applicant's pre-accident active lifestyle had been replaced by severe avoidant behaviours, fatigue, and an inability to cope with stress.

Preferring the evidence of the applicant's psychiatric assessor over the respondent's, the Tribunal concluded the applicant suffered a marked impairment in the domain of adaptation.

The claims for interest and a special award were dismissed as there were no specific monetary benefits in dispute.

The applicant sought a non-earner benefit and a medical benefit following a motor vehicle accident.

The Tribunal found that the insurer failed to provide a compliant denial notice for the non-earner benefit until November 26, 2016, and ordered payment of the benefit from the end of the 26-week deductible period until that date.

However, the Tribunal dismissed the claim for ongoing non-earner benefits, finding the applicant did not suffer a complete inability to carry on a normal life.

The claim for a medical benefit was also dismissed as the proposed treatment was not reasonable and necessary, given the applicant's extensive pre-existing back issues.

A claim for a special award under O. Reg 664 was dismissed.

The applicant sought statutory accident benefits following a single-vehicle motorcycle accident.

The insurer denied the benefits, arguing the applicant sustained no injuries and provided inconsistent accounts of the accident.

The Tribunal found the applicant's contemporaneous reports to first responders, which indicated a low-speed departure into a field without physical injury, to be the most reliable.

Consequently, claims for attendant care, physiotherapy, and an attendant care assessment were dismissed.

However, the Tribunal approved psychological treatment by a psychotherapist at a rate of $146.91 per hour, finding the insurer could not unilaterally impose a lower rate for an unregulated provider under the Guidelines.

The applicant brought a motion to compel the respondent's adjuster to answer questions refused during a cross-examination on her affidavit.

The respondent argued that the questions had already been answered during a subsequent day of the cross-examination.

The Tribunal found that the adjuster had indeed answered the disputed questions regarding communications about undertakings and refusals.

The motion to compel was dismissed.

The applicant sought payment for various treatment and assessment plans following a motor vehicle accident.

The insurer denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 coverage limit had been exhausted.

The Tribunal found that the applicant sustained predominantly minor injuries, specifically neck and back strains, and that her ongoing pain was attributable to pre-existing degenerative disc disease and osteoarthritis rather than the accident.

The Tribunal rejected the applicant's claims of chronic pain and psychological impairment, preferring the insurer's expert evidence.

As the applicant did not meet the criteria for a pre-existing condition exception, she remained subject to the MIG limit, and her claims for further benefits, interest, and a special award were dismissed.

The applicant sought interest on the cost of a chronic pain assessment following a motor vehicle accident.

The respondent insurer had initially denied the benefits but paid them prior to the hearing.

The sole issue was whether interest was owed due to late payment.

The Tribunal found that the applicant failed to provide evidence of when the invoice (OCF-21) was submitted to the insurer, which is required to trigger the 30-day payment period and subsequent interest obligations.

The claim for interest was dismissed.

The applicant, who was five years old at the time, was injured when a car crashed into her daycare in 2009.

Seven years later, she sought payment for chiropractic, massage, and psychological treatments, as well as a cognitive assessment, attributing her back pain and psychological symptoms to the accident.

The respondent insurer denied the benefits, arguing she had reached maximum medical recovery.

The Licence Appeal Tribunal dismissed the application, finding that the physical injuries had resolved shortly after the accident and current back pain was due to poor posture.

The Tribunal also found the proposed psychological treatment and cognitive assessment were not reasonable and necessary given the mildness of the symptoms and the applicant's reluctance to participate.

The applicant sought a determination that he sustained a catastrophic impairment following a motor vehicle accident, which would entitle him to enhanced statutory accident benefits.

The central dispute involved whether the applicant's lower extremity symptoms were caused by accident-related damage to the cauda equina or by pre-existing degenerative disc disease.

The Tribunal preferred the respondent's medical evidence, finding that the applicant suffered an L1 fracture and that his ongoing symptoms were degenerative rather than accident-related.

As the applicant's Whole Person Impairment score did not reach the 55% threshold without the cauda equina impairment rating, the motion was dismissed.

The respondent insurer brought a preliminary issue motion to determine whether the applicant was insured to drive his newly purchased motorcycle at the time of the accident.

The applicant had purchased the motorcycle 11 days prior to the accident but had not notified the insurer, who did not underwrite motorcycle insurance.

The Tribunal found that under section 2.2.1 of the Ontario Automobile Policy (OAP 1), the applicant was automatically covered for 14 days after acquiring the additional vehicle.

As the accident occurred on the 11th day, the applicant had insurance coverage and was not precluded from receiving statutory accident benefits.

The applicant sought a determination that he sustained a catastrophic impairment following a motor vehicle accident, which would entitle him to enhanced statutory accident benefits.

The dispute centered on whether his lower extremity symptoms were caused by accident-related damage to the cauda equina or pre-existing degenerative disc disease.

The tribunal accepted the respondent's medical evidence that the symptoms were degenerative and that treating physicians had ruled out cauda equina involvement.

Consequently, the applicant's Whole Person Impairment score did not meet the 55% threshold, and the application was dismissed.