Jesse A. Boyce

The applicant sought attendant care benefits following two motor vehicle accidents.

The insurer denied the claims, and the applicant filed appeals with the Tribunal three and five years later, respectively.

The insurer raised a preliminary issue that the claims were barred by the two-year limitation period under s. 56 of the Schedule.

The applicant's counsel withdrew before submissions were due, and the applicant failed to file any materials.

The Tribunal found the claims were limitation-barred and declined to extend the limitation period under s. 7 of the Licence Appeal Tribunal Act, as the applicant provided no evidence or submissions to support an extension.

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

A written hearing was scheduled, but the applicant failed to file any written submissions or evidence by the deadline and did not respond to correspondence from the Tribunal or the respondent.

The Tribunal found that the applicant had abandoned the application and failed to meet the burden of proving entitlement to the benefits sought.

The application was dismissed.

The applicant insurer sought repayment of Income Replacement Benefits (IRBs) paid to the respondent, alleging she failed to disclose her return to work and receipt of maternity benefits.

The Tribunal found that the respondent did not independently inform the insurer of her maternity income or return to work, which constituted an assertion not in accordance with the facts.

The Tribunal ordered the respondent to repay $14,317.80 in overpaid IRBs, plus $250.56 in interest, for a total of $14,568.36.

The applicant sought Income Replacement Benefits (IRBs) following a motor vehicle accident, claiming a substantial inability to perform his pre-accident essential tasks as a security guard due to a knee injury.

The respondent insurer terminated the benefits based on an insurer's examination concluding the knee issues were not causally related to the accident.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to provide contemporaneous medical evidence demonstrating an inability to perform the essential tasks of prolonged sitting and walking during the disputed period, noting he had engaged in sedentary work and later took a physically demanding job.

The applicant sought a special award under s. 10 of O. Reg. 664 and interest on treatment plans following a motor vehicle accident.

Prior to the hearing, the respondent removed the applicant from the Minor Injury Guideline and approved the treatment plans upon receiving new medical documentation.

The Tribunal dismissed the claim for a special award, finding the respondent acted reasonably, diligently, and in good faith by adjusting its position when new evidence was provided.

The claim for interest was also dismissed as the applicant failed to prove the treatment plans had been incurred.

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, claiming physical injuries, chronic pain, and psychological impairments warranted removal from the MIG.

The Tribunal found the physical injuries were minor, there was insufficient evidence of a pre-existing condition precluding recovery, and preferred the respondent's psychological assessment over the applicant's.

The Tribunal concluded the applicant failed to demonstrate his impairments warranted removal from the MIG, and dismissed the claims for treatment plans and interest as the MIG limits were exhausted.

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

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

The applicant argued for removal from the MIG based on pre-existing jaw pain, psychological issues, and chronic pain.

The Tribunal found insufficient medical evidence to support removal from the MIG, noting a lack of chronic pain diagnosis and preferring the respondent's psychological assessment which found symptom magnification.

As the MIG limits were exhausted, the claims for treatment plans and interest were dismissed.

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

A written hearing was scheduled, but the applicant failed to file written submissions, present a case, or respond to communications from the Tribunal.

The respondent requested that the application be dismissed as abandoned.

The Tribunal agreed, finding that the applicant abandoned the application and failed to meet their burden of proof.

The application was dismissed, with the respondent granted leave to make submissions on costs.

The applicant was a pedestrian whose foot was driven over by a vehicle.

He sought accident benefits, which the respondent denied on the basis that his injuries fell within the Minor Injury Guideline (MIG).

The applicant argued he sustained a psychological impairment warranting removal from the MIG.

The Tribunal found the applicant's physical injuries were minor and preferred the respondent's psychological assessment, which found no accident-related psychological impairment.

The application was dismissed, and the requested psychological assessment and interest were denied.

The applicant sought $2,000 for a chronic pain assessment following a motor vehicle accident, along with interest and an award for unreasonable delay.

The Licence Appeal Tribunal found that the applicant failed to demonstrate the assessment was reasonable and necessary, noting her diagnostic imaging was normal, she had returned to work full-time, and she did not meet the AMA Guides criteria for chronic pain.

The application was dismissed.

The applicant was involved in a single-vehicle collision after suffering a cardiac arrest and sought an occupational therapy assessment under the Statutory Accident Benefits Schedule.

The respondent insurer denied the benefit, arguing the applicant's brain injury was caused by the cardiac arrest, not accident-related trauma.

The Tribunal found the applicant failed to prove that his impairments would not have occurred but for the accident, noting extensive medical evidence attributing his anoxic brain injury to coronary artery disease.

The application for benefits was dismissed.

The applicant sought accident benefits following a 2012 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 chronic pain, psychological impairments, and a pre-existing condition.

The Tribunal found the applicant failed to provide sufficient medical evidence to warrant removal from the MIG, noting the injuries were predominantly soft tissue and there was no objective evidence of chronic pain or psychological impairment attributable to the accident.

Consequently, the disputed treatment plans for a psychological examination and catastrophic assessments were deemed not reasonable and necessary.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming costs for an attendant care assessment and a chronic pain assessment.

The respondent denied the benefits on the basis of the Minor Injury Guideline and because they were not reasonable and necessary.

The Tribunal found that the applicant failed to meet her burden of proof, as she submitted no medical evidence to support her claims and did not rebut the respondent's medical reports.

The application was dismissed, and no benefits or interest were awarded.

The applicant sought a catastrophic impairment assessment following a motor vehicle accident, which the respondent insurer denied.

A written hearing was scheduled, but the applicant failed to file any submissions or evidence.

The respondent requested the application be dismissed as abandoned.

The Tribunal discovered that the applicant's counsel of record had passed away and their practice was in trusteeship with the Law Society of Ontario.

Given the unique circumstances and the lack of clarity regarding the applicant's knowledge of the proceedings, the Tribunal declined to dismiss the application immediately.

Instead, the Tribunal ordered a resumption hearing and required the applicant to provide written submissions on why the matter should not be dismissed as abandoned.

The applicant sought payment for a physiotherapy treatment plan, interest, and a special award following a motor vehicle accident.

The insurer denied the treatment plan on the basis that the applicant's physical injuries were minor and did not warrant further facility-based treatment, relying on an insurer's examination report.

The Tribunal agreed with the insurer, finding insufficient objective medical evidence to support ongoing physical impairments requiring the proposed treatment.

The claims for the treatment plan, interest, and a special award were dismissed.

The applicant filed a request for reconsideration of a decision finding she did not meet the criteria for catastrophic impairment under s. 3.1(1)2(iii) of the Statutory Accident Benefits Schedule.

The applicant argued the Tribunal erred by inserting a permanency requirement into the Spinal Cord Independence Measure (SCIM) disability test and by characterizing her mobility impairment as temporary.

The Tribunal dismissed the request, finding no error of law or fact.

The Tribunal reaffirmed that s. 3.1(1)2(iii) requires a permanent alteration of function, measured by a permanent score between 0 and 5 on the SCIM, and that the applicant's temporary mobility impairment did not meet this threshold.

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

A written hearing was scheduled, but the applicant failed to file written submissions or respond to communications from the Tribunal.

The respondent requested that the application be dismissed as abandoned.

The Tribunal found that the applicant had abandoned his application and failed to meet his burden of proof.

The application was dismissed.

The applicant, who was injured in a motorcycle accident, sought payment for two physiotherapy treatment plans that were denied by the respondent insurer.

The insurer denied the plans based on section 44 insurer's examinations which concluded the treatments were not reasonable and necessary.

The Tribunal found that the applicant failed to meet his burden of proving the treatments were reasonable and necessary, noting that the applicant spent half the year in Florida without facility-based treatment and lacked objective medical evidence supporting the need for ongoing treatment.

The application was dismissed.

The applicant sought an income replacement benefit (IRB) and a medical treatment plan following a 2017 motor vehicle accident.

The insurer paid IRBs until February 2018 based on the applicant's reported income to the CRA, but denied further benefits based on section 44 assessments.

The Tribunal found the insurer correctly calculated the IRB quantum using the CRA reported income, as the Schedule prohibits relying on unreported income.

The Tribunal also found the applicant failed to prove ongoing substantial inability to perform the essential tasks of his pre-accident employment, and failed to prove the treatment plan was reasonable and necessary.

The application was dismissed.

The applicant sought an income replacement benefit (IRB) following a motor vehicle accident, which the respondent insurer denied based on insurer's examinations.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove a substantial inability to perform the essential tasks of his self-employment.

The Tribunal preferred the respondent's medical evidence, noting that the applicant's own clinical records indicated he had returned to work shortly after the accident and lacked objective medical evidence to support his claim.

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