Julia Fogarty

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

The Tribunal first addressed preliminary issues, finding that the applicant was barred from receiving benefits for a period due to missing a s. 44 examination, but that her claims were not time-barred because the limitation period was tolled by O. Reg. 73/20 during the COVID-19 pandemic.

The Tribunal also declined to exclude late-served medical records.

On the substantive issues, the Tribunal found the applicant was entitled to a neurological assessment, which the respondent conceded was reasonable and necessary.

However, the applicant failed to meet her burden of proof for the remaining treatment plans, including physiotherapy, a brainscope, a SPECT scan, and an in-home assessment, due to a lack of crucial information and objective evidence.

The claim for a s. 10 award was also dismissed.

The applicant sought non-earner benefits following a motor vehicle accident.

The Tribunal found that the applicant failed to meet the burden of proof to establish a complete inability to carry on a normal life, as his oral testimony was uncorroborated and contradicted by documentary evidence, including medical assessments and his own activity questionnaire.

The application for non-earner benefits and interest was dismissed.

The applicant sought statutory accident benefits following a 2010 motor vehicle accident.

After multiple adjournments and failures to comply with Tribunal orders, the applicant failed to attend the scheduled virtual hearing despite receiving proper notice.

The Tribunal proceeded in absentia and dismissed the application, as the applicant presented no evidence and failed to meet her burden of proof.

The Tribunal awarded $1,000 in costs to the respondent due to the applicant's serious misconduct in disregarding the Tribunal's process.

The applicant was injured in a motor vehicle accident and sought $2,486.00 for a chronic pain assessment under the Statutory Accident Benefits Schedule.

The respondent denied the benefit, arguing the applicant's injuries were psychological and fell within the Minor Injury Guideline.

The Tribunal found the assessment was reasonable and necessary, noting the applicant's consistent reports of pain and ongoing use of pain medication over several years.

The Tribunal ordered the respondent to pay for the assessment and awarded interest on the overdue amount.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically requesting $2,486.00 for a psychological assessment.

The insurer denied the treatment plan, arguing it was a duplication of services and that there was no chronic pain issue to investigate.

The Tribunal found that the applicant's ongoing pain, medication use, and psychological symptoms warranted further investigation.

The Tribunal ordered that the psychological assessment was reasonable and necessary, and payable once incurred, with interest applicable on any overdue benefits.

The applicant requested a reconsideration of a decision finding he was not involved in an accident under the Statutory Accident Benefits Schedule when he slipped and fell at a recycling facility.

The applicant argued the adjudicator made factual errors regarding the source of a cardboard box he slipped on and the ground conditions.

The Tribunal dismissed the request, finding no errors of fact, as the applicant's testimony about the box was equivocal and the evidence supported the finding of slushy and slippery conditions.

The applicant sought income replacement benefits, a medical benefit for physiotherapy and chiropractic services, an award for unreasonable delay, and interest following a motor vehicle accident.

The applicant failed to provide a document brief and relied on the respondent's materials.

The adjudicator found that the applicant did not meet the burden of proving entitlement to income replacement benefits, relying on medical reports indicating the applicant could perform his pre-accident office work and showed signs of malingering.

The medical benefit was denied as it was a duplicate of an already approved treatment plan.

The claims for a special award and interest were consequently dismissed.

The applicant sought various statutory accident benefits after being struck by a detached tire while walking.

The Licence Appeal Tribunal dismissed the application in its entirety, finding that the applicant had fully recovered from his physical injuries and was engaging in 'learned helplessness'.

The Tribunal denied claims for attendant care, assistive devices, occupational therapy, and chiropractic treatments, noting inconsistencies in the applicant's expert evidence and exaggerated assessment fees.

The claim for non-earner benefits was dismissed as time-barred and substantively unproven.

Claims for a special award and interest were also dismissed.

The applicant sought a determination of catastrophic impairment and entitlement to attendant care benefits following a motor vehicle accident that resulted in a traumatic brain injury.

The central issue was whether the applicant's brain injury restricted his ability to work such that he met the criteria for catastrophic impairment under the GOS-E Guideline.

The Tribunal found that the applicant was capable of working in a reduced capacity, as evidenced by his post-accident construction work and his role teaching martial arts to children, and therefore did not meet the threshold for catastrophic impairment.

The Tribunal also dismissed the claim for attendant care benefits, finding the applicant to be highly functional both physically and cognitively, and denied the claim for interest.

The applicant sought statutory accident benefits after slipping and falling in a parking lot at a recycling centre while unloading cardboard from his truck.

The insurer denied the claim on the basis that the incident did not meet the definition of an 'accident' under section 3(1) of the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal applied the purpose and causation test, finding that while unloading the truck was an ordinary use of a vehicle, the use of the vehicle was not the direct cause of the injuries.

The Tribunal concluded that slipping on a cardboard box in a slushy parking lot was an intervening act that broke the chain of causation.

The application was dismissed.

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

The applicant failed to attend the videoconference hearing despite multiple notices and grace periods.

The Tribunal proceeded in absentia and dismissed the applicant's claims for failing to meet her burden of proof.

The respondent insurer sought repayment of $8,232 in income replacement benefits, presenting surveillance evidence that the applicant was working at spas while receiving benefits.

The Tribunal found the applicant fraudulently claimed the benefits and ordered repayment with interest.

The applicant sought a special award under s. 10 of Regulation 664 and interest on an approved treatment plan following a motor vehicle accident.

The applicant argued the insurer unreasonably delayed benefits by insisting on in-person assessments during the COVID-19 pandemic and keeping her in the Minor Injury Guideline.

The Tribunal found the insurer's conduct was reasonable and proportionate, noting the applicant worked in a medical lab during the pandemic and the insurer offered alternate arrangements.

The claim for a s. 10 award was dismissed.

However, the Tribunal ordered the insurer to pay interest on the approved psychological assessment from the date it became overdue.

The applicant was struck by a backhoe while walking on the shoulder of a highway and sought statutory accident benefits.

The respondent insurer denied benefits, arguing the backhoe was a road-building machine and therefore exempt from the definition of an automobile.

The Tribunal applied the Adams test and the Highway Traffic Act definitions, finding that the backhoe was being operated outside the prescribed regulations for an off-road excavator.

Consequently, it was classified as a mobile equipment vehicle, which falls under the enlarged definition of an automobile.

The Tribunal concluded the backhoe was an automobile for the purposes of the Schedule.

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) and seeking income replacement benefits (IRBs) and various treatment plans.

At the hearing, the self-represented applicant failed to produce any medical records or expert evidence to support his claims.

The respondent relied on orthopaedic and psychological assessments concluding the applicant's injuries were minor and he was able to work.

The Tribunal found the applicant failed to meet his burden of proof for removal from the MIG, entitlement to IRBs, or the reasonableness and necessity of the treatment plans.

The Tribunal also denied the applicant's post-hearing request for an adjournment, noting the matter had been delayed multiple times and a "do-over" was not a valid ground.

The application was dismissed.

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

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

The applicant argued she should be removed from the MIG due to pre-existing back and neck pain, chronic pain, and psychological issues.

The Tribunal found insufficient medical evidence to establish a pre-existing condition that would preclude recovery within the MIG.

Furthermore, applying the AMA criteria, the Tribunal concluded the applicant did not suffer from chronic pain or a psychological impairment caused by the accident.

The application was dismissed, and the respondent's request for costs was denied.

The applicant sought a determination of catastrophic impairment and entitlement to attendant care and housekeeping benefits following a 2013 motor vehicle accident.

The Licence Appeal Tribunal found that the applicant's psychological issues, primarily anxiety, were pre-existing and related to prior health crises, not the accident.

The Tribunal concluded the applicant did not sustain a catastrophic impairment under either the 55% whole person impairment threshold or the marked impairment in adaptation criterion, noting her ability to travel, socialize, and adapt to her pain.

Because the applicant was not catastrophically impaired, her claims for attendant care and housekeeping benefits were dismissed as time-barred and not payable.