Jesse A. Boyce

The applicant sought entitlement to statutory accident benefits for physiotherapy, a chronic pain program, and occupational therapy following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant failed to prove the treatment plans for physiotherapy and the chronic pain program were reasonable and necessary, noting a lack of supporting clinical records and preferring the respondent's medical assessments.

The Tribunal partially approved the occupational therapy claim, granting entitlement to specific assistive devices such as ear plugs, sunglasses, and long-handled tools to mitigate the applicant's symptoms, but denied the occupational therapy sessions.

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

The insurer denied treatment plans beyond the Minor Injury Guideline (MIG) limit and scheduled section 44 Insurer's Examinations.

The applicant failed to attend the examinations and applied to the Licence Appeal Tribunal.

The Tribunal held that the insurer provided valid reasons for its denials and properly scheduled the examinations.

Consequently, the applicant is statute-barred from proceeding with her application until she attends the scheduled examinations.

The applicant was injured in a bicycle-motorcycle collision and sought various statutory accident benefits, including a determination of catastrophic impairment (CAT).

The Licence Appeal Tribunal found that the applicant sustained a catastrophic impairment due to a marked impairment in the adaptation domain resulting from psychological and behavioural disorders.

However, the Tribunal dismissed the applicant's claims for post-104 week income replacement benefits, finding he did not suffer a complete inability to work.

Claims for attendant care and housekeeping benefits were also dismissed because the applicant failed to prove his father, the service provider, suffered an economic loss.

A claim for a special award was denied as the insurer did not unreasonably withhold benefits.

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

The insurer denied several treatment plans and non-earner benefits on the basis that the injuries fell within the Minor Injury Guideline (MIG) and requested section 44 insurer's examinations (IEs).

The applicant refused to attend the IEs, arguing that an insurer cannot compel an IE specifically to determine the applicability of the MIG.

The Tribunal held that determining whether an impairment falls within the MIG is a prerequisite to assessing whether treatment plans are reasonable and necessary, and that section 38(10) permits an insurer to request an IE when it believes the MIG applies.

Because the applicant failed to attend properly scheduled IEs without a reasonable excuse, she is statute-barred from proceeding with her application under section 55(1)2 of the Schedule.

The applicant was struck by a bus and sought statutory accident benefits from the Toronto Transit Commission (TTC).

The Licence Appeal Tribunal denied the applicant's claims for non-earner benefits and attendant care benefits, finding she did not suffer a complete inability to carry on a normal life and failed to prove her mother sustained an economic loss.

However, the Tribunal approved treatment plans for physiotherapy and chiropractic care as reasonable and necessary to treat ongoing pain.

The Tribunal also ordered the TTC to pay a $1,000 award under O. Reg. 664, finding the insurer breached its duty of good faith by unreasonably delaying benefits and failing to maintain transparent internal records.

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

After the applicant's counsel got off the record, the applicant failed to comply with production orders, missed submission deadlines, and failed to attend a case conference resumption.

The Tribunal dismissed the appeal, finding that the applicant had abandoned the proceeding and failed to present a case to prove entitlement to the disputed benefits.

The applicant sought Non-Earner Benefits following a motor vehicle accident, claiming a complete inability to carry on a normal life due to physical and psychological impairments.

The Tribunal dismissed the application, finding that surveillance evidence showing the applicant shopping and lifting items contradicted her reported limitations.

The Tribunal also noted the applicant's pre-existing end-stage renal failure and an intervening accident as complicating factors.

Additionally, the Tribunal dismissed the applicant's procedural objections, finding no breach of her s. 14 Charter right to an interpreter and no denial of natural justice regarding the refusal to hear closing arguments.

The applicant sought non-earner benefits and a chronic pain assessment following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant did not suffer a complete inability to carry on a normal life, as his pain did not practically prevent him from engaging in his daily activities and there were significant pre-existing conditions from a prior workplace accident.

However, the Tribunal found the chronic pain assessment to be reasonable and necessary given the applicant's consistent reports of pain.

The applicant was awarded the cost of the assessment and applicable interest, but denied non-earner benefits.

The applicant sought Non-Earner Benefits (NEBs) following a motor vehicle accident, claiming a complete inability to carry on a normal life due to physical and psychological impairments.

The respondent insurer denied the claim.

The Tribunal found that the applicant's impairments did not continuously prevent her from engaging in substantially all of her pre-accident activities, relying on surveillance evidence showing her performing various daily tasks and the opinions of the respondent's assessors who examined her during the relevant period.

The Tribunal gave little weight to the applicant's occupational therapist's report because it was prepared long after the accident and following a second motor vehicle accident.

The application for NEBs, an award, and interest was dismissed.

The applicant was injured in a motor vehicle accident and sought non-earner benefits and medical and rehabilitation benefits from the respondent insurer.

The Tribunal found that the applicant did not suffer a complete inability to carry on a normal life, as her pain did not practically prevent her from engaging in her pre-accident activities, and dismissed the claim for non-earner benefits.

However, the Tribunal found that several of the disputed treatment plans for physiotherapy, chiropractic, acupuncture, and massage services were reasonable and necessary to treat her lingering pain.

The applicant was awarded the approved medical benefits along with interest on overdue amounts.

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

The insurer terminated non-earner benefits and denied several treatment plans and assessments.

The Tribunal found that the applicant did not suffer a complete inability to carry on a normal life, as his pain did not practically prevent him from engaging in his pre-accident activities, and dismissed the claim for non-earner benefits.

However, the Tribunal found that chiropractic treatment and a chronic pain assessment were reasonable and necessary given the applicant's ongoing pain.

Claims for an attendant care assessment and a functional abilities evaluation were dismissed for lack of evidence of functional impairment.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to two treatment plans for chronic pain and physiotherapy that were denied by the insurer.

Following a reconsideration order, the Licence Appeal Tribunal reheard the matter and found that the applicant suffered from chronic pain syndrome, supported by credible self-reporting and medical evidence.

The Tribunal concluded that both treatment plans were reasonable and necessary to treat the applicant's chronic pain and functional impairments.

The insurer was ordered to pay the disputed amounts of $9,464.40 and $1,312.63, along with interest on the overdue benefits.

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

The respondent denied claims for non-earner benefits, attendant care benefits, and a neurological assessment.

The applicant filed an application for dispute resolution with the Licence Appeal Tribunal after the limitation period had expired.

The Tribunal applied the Manuel factors under section 7 of the Licence Appeal Tribunal Act and granted an extension of time, finding that the applicant had a bona fide intention to appeal, the delay was not significant, the respondent was not prejudiced, and the appeal had merit given the applicant's recent catastrophic impairment designation.

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

The insurer initially denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG), but later conceded the injuries were outside the MIG.

The Tribunal found that the disputed treatment plans for assistive devices, chiropractic treatment, and a functional abilities evaluation were reasonable and necessary to manage the applicant's ongoing pain and assist her in her self-employment.

The Tribunal ordered the insurer to pay the disputed benefits with interest, but declined to order a special award as the insurer's delay did not prejudice the applicant.

The applicant sought statutory accident benefits after tripping and falling into an open service bay at a mechanic's garage while getting an emissions test.

The respondent denied the claim on the basis that the incident was not an 'accident' under the Statutory Accident Benefits Schedule.

The Tribunal applied the Amos and Greenhalgh tests and found that while the purpose test was met, the causation test was not.

The applicant's use and operation of the vehicle had ceased when she walked away from it, and the netting over the open service bay acted as an intervening cause.

The application was dismissed.

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

The insurer denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the treatment plans were not reasonable and necessary.

The Licence Appeal Tribunal found that the applicant's physical injuries were predominantly minor and that she failed to prove on a balance of probabilities that she suffered from chronic pain or a psychological impairment that would warrant removal from the MIG.

As the applicant had exhausted the $3,500 MIG limit, the application for further benefits and interest was dismissed.

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

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

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

The Tribunal found that the applicant failed to provide compelling medical evidence of functional impairment from chronic pain or a psychological impairment, preferring the respondent's s. 44 psychological assessment.

As the applicant's injuries were predominantly minor and the MIG funding was exhausted, the application for further benefits and interest was dismissed.

The applicant sought reinstatement of an income replacement benefit (IRB) of $400 per week following a motor vehicle accident.

The insurer had suspended the IRB after 44 weeks based on insurer's examinations indicating the applicant no longer met the criteria.

The Tribunal dismissed the application, finding the applicant failed to prove a substantial inability to perform the essential tasks of her employment.

The Tribunal also noted the applicant's failure to comply with multiple production orders for employment and financial documentation, which severely undermined her case.

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

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

The applicant argued that pre-existing migraines and wrist pain, as well as psychological impairments, removed him from the MIG.

The Tribunal found that the applicant failed to provide compelling evidence that his pre-existing conditions would prevent maximal recovery under the MIG limits.

Furthermore, the applicant was precluded from relying on his psychological assessment to escape the MIG because he failed to attend the scheduled section 44 insurer's examinations.

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

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

The insurer denied benefits and requested the applicant attend a section 44 insurer's examination.

The applicant refused to attend, arguing the request was unreasonable.

The Tribunal found the insurer's request was reasonable and compliant with the Schedule, noting the applicant's own medical professionals recommended a neurological assessment.

Because the applicant failed to attend the properly scheduled examination, he was statute-barred from applying to the Tribunal under section 55(1)2 of the Schedule.

The application was dismissed.