Jesse A. Boyce

The applicant was injured in a motor vehicle accident and sought an income replacement benefit (IRB) and various medical benefits from the respondent insurer.

The insurer terminated the IRB and denied the treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to provide sufficient medical evidence demonstrating a substantial inability to perform the essential tasks of his employment as a car washer.

Furthermore, the Tribunal held that the insurer validly denied the treatment plans under s. 38(5) of the Schedule because the applicant failed to submit them via an OCF-23 while subject to the MIG, and such denials are not subject to review pursuant to s. 38(6).

The applicant sought Non-Earner Benefits (NEBs) and Attendant Care Benefits (ACBs) following a motor vehicle accident.

The Tribunal dismissed the claim for NEBs, finding the applicant failed to prove a complete inability to carry on a normal life, noting surveillance evidence showing she could still drive, perform personal care, and shop.

The Tribunal also dismissed the claim for ACBs, finding the requested 90 hours per month was not reasonable or necessary given her demonstrated functionality, and the expenses were not incurred.

Claims for an award and interest were also dismissed.

The applicant was injured in a motor vehicle accident and received income replacement benefits (IRBs) until he returned to work, at which point the insurer terminated the benefits.

More than two years later, the applicant sought reinstatement of the IRBs and applied to the Tribunal.

The insurer raised a preliminary issue that the application was statute-barred.

The Tribunal found that the insurer's initial denial was clear, unequivocal, and provided valid reasons, thereby triggering the two-year limitation period.

The Tribunal declined to extend the limitation period under section 7 of the LAT Act, finding the 10-month delay excessive and without compelling excuse.

The application for IRBs was dismissed as statute-barred.

The applicant was injured in a motor vehicle accident and sought medical and rehabilitation benefits for psychological treatment and a chronic pain program.

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

The Tribunal found that the applicant suffered from chronic pain and was entitled to partial payment for both treatment plans.

The rehabilitative components and psychological services were deemed reasonable and necessary, while transportation costs, social work, education elements, and additional progress reports were denied.

The applicant was injured in an ATV accident and deemed catastrophically impaired.

After initially returning to work and reporting no need for housekeeping assistance, his condition deteriorated and he sought post-104-week income replacement and housekeeping benefits.

The insurer requested section 44 insurer's examinations to assess entitlement, which the applicant refused to attend.

The Tribunal found the requested examinations were reasonably necessary given the change in the applicant's condition and the lack of prior examinations for these specific benefits.

The applicant was held to be statute-barred under section 55 of the Schedule from proceeding with his application until he attends the scheduled examinations.

The applicant was injured in a motor vehicle accident and sought an income replacement benefit (IRB) and various medical and rehabilitation benefits from the respondent insurer.

The insurer terminated the IRB and denied several treatment plans on the basis that the applicant no longer suffered a substantial inability to perform his pre-accident job tasks and that the treatments were not reasonable and necessary.

The Tribunal found that the applicant failed to prove a substantial inability to perform his employment tasks during the disputed period, relying on the insurer's expert assessments.

The Tribunal approved one chiropractic treatment plan as reasonable and necessary, noting the applicant's ongoing pain and the insurer's failure to conduct a timely examination, but denied the remaining plans for chiropractic, psychological, and occupational therapy services due to a lack of corroborating medical evidence.

The applicant was injured in a snowmobile accident in 2012 but did not apply for statutory accident benefits until 2017, a delay of over five years.

The respondent insurer denied the claim based on the delay.

The Tribunal found that while the applicant's explanations regarding an abusive relationship and other hardships were credible, they did not reasonably explain the entire five-year and eight-month delay, particularly the two and a half years following her separation from her ex-husband.

The Tribunal held that the applicant failed to provide a reasonable explanation for the delay and is therefore statute-barred from proceeding with her application.

The applicant was injured in a motor vehicle accident and sought a non-earner benefit, the cost of a social work assessment, and the cost of three disability certificates from her insurer.

The insurer denied the claims, arguing the applicant did not suffer a complete inability to carry on a normal life and that the assessments were not reasonable and necessary.

The Licence Appeal Tribunal dismissed the application, finding the applicant's self-reported activities and the insurer's medical examinations demonstrated she was not completely prevented from engaging in her pre-accident activities.

The Tribunal also found the social work assessment was not reasonable and necessary, and the disability certificates were not payable as they were duplicative and not requested by the insurer.

The applicant, an 80-year-old pedestrian struck by a vehicle, sustained physical injuries and a traumatic brain injury, resulting in catastrophic impairment.

She sought a housing modification benefit of $158,476.89.

The respondent insurer partially approved $24,282.00 based on its own assessments, arguing the applicant's proposed modifications were excessive.

The Tribunal found the applicant's proposal largely unrealistic and disproportionate, preferring the respondent's more modest proposal.

However, the Tribunal also approved the applicant's request for an accessible kitchen package and closet organizers as reasonable and necessary to accommodate her accident-related impairments.

The applicant was injured in a motor vehicle accident and sought a medical benefit of $1,067.50 for physiotherapy.

The respondent denied the claim, asserting the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant's soft-tissue injuries were predominantly minor and that she failed to provide compelling medical evidence of a pre-existing condition, psychological impairment, or chronic pain to justify removal from the MIG.

As the MIG limits had been exhausted, the disputed treatment plan was deemed not reasonable and necessary.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for chiropractic treatment, a psychological assessment, and an orthopedic assessment.

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

The Licence Appeal Tribunal dismissed the application, finding that the applicant had not met the onus of proving the treatments and assessments were reasonable and necessary, noting the applicant had been discharged from a clinic due to being pain-free and lacked corroborating medical evidence for the psychological complaints.

Claims for interest and an award for unreasonable delay were also dismissed.

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

The insurer requested a neuropsychological insurer's examination (IE) to assess the claim, which the applicant refused to attend, arguing it was not reasonably necessary.

The insurer raised a preliminary issue that the applicant was statute-barred from proceeding with her Licence Appeal Tribunal application under section 55 of the Statutory Accident Benefits Schedule.

The Tribunal found the neuropsychological IE was reasonably necessary to determine catastrophic impairment and ordered that the applicant is statute-barred from proceeding until she attends the examination.

The applicant sought attendant care, medical, and rehabilitation benefits following a motor vehicle accident.

The insurer denied the benefits, arguing the applicant's mother did not meet the requirements for a professional service provider and that the medical benefits fell within the Minor Injury Guideline.

The Licence Appeal Tribunal dismissed the application, finding the mother was not acting in the course of her employment as a Health Care Aide and did not sustain an economic loss.

The Tribunal also found the applicant failed to prove the treatment plans were reasonable and necessary, as there was a lack of timely, objective medical evidence supporting the claims.

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits, including psychological testing, psychological services, and physiotherapy.

The insurer partially approved the psychological treatment plans based on independent medical examinations and denied the physiotherapy plans.

The Tribunal found the applicant failed to prove the unapproved portions of the psychological plans were reasonable and necessary.

However, the Tribunal approved one of the two identical physiotherapy treatment plans to determine if further passive modalities could provide tangible benefit.

The claim for an award for unreasonable delay was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including an income replacement benefit (IRB), medical benefits for chiropractic services, and various expenses.

The insurer denied the claims.

The Tribunal found the applicant failed to provide sufficient medical and financial evidence to prove a substantial inability to perform the essential tasks of her employment for the IRB.

The Tribunal also found the applicant failed to prove the medical benefits and expenses were reasonable and necessary, noting a lack of supporting medical documentation and failure to rebut the insurer's examination report.

The application was dismissed.

The applicant sought statutory accident benefits for a chronic pain programme following a motor vehicle accident.

The insurer denied the benefit and requested an insurer's examination (IE) under s. 44 of the Schedule.

The applicant refused to attend, arguing that she had already undergone numerous IEs and that the request was unreasonable.

The Tribunal found that the IE request was reasonably necessary because the chronic pain programme constituted a new benefit claim.

As the applicant failed to provide a reasonable excuse for non-attendance, she was statute-barred under s. 55(1)2 from proceeding with her application for the chronic pain programme until she attended the IE.

The insurer's request for costs was denied.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits from the respondent insurer.

The insurer partially denied the cost of a slate of catastrophic examinations and fully denied claims for chiropractic treatment.

The Licence Appeal Tribunal found that the Functional Abilities Evaluation and associated travel and completion fees were reasonable and necessary for the catastrophic impairment determination.

However, the Tribunal dismissed the claims for the remaining catastrophic assessments, finding them duplicative, and denied the chiropractic treatment plans because the applicant failed to demonstrate they were reasonable and necessary.

The claim for an award for unreasonable delay was also dismissed.

The applicant sought income replacement benefits following two separate motor vehicle accidents.

The insurer denied the claims and the applicant applied to the Licence Appeal Tribunal more than two years after the denials.

The insurer raised a preliminary issue that the applications were statute-barred.

The Tribunal found that the insurer's denials were clear and unequivocal, triggering the two-year limitation period under s. 56 of the Statutory Accident Benefits Schedule.

The Tribunal declined to exercise its discretion under s. 7 of the Licence Appeal Tribunal Act to extend the limitation period, finding the applicant failed to demonstrate a bona fide intention to appeal within the time limit or provide compelling reasons for the delay.

The claims for ongoing entitlement were dismissed as statute-barred, though the applicant was permitted to proceed on the issue of quantum for a previously accepted period.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, which the respondent insurer denied.

The applicant applied to the Licence Appeal Tribunal for dispute resolution.

After failing to comply with submission deadlines, failing to communicate with the Tribunal or his counsel, and failing to respond to the respondent's motion to dismiss, the Tribunal found the applicant had abandoned his application.

The application was dismissed pursuant to Rule 3.4(d) of the Tribunal's Common Rules of Practice and Procedure.

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

The applicant, who was self-represented after his counsel withdrew, failed to attend the case conference or the written hearing and provided no evidence or submissions.

The Tribunal found the applicant failed to meet his onus to prove entitlement to the benefits under section 5(1) of the Statutory Accident Benefits Schedule, as the available evidence indicated he was not employed at the time of the accident and had not worked the requisite 26 weeks in the preceding 52 weeks.

The application was dismissed.

The Tribunal declined to award costs to the respondent, finding it unreasonable to penalize a self-represented applicant who had effectively abandoned the claim.