Jesse A. Boyce

The applicant insurer sought repayment of $9,197.65 in income replacement benefits (IRBs) paid to the respondent following a motor vehicle accident.

The insurer alleged the respondent wilfully misrepresented his employment status, as records later revealed he had been terminated from his job prior to the accident.

The respondent did not participate in the hearing.

The Tribunal found that the respondent had wilfully misrepresented his employment status and that the insurer met the procedural requirements for repayment under section 52 of the Schedule.

The Tribunal ordered the respondent to repay the IRBs with interest.

The applicant insurer accidentally deposited $1,114.60 into the respondent insured's bank account instead of paying an invoice for an examination under oath.

The insurer quickly realized the error, paid the correct party, and requested repayment from the insured.

The insured failed to respond to multiple requests or participate in the Tribunal proceedings.

The Tribunal found the insurer met the requirements of section 52 of the Statutory Accident Benefits Schedule and ordered the insured to repay the funds with interest.

The Tribunal declined to award costs against the insured.

The applicant was involved in a motor vehicle accident and suffered a cardiac arrest twelve days later, resulting in severe anoxic brain damage.

He sought various accident benefits, arguing the accident caused increased stress that led to the heart attack.

The Tribunal dismissed the application, finding the applicant failed to meet the 'but for' causation test.

Relying on medical evidence of advanced pre-existing coronary artery disease and the lack of documented stress complaints immediately post-accident, the Tribunal concluded the accident was not a necessary cause of the cardiac arrest.

The applicant's physical injuries were deemed soft-tissue in nature and subject to the Minor Injury Guideline.

The applicant sought entitlement to various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule following a motor vehicle accident while being transported in a police van.

The insurer denied the treatment plans on the basis that they were not reasonable and necessary.

The Tribunal dismissed the application, finding that the applicant failed to comply with section 33 production requests for relevant medical records.

Furthermore, the applicant failed to provide objective medical evidence or persuasive analysis to prove that the disputed treatment plans were reasonable and necessary for accident-related impairments.

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

After the respondent eventually agreed to fund the disputed benefits, the sole remaining issue was whether the applicant was entitled to a special award under section 10 of O. Reg. 664 for unreasonable delay.

The Tribunal found that the respondent unreasonably delayed payment by improperly claiming that section 25 assessments were duplications of section 44 assessments and by failing to reconsider earlier denials after removing the applicant from the Minor Injury Guideline.

A nominal special award of $400 was ordered.

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

The parties disputed the correct calculation of the IRB, specifically whether a $120,000 lump sum settlement the applicant received from her long-term disability (LTD) carrier should be deducted from her IRBs.

The Tribunal found that the LTD settlement encompassed all claims against the LTD carrier, including extracontractual damages, and could not be broken down to satisfy the requirements of the Schedule.

Therefore, the LTD settlement was not deductible from the IRBs.

The Tribunal ordered the respondent to pay IRBs at $400 per week plus interest, denied the respondent's claim for repayment, and declined to make an award for unreasonable withholding of benefits.

The applicant requested a reconsideration of a preliminary issue decision that found her statute-barred from proceeding with her LAT application for failing to attend Insurer's Examinations.

The applicant alleged errors of fact and law, procedural unfairness, and adjudicator bias.

The adjudicator dismissed the reconsideration request, finding no errors or bias, and strongly criticized the applicant's counsel for toxic and baseless submissions.

The respondent's request for costs was declined to avoid penalizing the applicant for her counsel's behaviour.

The applicant insurer sought repayment of $15,028.57 in income replacement benefits (IRBs) paid to the respondent, arguing the payments were made in error.

The respondent's tax returns showed no reported employment income prior to the accident, meaning her IRB quantum under s. 4(5) of the Schedule should have been $0.00.

The respondent did not participate in the written hearing.

The Tribunal found the insurer provided proper notice under s. 52(2) and ordered the respondent to repay the overpayment plus applicable interest.

The applicant requested a reconsideration of a preliminary issue decision which found his application for income replacement benefits was statute-barred.

The applicant argued the adjudicator erred in finding the insurer's denial notice was valid because it did not provide a medical reason for termination alongside the fact that he had returned to work.

The Tribunal dismissed the reconsideration request, holding that a return to pre-accident employment is a valid reason for termination under section 37 of the Schedule that does not require an accompanying medical reason, and the denial notice was clear and unequivocal.

The applicant was injured in a motor vehicle accident in 2002 when he was six years old.

He did not apply for accident benefits until 2016, after reaching the age of majority.

The respondent insurer denied the application on the basis that it was statute-barred due to delay.

The applicant argued that a tort action letter sent to the insurer in 2014 constituted sufficient notice and that he had a reasonable explanation for the delay.

The Tribunal found that the tort action letter provided sufficient notice and that the insurer failed to meet its obligations to provide the applicant with the necessary forms.

The Tribunal also found that the applicant had a reasonable explanation for the delay, given his age at the time of the accident and his parents' status as recent immigrants without insurance.

The applicant was permitted to proceed with his claim.

The respondent insurer filed a request for reconsideration of a Tribunal decision awarding the applicant non-earner benefits and a medical benefit due to the insurer's procedural non-compliance.

The insurer argued that procedural breaches should not automatically result in substantive entitlement and that the Tribunal ignored the applicant's own procedural delays.

The adjudicator dismissed the reconsideration request, finding no error of law or fact.

The adjudicator confirmed that section 36(6) of the Statutory Accident Benefits Schedule is a mandatory 'shall-pay' provision, and that the insurer's reasons for denying the medical benefit were insufficient to meet its obligations under section 38.

The applicant was injured in a motor vehicle accident and sought an income replacement benefit (IRB) more than three years later, after her condition deteriorated.

The insurer denied the claim on the basis that she did not suffer a substantial inability to perform the essential tasks of her employment within 104 weeks of the accident, as required by s. 5(1) of the Statutory Accident Benefits Schedule, and that the claim was statute-barred under s. 56 because she failed to dispute a valid denial within the two-year limitation period.

The Tribunal agreed with the insurer, finding that the discoverability rule did not apply to save the claim where the substantive right to an IRB was not established within the initial 104-week period.

The application was dismissed as statute-barred.

The applicant was injured in a motor vehicle accident and initially continued to work, not meeting the test for an income replacement benefit (IRB).

Over three years later, her condition deteriorated, and she applied for an IRB.

The insurer denied the claim on the basis that she did not establish eligibility within 104 weeks of the accident and that the two-year limitation period had expired since the initial denial.

The Tribunal found that the applicant was statute-barred under s. 56 of the Schedule because she failed to appeal the valid initial denial within two years.

Furthermore, the Tribunal held that the discoverability doctrine did not apply to save the claim, as she failed to demonstrate substantive entitlement to an IRB within 104 weeks post-accident under s. 5(1).

The applicant sought attendant care benefits following a motor vehicle accident.

The insurer denied the benefits and scheduled insurer's examinations (IEs), which the applicant failed to attend.

The applicant appealed to the Tribunal more than two years after the initial denial.

The Tribunal held that the applicant was statute-barred from proceeding with the attendant care benefits claim because the appeal was filed outside the two-year limitation period under s. 56 of the Schedule, and declined to extend the time under s. 7 of the LAT Act.

Furthermore, the Tribunal found the applicant was statute-barred under s. 55 from proceeding with several other benefit claims due to his unjustified failure to attend properly scheduled s. 44 IEs.

The applicant was injured in a motor vehicle accident and sought medical benefits for physiotherapy.

The respondent denied the treatment plan, arguing the applicant's injuries fell within the $3,500 Minor Injury Guideline (MIG) limit.

The Tribunal found that the applicant's pre-existing chronic pain, which was exacerbated by the accident, justified removal from the MIG under section 18(2) of the Schedule.

The disputed treatment plan was found to be partially reasonable and necessary, and the respondent was ordered to pay $3,608.06 for kinesiology and occupational therapy assessments.

The applicant, who was catastrophically impaired in a 2013 motor vehicle accident, sought payment for an in-home occupational therapy assessment to determine ongoing attendant care and housekeeping needs.

The respondent insurer denied the claim, arguing it was statute-barred under s. 56 of the Schedule because a previous denial was not disputed within two years, and that the assessment was not reasonable and necessary.

The Tribunal found that a 2016 partial settlement agreement did not permanently end the applicant's entitlement to these benefits and no settlement disclosure notice was provided.

The Tribunal concluded the claim was not statute-barred and that the assessment was reasonable and necessary given evidence of changes in the applicant's circumstances.

The applicant sought statutory accident benefits for physiotherapy and CBD oil following a motor vehicle accident.

The respondent denied the benefits based on insurer examinations concluding the applicant had reached maximum medical recovery.

The Tribunal found that one physiotherapy treatment plan and a portion of the CBD oil treatment plan were reasonable and necessary to manage the applicant's chronic back pain, noting flare-ups occurred when treatment ceased.

The remaining physiotherapy plans and assessment costs for the CBD oil were denied.

The applicant was injured in a motor vehicle accident and sought physiotherapy treatment.

The respondent insurer denied the treatment plans, determining the injuries fell within the Minor Injury Guideline (MIG).

The applicant argued that pre-existing conditions, including chronic pain and psychological issues from a prior accident, warranted removal from the MIG.

The Tribunal found the applicant failed to provide compelling medical evidence that her pre-existing conditions prevented maximal medical recovery within the MIG, noting her medical reports predated the current accident.

The Tribunal concluded the injuries were predominantly minor, the MIG limits were exhausted, and the treatment plans were not reasonable and necessary.

Claims for an award and interest were also dismissed.

The applicant was injured in a motor vehicle accident and sought payment for a medical cannabis treatment plan to address chronic neck and back pain and sleep issues.

The respondent insurer denied the treatment plan, relying on a section 44 assessment that concluded cannabis was not reasonable and necessary for chronic pain.

The Tribunal preferred the evidence of the applicant's chronic pain specialist and cannabis clinic physician, finding that the treatment goals of reducing pain were reasonable and likely to be achieved.

The Tribunal ordered the respondent to pay the cost of the treatment plan, plus interest on the overdue amount.

The applicant, who was catastrophically impaired in a motor vehicle accident, sought various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal found that a protective cell phone case, an ergonomic lawn chair, a mattress, and the Guideline rate for a registered nurse case manager were reasonable and necessary.

However, claims for a new iPhone, a FitBit, a riding lawnmower, and an increased rate for an acupuncturist were dismissed as not reasonable and necessary.

The Tribunal also denied the applicant's request for a special award and costs.