Jesse A. Boyce

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

The respondent initially denied treatment plans on the basis that the minor injury guideline applied, but later approved them.

The only 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 did not act unreasonably, as the applicant failed to timely provide compelling medical evidence and failed to attend a scheduled section 44 examination.

The claim for a special award was dismissed.

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

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

The applicant sought removal from the MIG on the basis of chronic pain.

The Licence Appeal Tribunal found that the applicant failed to provide compelling medical evidence of chronic pain or functional impairment, noting limited contemporaneous complaints and no chronic pain diagnosis.

As the MIG limits were exhausted, the disputed treatment plans were deemed not reasonable and necessary, and no interest was payable.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's determination that his injuries fell within the Minor Injury Guideline (MIG).

The applicant argued for removal from the MIG based on pre-existing conditions, chronic pain, and a psychological impairment.

The Tribunal found insufficient medical evidence to support removal, noting the applicant's injuries were primarily sprains and strains, and relied on s. 44 assessments that found no objective impairments or psychological diagnoses warranting treatment beyond the MIG.

The application for a psychological treatment plan and interest was dismissed.

The applicant was involved in a motor vehicle accident and sought non-earner benefits (NEBs) and attendant care benefits (ACBs) from the respondent insurer.

The insurer denied the benefits and raised a preliminary issue that the applicant was statute-barred from proceeding with her application for failing to appeal within the two-year limitation period.

The Tribunal found that the ACB claim was not properly before it because the applicant had never submitted an Assessment of Attendant Care Needs (Form-1), meaning no valid denial could have been made.

Regarding the NEB claim, the Tribunal found the insurer's denial was clear and unequivocal, triggering the limitation period.

However, the Tribunal exercised its discretion under section 7 of the Licence Appeal Tribunal Act to extend the limitation period, noting the applicant's bona fide intention to appeal, the negligible six-business-day delay, the lack of prejudice to the insurer, and the potential merit of the claim.

The applicant was permitted to proceed with her NEB claim.

The applicant sought statutory 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 Licence Appeal Tribunal, arguing for removal from the MIG due to ongoing pain and potential need for a chronic pain program.

The Tribunal found the applicant's injuries were predominantly minor sprains and strains, and there was insufficient evidence of a pre-existing condition, chronic pain with functional impairment, or psychological injury to warrant removal from the MIG.

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

Claims for a section 10 award and interest were also dismissed.

The applicant sought statutory 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 argued for removal from the MIG based on pre-existing conditions, chronic pain, and psychological impairment.

The Tribunal found the applicant's physical injuries were predominantly minor sprains and strains, and his pre-existing age-related conditions did not preclude recovery within the MIG.

The Tribunal also found insufficient evidence of accident-related chronic pain causing functional impairment or psychological impairment.

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

The applicant, who sustained catastrophic impairments in a motor vehicle accident, sought payment for various medical and rehabilitation benefits, including a 3D mattress system, a portable modulation stimulator, naturopathic treatments, and an infrared sauna.

The respondent denied the claims primarily on the basis that the expenses were incurred prior to the submission of treatment plans (OCF-18s) or were experimental and not reasonable and necessary.

The Tribunal found that section 38 of the Schedule barred recovery for most of the expenses incurred prior to submission.

The Tribunal also accepted the respondent's expert evidence that certain treatments were experimental.

The application was allowed in part for an eye exam and specific wellness products, but the majority of the claims and the request for costs were dismissed.

The applicant sought statutory accident benefits, including an income replacement benefit (IRB) and medical benefits for physiotherapy and psychotherapy, after allegedly being struck by a reversing vehicle.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove she was employed at the time of the accident or that she suffered a substantial inability to perform the essential tasks of her employment.

The Tribunal also denied the treatment plans, preferring the respondent's section 44 assessments which found no objective musculoskeletal or psychological impairments, and noting a lack of contemporaneous complaints in the applicant's medical records.

The applicant sought non-earner benefits following a 2000 transit accident when he was a minor.

The insurer denied the claim in 2001, 2010, and 2017.

The applicant filed an application with the Tribunal in 2020.

The Tribunal held that the application was statute-barred under s. 51 of the Statutory Accident Benefits Schedule because it was not commenced within two years of a valid denial.

The Tribunal declined to extend the limitation period under s. 7 of the Licence Appeal Tribunal Act, noting the significant delay and prejudice to the insurer.

The applicant, a pedestrian struck by a vehicle, sought statutory accident benefits for physical and psychological injuries.

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

The Licence Appeal Tribunal found that the applicant's physical injuries were uncomplicated soft-tissue sprains and strains, and that she failed to prove a psychological impairment warranting removal from the MIG, noting her quick return to work and lack of contemporaneous complaints to her family physician.

Consequently, the disputed treatment and assessment plans were deemed not reasonable and necessary, and the application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming a full-thickness shoulder tear warranted removal from the Minor Injury Guideline (MIG).

The respondent denied the claim, arguing the injuries were minor and the shoulder tear was not accident-related.

The Tribunal found the applicant failed to prove causation, noting a lack of contemporaneous complaints, a subsequent snow-shoveling injury, and a two-and-a-half-year delay before the ultrasound.

The application was dismissed, and the disputed treatment plan was denied.

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits, which the respondent insurer denied on the basis that her injuries fell within the Minor Injury Guideline (MIG).

The applicant argued that pre-existing conditions, chronic pain, and psychological impairments warranted removal from the MIG.

The Tribunal found that the applicant's physical injuries were uncomplicated soft-tissue injuries and that she failed to provide compelling evidence that any pre-existing condition prevented her recovery within the MIG.

Furthermore, the Tribunal preferred the respondent's medical evidence regarding the lack of a psychological impairment, noting inconsistencies in the applicant's expert reports.

The application was dismissed, and the disputed treatment plans were found not to be reasonable and necessary.

The applicant sought payment for four chiropractic treatment plans following a motor vehicle accident.

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

The Licence Appeal Tribunal found that the applicant failed to meet his burden of proof, noting that the treatment goals were identical across all plans, there was limited evidence of progress, and the treatment was not tailored to his predominantly minor physical injuries.

The Tribunal preferred the respondent's section 44 medical assessment and dismissed the application.

The applicant requested a reconsideration of a decision that determined he was not entitled to an income replacement benefit (IRB) in excess of the statutory maximum, and that the insurer correctly calculated the ramp-down formula after he turned 65.

The applicant argued the Tribunal acted outside its jurisdiction and made errors of law by varying the IRB amount he claimed was fixed by a tort claim pleading.

The Tribunal dismissed the request, finding no jurisdictional error, as the Insurance Act grants the Tribunal authority to resolve benefit disputes, and no error of law in applying the statutory ramp-down calculation.

The applicant sought statutory accident benefits after experiencing intense back and leg pain while lifting her son into his car seat and subsequently pressing the accelerator.

The respondent denied the claim, arguing the incident did not constitute an 'accident' under s. 3(1) of the Statutory Accident Benefits Schedule.

The Tribunal found that the incident met both the purpose and causation tests, as loading a vehicle and driving are ordinary uses of an automobile, and there was no intervening act breaking the chain of causation.

The Tribunal concluded the incident was an accident and directed the parties to schedule a case conference.

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

The respondent denied the benefits on the basis that they were not reasonable and necessary.

The Tribunal found that the first treatment plan was duplicative and the proposing clinic no longer existed.

For the second treatment plan, the Tribunal found a lack of medical evidence supporting the need for treatment and that the applicant failed to establish causation, noting a more serious prior accident.

The application was dismissed and no interest was payable.

The applicant sought statutory 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 argued that a pre-existing condition of Ataxia was exacerbated by the accident, warranting removal from the MIG.

The Tribunal found that the applicant failed to provide compelling medical evidence that the pre-existing condition would preclude his recovery within the MIG.

The application for a chiropractic treatment plan and interest was dismissed.

The applicant sought statutory accident benefits following a 2017 motor vehicle accident, specifically claiming entitlement to a chronic pain assessment.

The insurer denied the benefit, arguing the applicant's pain was related to a more severe 2018 accident and that he did not meet the AMA Guides criteria for chronic pain.

The Tribunal found the applicant failed to establish that the assessment was reasonable and necessary, noting the lack of objective evidence linking his pain to the 2017 accident and his failure to meet three of the six AMA Guides criteria.

The claims for the assessment, interest, and a section 10 award were dismissed.

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

The insurer denied the benefits and the applicant failed to dispute the denial within the two-year limitation period under section 56 of the Statutory Accident Benefits Schedule.

The applicant had previously filed and withdrawn an application within the limitation period, but later filed a new application after the period expired.

The Tribunal found the claim statute-barred and dismissed the application, awarding $250 in costs to the insurer due to the applicant's failure to participate in the proceedings.

The applicant sought payment for a $2,488.45 physiotherapy treatment plan following a motor vehicle accident.

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

The Tribunal found that the applicant failed to meet her burden of proof, as her submissions focused on psychological impairments and a different treatment plan not in dispute.

Relying on the respondent's section 44 assessment, which found no objective evidence of ongoing physical impairment requiring further therapy, the Tribunal dismissed the application.