Jesse A. Boyce

The applicant was injured in a motor vehicle accident and sought various statutory accident benefits, including attendant care, physiotherapy, and a psychological assessment.

The respondent insurer denied the benefits on the basis that the applicant's impairments fell within the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant sustained predominantly minor injuries and failed to provide compelling medical evidence of a pre-existing condition or psychological impairment that would warrant removal from the MIG.

Consequently, the applicant was not entitled to the claimed treatment plans, attendant care benefits, or an award for unreasonable delay.

The applicant sought payment for two physiotherapy treatment plans following a motor vehicle accident.

The insurer denied the plans based on section 44 assessments indicating the applicant had achieved maximal medical recovery.

The Tribunal found the applicant failed to demonstrate the treatment plans were reasonable and necessary, noting limited evidence of improvement, the applicant's self-reported normal function, and the lack of objective referrals for treatment.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought various medical, rehabilitation, and assessment benefits from the respondent insurer.

The respondent denied the benefits on the basis that they were not reasonable and necessary, relying on insurer examinations.

The adjudicator found that the applicant failed to meet his burden of proving the treatment and assessment plans were reasonable and necessary, noting a lack of objective medical evidence linking his current complaints to the accident and a lack of functional impairment.

Additionally, one claim for chiropractic treatment was found to be statute-barred as the appeal was filed past the two-year limitation period.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought a medical benefit for psychological services, arguing her pre-existing depression and anxiety warranted removal from the Minor Injury Guideline (MIG).

The respondent denied the benefit, relying on a section 44 psychological assessment.

The Tribunal found that the applicant sustained predominantly minor injuries and failed to prove her pre-existing conditions were exacerbated by the accident or prevented maximal medical recovery within the MIG.

The Tribunal preferred the respondent's expert evidence and concluded the proposed treatment plan was not reasonable and necessary.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought medical and rehabilitation benefits, as well as the cost of assessments, from the respondent insurer.

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

The applicant argued that his chronic pain and psychological impairments warranted removal from the MIG.

The Tribunal found that the applicant failed to provide sufficient medical evidence demonstrating functional impairment or debilitating pain that would prevent his maximal medical recovery within the MIG.

The Tribunal preferred the insurer's medical assessments over the applicant's, noting inconsistencies between the applicant's self-reporting and objective testing.

The application was dismissed, and no benefits were awarded.

The applicant sought attendant care benefits, interest, and an award under O. Reg. 664 following a motor vehicle accident.

The insurer denied the benefits, initially arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

Although the insurer later removed the applicant from the MIG due to psychological impairments, it maintained the denial of attendant care.

The Tribunal found that the requested attendant care was not reasonable and necessary, noting the applicant's self-reported independence and return to work.

The Tribunal also declined to deem the expenses incurred under s. 3(8) of the Schedule, finding the insurer did not act unreasonably in its handling of the claim.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought various medical benefits and costs of examinations from the respondent insurer.

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

The Tribunal found that the applicant failed to meet the burden of proving that his physical or psychological impairments warranted removal from the MIG.

The Tribunal also dismissed the claims for the costs of examinations, finding them not reasonable and necessary, and denied the claim for a section 10 award.

The applicant sought entitlement to an income replacement benefit and a medical benefit for chiropractic treatment following a motor vehicle accident.

The adjudicator found the applicant was not entitled to the income replacement benefit because he failed to attend properly scheduled insurer's examinations and did not provide a reasonable explanation for his non-attendance.

The claim for chiropractic treatment was also dismissed, as the adjudicator preferred the respondent's expert reports over the applicant's family physician notes, concluding the treatment was not reasonable and necessary.

Claims for interest and an award were consequently dismissed.

The applicant was injured in a motor vehicle accident and sought transportation expenses and a special award under s. 10 of O. Reg. 664 for unreasonable delay in paying income replacement benefits.

The Licence Appeal Tribunal found that the transportation expenses were not payable because the round trip was under 50 kilometres and the applicant was not catastrophically impaired.

The Tribunal also dismissed the claim for a special award, finding that the insurer's denials were based on properly scheduled assessments and there was no evidence of unreasonable behaviour.

The applicant, a minor, was injured in a motor vehicle accident and sought attendant care benefits and physiotherapy from the respondent insurer.

The insurer denied the benefits on the basis that they were no longer reasonable and necessary.

The Tribunal found that the applicant was not entitled to attendant care benefits, as medical evidence indicated he had largely recovered and resumed daily activities.

However, the Tribunal partially approved the physiotherapy treatment plan, finding it reasonable and necessary to address lingering back impairments, and awarded $1,892.15 plus interest.

The applicant sought to reopen a previously withdrawn application for statutory accident benefits 14 months after the Tribunal confirmed it was withdrawn.

The respondent argued the applicant was attempting to circumvent the two-year limitation period under section 56 of the Statutory Accident Benefits Schedule.

The Tribunal found no statutory authority or rule permitting a withdrawn application to be reopened, refreshed, or revived.

The application was dismissed as statute-barred.

The Tribunal declined to award costs to the respondent, finding the applicant's conduct did not significantly prejudice the respondent or abuse the Tribunal's process.

The applicant, a minor injured in a motor vehicle accident, sought attendant care benefits and physiotherapy treatment from the respondent insurer.

The insurer denied the benefits on the basis that the applicant had fully recovered from his fractured arm and the treatments were no longer reasonable and necessary.

The Tribunal found that the medical evidence overwhelmingly indicated the applicant had healed well before the disputed period and had returned to normal activities.

The application was dismissed, as the applicant failed to prove the benefits were reasonable and necessary or that the attendant care expenses were incurred.

The insurer requested a reconsideration of a Tribunal decision that awarded the insured up to $6,000 per month in attendant care benefits and a 25% special award under section 10 of O. Reg. 664.

The reconsideration adjudicator granted the request, finding that the first-instance Tribunal erred in law by failing to calculate the attendant care benefits using the mandatory hourly rates prescribed by the Guideline.

The adjudicator recalculated the incurred attendant care based on a ratio derived from the occupational therapist's recommendations.

Furthermore, the adjudicator set aside the 25% special award, concluding that the insurer's conduct in relying on its own experts' reports to partially approve benefits was not excessive, imprudent, or inflexible, and did not meet the threshold for an unreasonable withholding or delay of benefits.

The applicant sought attendant care benefits, interest, and an award under s. 10 of O. Reg. 664 following a motor vehicle accident.

The Tribunal found that the applicant failed to prove the attendant care services were reasonable and necessary, noting a lack of detail in the invoices and a nearly year-long gap before services were allegedly incurred.

As no benefits were payable, the claims for interest and a bad faith award were also dismissed.

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

The insurer denied two treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and scheduled section 44 insurer's examinations.

The applicant refused to attend the examinations and filed an application with the Licence Appeal Tribunal over six months after the two-year limitation period expired.

The Tribunal found the application was statute-barred due to the expired limitation period and declined to extend it under section 7 of the LAT Act.

Furthermore, the Tribunal held the applicant was barred from proceeding under section 55 of the Schedule for failing to attend the properly scheduled examinations.

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

The insurer denied the claims, arguing the injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that while the applicant's physical injuries were predominantly minor, her psychological diagnosis of Adjustment Disorder with Mixed Anxiety and Depressed Mood justified removal from the MIG.

The Tribunal approved a psychological assessment as reasonable and necessary, but denied the proposed chiropractic treatment plans, finding the applicant had reached maximum medical recovery for her physical impairments.

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits from the respondent insurer under the Statutory Accident Benefits Schedule.

The insurer denied several treatment plans on the basis that they were not reasonable and necessary, relying on section 44 assessments.

The Tribunal found that the applicant was entitled to $338.61 for a therapeutic pool membership and $2,359.99 for chiropractic treatment, as these were reasonable, necessary, and incurred.

However, the Tribunal dismissed the claims for the remaining treatment plans, finding that the applicant failed to meet her burden of proving they were reasonable and necessary, particularly given the lack of substantive analysis and the inclusion of excessive ancillary fees.

Interest was awarded on the overdue benefits.

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

The respondent insurer limited the applicant's medical and rehabilitation benefits to the $3,500 cap under the Minor Injury Guideline (MIG).

The applicant applied to the Licence Appeal Tribunal, arguing that pre-existing conditions, chronic pain, and psychological impairments warranted removal from the MIG.

The Tribunal found that the applicant failed to prove her impairments fell outside the MIG, preferring the respondent's section 44 assessment reports which found no functional impairment or DSM-V diagnosis.

As the MIG limits were exhausted, the disputed treatment plans were deemed not reasonable and necessary.

Claims for an award, costs, and interest were dismissed.

The applicant was injured in a motor vehicle accident and initially placed in the Minor Injury Guideline (MIG) by the respondent insurer, which precluded her from receiving attendant care benefits.

The applicant filed an appeal with the Tribunal and delivered a Notice of Constitutional Question challenging the constitutionality of the MIG and section 14 of the Schedule.

Subsequently, the insurer removed the applicant from the MIG and the parties resolved all substantive issues in dispute, including a claim for a section 10 award.

The insurer then raised a preliminary issue arguing that the constitutional challenge was moot.

The Tribunal agreed, finding that there was no longer a live controversy between the parties.

Furthermore, the Tribunal held that it lacked jurisdiction to decide the constitutional question because its statutory mandate had been exhausted by the resolution of the underlying accident benefits claim.

The application was dismissed.

The respondent insurer requested a reconsideration of a Tribunal decision which found that HST claimed with respect to attendant care services was to be paid outside of the attendant care benefit limits prescribed by the Statutory Accident Benefits Schedule.

The insurer argued the Tribunal made multiple errors of law, including finding that HST is not an 'expense' subject to the limits, relying on non-binding FSCO Bulletins, and misapprehending expert evidence.

The Tribunal dismissed the request for reconsideration, finding no significant errors of law that would warrant a different outcome.

The Tribunal affirmed that interpreting HST as a tax rather than a 'reasonable and necessary expense' is consistent with a plain reading of the Schedule.