Jesse A. Boyce

The applicant was injured in a motor vehicle accident while riding his bicycle and sought statutory accident benefits for physiotherapy, massage therapy, and psychological treatment.

The insurer denied the treatment plans based on section 44 assessments indicating that the applicant had reached maximum medical recovery and that further treatment was not reasonable and necessary.

The Tribunal dismissed the application, finding that the applicant failed to demonstrate the treatments were reasonable and necessary, noting a lack of objective evidence for physical impairment and the applicant's own admission that two years of prior psychological treatment had no beneficial effect.

The applicant sought accident benefits following a motor vehicle accident.

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

The applicant applied to the Tribunal, claiming chronic pain and psychological impairments warranted removal from the MIG.

The Tribunal found the applicant failed to provide objective medical evidence supporting removal from the MIG, noting his physical injuries were soft-tissue in nature and his psychological issues were related to work rather than the accident.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including non-earner benefits and medical benefits for physiotherapy.

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

The Licence Appeal Tribunal found that the applicant's physical impairments were sprain and strain-type injuries falling within the MIG, and she failed to provide sufficient medical evidence of chronic pain or psychological impairment to warrant removal.

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

The Tribunal also dismissed the claim for non-earner benefits, finding the applicant failed to demonstrate a complete inability to carry on a normal life.

The applicant was injured in a motor vehicle accident and sought $1,230.92 for an attendant care assessment, along with interest and a special award.

The insurer denied the benefit on the basis that it was not reasonable and necessary.

The Tribunal found that the applicant failed to demonstrate the assessment was reasonable and necessary, noting a lack of contemporaneous objective evidence and preferring the insurer's section 44 multidisciplinary reports.

As no benefits were overdue, the claims for interest and a special award were also dismissed.

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

The respondent denied the treatment plans.

The Tribunal found that the applicant failed to meet her burden of proving the treatment plans were reasonable and necessary.

The applicant failed to provide several of the disputed treatment plans (OCF-18s) in evidence and did not provide specific submissions to support the goals and costs of the treatment.

The Tribunal also confirmed that the 'but for' test, not the 'material contribution' test, applies to causation in accident benefits cases.

The application was dismissed.

The applicant sought post-104-week income replacement benefits (IRBs) following a motor vehicle accident.

The respondent terminated IRBs at the 104-week mark based on insurer examinations suggesting the applicant did not suffer a complete inability to engage in suitable employment.

The Tribunal found that the applicant's pre-existing psychological impairments, primarily anxiety, were exacerbated by the accident and prevented her from maintaining employment or self-employment.

The Tribunal preferred the applicant's medical evidence over the respondent's dated assessments.

The applicant was awarded ongoing IRBs, though the quantum was reduced to $107.25 per week due to an initial calculation error by the employer, plus interest on overdue amounts.

The applicant sought statutory accident benefits following a 2018 motor vehicle accident.

The respondent denied an attendant care assessment on the basis that the applicant's impairments fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant failed to prove his injuries warranted removal from the MIG, noting a subsequent 2019 accident and a lack of medical evidence linking his ongoing impairments to the 2018 accident.

The application was dismissed, and claims for an award and interest were denied.

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

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

The applicant argued for removal from the MIG due to chronic pain and psychological impairments.

The Tribunal found the applicant failed to meet the burden of proving his injuries warranted removal from the MIG, noting a lack of medical evidence supporting chronic pain with functional impairment or psychological issues.

Consequently, the claim for a physiotherapy treatment plan and interest was dismissed.

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

The respondent denied a treatment plan for chiropractic services, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant applied to the Licence Appeal Tribunal but failed to file any submissions or evidence for the written hearing.

The Tribunal found the applicant failed to meet the burden of proving their injuries warranted removal from the MIG.

As the MIG limits were exhausted, the treatment plan was not reasonable and necessary.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for a treatment plan totaling $1,982.44.

The respondent denied the treatment plan on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and that maximum medical recovery had been achieved.

The Tribunal found that the applicant failed to provide sufficient medical evidence to demonstrate that his injuries warranted removal from the MIG, either due to chronic pain or a pre-existing condition.

Furthermore, the applicant failed to prove that the proposed treatment plan was reasonable and necessary.

The application was dismissed.

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

The insurer scheduled an insurer's examination (IE) under s. 44 of the Statutory Accident Benefits Schedule, which the applicant failed to attend because he left the country to play competitive hockey.

The insurer raised a preliminary issue that the applicant was barred from proceeding with his application under s. 55(1)2.

The Tribunal found that the applicant's choice to leave Ontario mere days before the scheduled IE was not a reasonable explanation for his non-attendance.

The Tribunal held that the applicant is statute-barred from proceeding with his claim.

The applicant sought funding for catastrophic impairment (CAT) assessments proposed in an OCF-18 completed by an occupational therapist.

The insurer denied the OCF-18, arguing that under s. 45(2)1 of the Schedule, an OCF-18 for CAT assessments must be completed by a physician.

The Tribunal held that s. 45(2)1 applies only to the completion of the OCF-19 application for a CAT determination, not to an OCF-18 proposing assessments.

Therefore, a non-physician may complete Part 4 of an OCF-18 for CAT assessments.

The applicant's request for costs was denied.

The applicant requested a reconsideration of a decision denying two OCF-18s for passive therapy.

The applicant argued the adjudicator made a significant error of fact by not considering the impact of suspending passive rehabilitation on her pain relief and function.

The Vice-Chair dismissed the request, finding that the applicant was merely attempting to re-litigate the weight assigned to the medical evidence, particularly the preference for the insurer's section 44 examination report over the applicant's medical evidence.

The Vice-Chair confirmed that the original decision properly considered the evidence and the applicant's failure to meet her burden of proof.

The applicant, a pedestrian involved in a 2010 motor vehicle accident, sought funding for $26,919.25 in catastrophic impairment (CAT) assessments.

The insurer denied the funding after conducting its own assessments and determining the applicant was not catastrophically impaired.

On a reconsideration hearing, the Tribunal found that the applicant failed to prove the proposed assessments were reasonable and necessary.

The Tribunal noted a lack of objective medical evidence supporting a reasonable possibility of catastrophic impairment, significant inconsistencies in the applicant's reporting, and the fact that the applicant had used less than $10,000 in treatment funding over ten years.

The claims for the assessment costs, interest, and an award were dismissed.

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

The insurer denied the benefits and the applicant applied to the Tribunal more than two years later.

The Tribunal held that the applicant was statute-barred from proceeding under s. 56 of the Schedule because the application was commenced after the two-year limitation period expired, and there were no reasonable grounds to extend it.

Furthermore, the applicant was statute-barred under s. 55(1)2 for failing to attend properly scheduled insurer's examinations.

The applicant sought reconsideration of a decision finding that the Canada Recovery Benefit (CRB) and Canada Emergency Response Benefit (CERB) were deductible from his Income Replacement Benefit (IRB).

Both parties agreed that the original adjudicator erred in law.

The Vice-Chair granted the reconsideration, finding that CRB/CERB are not calculated with reference to income from employment, are not 'gross employment income', and are not akin to Employment Insurance benefits.

Therefore, they are not deductible from IRBs under the Statutory Accident Benefits Schedule.

The applicant, who sustained a catastrophic impairment in a motor vehicle accident and remains in a persistent vegetative state, sought funding for occupational therapy and a speech-language therapy assessment.

The respondent denied the treatments as not reasonable and necessary.

Prior to the decision, the respondent agreed to pay for the speech-language assessment.

The Tribunal found that the occupational therapy services were reasonable and necessary, noting the applicant's potential for improvement and the relatively minor cost of the treatment plan.

The applicant was awarded the balance of the occupational therapy services and interest on overdue amounts.

The applicant sought various medical and rehabilitation benefits following a 2015 motor vehicle accident.

The Licence Appeal Tribunal reviewed treatment plans for psychological services, an audiometric assessment, an optometric assessment, and a driving assessment.

The Tribunal found that the applicant failed to prove the psychological, audiometric, and optometric plans were reasonable and necessary, largely relying on the respondent's section 44 medical examination reports.

However, the Tribunal approved the driving assessment, finding it reasonable and necessary to address the applicant's well-documented driving anxiety.

The applicant sought statutory accident benefits after an altercation with a motorcyclist.

The applicant walked into the street to confront the motorcyclist about noise, grabbed the motorcycle's handlebars, and was subsequently assaulted by the motorcyclist.

The respondent denied benefits on the basis that the incident was not an 'accident' under the Schedule.

The Tribunal agreed, finding that the incident was an assault that broke the chain of causation and did not arise out of the ordinary and well-known activities for which motorcycles are used.

The application was dismissed.

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

The insurer scheduled section 44 Insurer's Examinations to assess the claims for neurological, sleep study, and neuropsychological assessments, but the applicant failed to attend.

The insurer raised a preliminary issue that the applicant was statute-barred from proceeding.

The Tribunal found that the insurer's requests for the examinations were reasonably necessary and the notices were proper.

Because the applicant failed to attend the properly scheduled examinations, he was statute-barred from proceeding with his claims under section 55(1)2 of the Schedule.