Jesse A. Boyce

The applicant was injured in a motor vehicle accident and sought medical benefits for physiotherapy.

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

The applicant argued that his injuries warranted removal from the MIG due to a pre-existing condition and chronic pain syndrome.

The Tribunal found that the applicant failed to demonstrate that his injuries fell outside the MIG or that he suffered from chronic pain syndrome.

As the MIG limits were exhausted, the benefits and an award for unreasonable delay were denied.

The applicant sought payment for a $2,065.00 chiropractic treatment plan following a 2016 motor vehicle accident.

The respondent insurer denied the benefit, arguing the applicant had reached maximum medical recovery.

The Tribunal found that the applicant failed to prove the treatment was reasonable and necessary, noting that her ongoing pain was likely attributable to pre-existing juvenile rheumatoid arthritis rather than the accident.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought medical benefits for optometric services and an occupational therapy assessment under the Statutory Accident Benefits Schedule.

The respondent denied the benefits, arguing the applicant's impairments were caused by a pre-existing brain aneurysm and other life stressors rather than the accident.

The Tribunal applied the 'but-for' test for causation and found the accident was a necessary cause of the applicant's increased symptoms.

The Tribunal preferred the evidence of the applicant's treating practitioners over the respondent's assessor, concluding the proposed treatment plans were reasonable and necessary.

The applicant was awarded the claimed benefits.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, which the insurer denied or partially approved based on the Minor Injury Guideline.

The applicant applied to the Licence Appeal Tribunal to dispute the denials.

The Tribunal found that the applicant was entitled to payment for a physiatry assessment, as well as interest on overdue payments for psychological and physiotherapy treatments.

Furthermore, the Tribunal awarded the applicant $1,500 under s. 10 of O. Reg. 664, finding that the insurer unreasonably withheld and delayed the payment of the applicant's income replacement benefit and psychological treatment.

The applicant, who sustained a catastrophic impairment in a motor vehicle accident, sought funding for a home alarm monitoring system and household appliances (a dishwasher and washer/dryer) under the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal found the alarm system was not reasonable and necessary as it was a standard residential alarm rather than a medical alert system.

The Tribunal allowed the cost of the dishwasher up to $999.99 to assist with housekeeping and attendant care, but denied the washer/dryer combination as the applicant had access to building laundry facilities.

The claim for a special award under s. 10 of O. Reg. 664 was dismissed as the insurer's denials were based on a genuine dispute.

The applicant, who sustained a catastrophic brain injury in a motorcycle accident, sought $7,017.40 for the unapproved portion of a home modification assessment treatment plan.

The insurer had partially approved the plan up to the $2,000 cap for assessments.

The Tribunal found that the home modification assessment involved an appraisal of the applicant's health status and functional limitations, and was therefore subject to the $2,000 cap under s. 25(5)(a) of the Schedule.

The application for the unapproved balance and interest was dismissed.

The applicant sought accident benefits for physiotherapy and removal from the Minor Injury Guideline (MIG) following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant failed to provide sufficient medical evidence to demonstrate that her soft-tissue injuries, lingering pain, or alleged psychological distress warranted removal from the MIG.

The Tribunal also dismissed the claim for a $2,384.58 physiotherapy treatment plan because the applicant failed to submit the required OCF-21 invoice.

All claims, including the request for a section 10 award, were dismissed.

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

The insurer scheduled section 44 insurer's examinations, which the applicant refused to attend because she objected to a check box on the clinic's consent form requiring confirmation that she provided photo identification.

The Tribunal found the insurer's consent form requirement to be reasonable and the applicant's refusal to attend unreasonable.

Consequently, the applicant is statute-barred under section 55 of the Schedule from proceeding with her application until she attends the examinations.

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

The insurer denied the claims between 2015 and 2017.

The applicant filed an application with the Tribunal in August 2019, well beyond the two-year limitation period.

The insurer raised a preliminary issue that the application was statute-barred under s. 56 of the Schedule.

The Tribunal found that the insurer's denial notices were clear and unequivocal, meeting the requirements set out in Smith v. Co-Operators.

The Tribunal also declined to extend the limitation period under s. 7 of the LAT Act, finding no bona fide intention to appeal within the time limit, significant delay, and prejudice to the insurer.

The application was dismissed as statute-barred.

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs).

The insurer paid the statutory maximum of $400 per week and subsequently reduced the quantum to $16 per week after the applicant turned 65, applying the statutory 'ramp down' formula.

The applicant disputed the calculations, arguing for a higher quantum based on his annualized pre-accident income and challenging the constitutionality of the Schedule.

The Tribunal dismissed the application, finding the insurer correctly calculated the initial IRB at the statutory maximum and properly applied the ramp down formula.

The constitutional claims were dismissed for failure to serve a Notice of Constitutional Question.

The applicant sought payment for a physiotherapy treatment plan in the amount of $2,580.63 following a motor vehicle accident.

The respondent denied the benefit, stating that the injuries should have reached maximum medical recovery after two years.

The Tribunal found that the respondent's denial did not provide proper medical reasons as required by s. 38(8) of the Schedule.

Consequently, under s. 38(11), the respondent was ordered to pay for the treatment plan.

The Tribunal also awarded $250.00 under s. 10 of O. Reg. 664 for the respondent's unreasonable delay and deficient notice.

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 that her pre-existing headaches and accident-related psychological impairments warranted removal from the MIG.

The Tribunal found that the applicant failed to provide compelling medical evidence that her pre-existing conditions precluded recovery within the MIG, or that she sustained a psychological impairment from the accident.

As the MIG limits were exhausted, the disputed treatment plans were not reasonable and necessary, and the claims for interest and an award for unreasonable delay were dismissed.

The applicant sought various medical and rehabilitation benefits following a 2012 motor vehicle accident.

The Licence Appeal Tribunal denied claims for PRP injections, a neuropsychological assessment, an in-home assessment balance, and assistive devices, finding them either not reasonable and necessary or statute-barred for failure to attend an insurer's examination.

The Tribunal partially approved a treatment plan for psychological counselling, awarding $3,118.77 plus interest, after finding the proposed costs for transportation, brokerage, and documentation to be gratuitous and inflated.

The applicant insurer sought repayment of $9,197.65 in income replacement benefits paid to the respondent following a motor vehicle accident.

The insurer alleged the respondent wilfully misrepresented his employment status, as Records of Employment confirmed he was terminated prior to the accident.

The respondent did not participate in the hearing.

The Tribunal found the insurer proved wilful misrepresentation and ordered the respondent to repay the benefits with interest.

The applicant, who was catastrophically impaired in a motor vehicle accident, sought payment for various assessment costs under the Statutory Accident Benefits Schedule.

The insurer denied portions of the treatment plans on the basis that they exceeded the $2,000 cap per assessment under s. 25(5)(a) or were for provider travel expenses not covered under s. 25(4).

The Tribunal agreed with the insurer, finding that the applicant failed to demonstrate the reasonableness of the unapproved portions, including attempts to bifurcate assessments to circumvent the fee cap.

The application was dismissed.

The applicant sought statutory accident benefits for psychological impairments sustained after rushing to the scene of a fatal motor vehicle accident to assist a pedestrian who had been struck.

The respondent denied the claim on the basis that the applicant was not an 'insured' who was 'involved' in an 'accident' under s. 3(1) of the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal dismissed the application, finding that the applicant was not involved in the accident, as he was sitting on a nearby patio when the collision occurred and only attended the scene after the use or operation of the vehicle had ceased.

The Tribunal rejected the applicant's argument that tort principles regarding rescuers should expand the definition of an accident under the Schedule.

The applicant sought an income replacement benefit (IRB) for the period of September 15, 2016 to March 1, 2017, following a motor vehicle accident.

The applicant had returned to modified duties as a delivery driver but was subsequently terminated for reasons unrelated to his injuries.

The Tribunal found that the applicant failed to provide objective medical evidence demonstrating a substantial inability to perform the essential tasks of his pre-accident employment during the disputed period.

The application for IRB, interest, a special award, and costs was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for the cost difference of upgrading her vehicle to accommodate her accident-related hip injuries.

The respondent insurer denied the claim without scheduling an insurer's examination or providing a valid medical reason.

The Licence Appeal Tribunal found the vehicle upgrade was a reasonable and necessary expense to relieve the applicant's pain and allow her to continue her employment.

The Tribunal ordered the respondent to pay the $12,341.56 cost difference, plus interest, and awarded $1,200 under s. 10 of O. Reg. 664 for the respondent's unreasonable delay and withholding of benefits.

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

The respondent denied a treatment plan for physiotherapy on the basis that the applicant's impairments fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant failed to meet his burden of proving that his injuries warranted removal from the MIG, as he provided insufficient medical evidence of pre-existing conditions precluding recovery.

The Tribunal also found the treatment plan was not proven to be reasonable and necessary.

The application was dismissed.

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

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

The applicant argued that her pre-existing conditions, chronic pain, and Graves' disease warranted removal from the MIG.

The Tribunal found that the applicant failed to provide compelling medical evidence that her pre-existing conditions or alleged chronic pain prevented her from reaching maximal recovery within the MIG.

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