Kate Grieves

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

The insurer denied the claim on the basis that the applicant was not employed at the time of the accident and had not worked at least 26 weeks during the 52 weeks before the accident.

The applicant argued she was employed because she received payout for banked hours during the 52-week period.

The Tribunal found that receiving payout for banked hours after resigning did not constitute receiving wages in exchange for services rendered.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including attendant care and various medical benefits.

The Licence Appeal Tribunal dismissed the claims for attendant care and most medical benefits, finding the insurer's denial notices compliant with the Schedule.

However, the Tribunal ordered payment for a neurological assessment that had been previously approved but later denied because it was conducted virtually during the early days of the COVID-19 pandemic.

The Tribunal also granted a 10% award under section 10 of Regulation 664 for the unreasonable withholding of the neurological assessment benefit.

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 due to pre-existing conditions, chronic pain, and psychological impairment.

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

Consequently, the claims for medical benefits exceeding the $3,500 limit and interest were dismissed.

The applicant sought statutory accident benefits following a rear-end motor vehicle collision.

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

The Tribunal found that the applicant failed to prove she suffered from a pre-existing condition, a concussion, or chronic pain that would warrant removal from the MIG.

Consequently, the applicant was not entitled to the disputed treatment plans as they exceeded the $3,500 funding limit, and no interest was payable.

The application was dismissed.

The applicant sought statutory accident benefits following a minor motor vehicle accident, claiming she sustained a catastrophic impairment due to psychological issues.

The Tribunal found that the applicant's significant psychological impairments, including a history of threatening behaviours and inability to work, pre-dated the accident.

The Tribunal rejected the applicant's expert evidence as it was based on inaccurate self-reporting of her pre-accident function.

The application was dismissed, as the applicant failed to prove a catastrophic impairment, and her claims for various treatment plans were either statute-barred or unsupported by submissions.

The applicant sought medical benefits for physiotherapy, a TMJ assessment, and an orthopedic assessment following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant failed to prove the proposed treatments and assessments were reasonable and necessary.

The evidence showed physiotherapy had not been helpful, there was no indication of a jaw injury from the accident, and the orthopedic assessment would be duplicative of previous assessments.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for occupational therapy, chiropractic services, and Botox injections.

The respondent insurer denied the treatment plans.

The Tribunal found that the applicant failed to prove the treatment plans were reasonable and necessary, as her goals for occupational therapy were largely met, there was insufficient evidence supporting the need for further chiropractic services, and the Botox injections were recommended by a social worker without the necessary qualifications and contrary to a neurologist's recommendations.

The application was dismissed.

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

The insurer denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and its $3,500 funding limit.

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

The Tribunal found that the applicant failed to establish on a balance of probabilities that her pre-existing conditions prevented maximal recovery within the MIG, or that she suffered from chronic pain or psychological impairments caused by the accident.

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

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

The respondent insurer denied benefits, arguing the injuries fell within the Minor Injury Guideline (MIG) and its $3,500 funding limit.

The applicant argued he suffered from chronic pain and psychological impairments that removed him from the MIG.

The Tribunal found insufficient medical evidence to support a diagnosis of chronic pain syndrome or a psychological impairment caused by the accident.

The Tribunal concluded the applicant sustained a minor injury, dismissed the claim for a psychological assessment outside the MIG limit, and denied interest.

The applicant was injured in a rear-end motor vehicle accident and sought medical and rehabilitation benefits beyond the $3,500 Minor Injury Guideline (MIG) limit, claiming he suffered from chronic pain syndrome.

The Licence Appeal Tribunal found that the applicant failed to prove his injuries fell outside the MIG.

The medical evidence, including clinical notes and Insurer's Examination reports, indicated predominantly soft-tissue injuries, and the applicant did not meet the criteria for chronic pain syndrome under the AMA Guides.

As the MIG limit was exhausted, the disputed treatment plans and claim for interest were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming the balance of treatment plans for two iPads and a home modification assessment.

The Tribunal found that the insurer's approval of one Samsung tablet was sufficient and the applicant failed to prove that two iPads were reasonable and necessary.

The Tribunal also held that the home modification assessment was a clinical evaluation of health status and therefore subject to the $2,000 cap under section 25 of the Schedule.

The application was dismissed.

The applicant sought statutory accident benefits following a rear-end motor vehicle accident.

The respondent denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and its $3,500 funding limit.

The applicant argued she suffered from chronic pain and psychological impairments that warranted removal from the MIG.

The Licence Appeal Tribunal found that the applicant failed to meet her burden of proving her injuries fell outside the MIG, noting inconsistencies in the medical evidence and a failure to meet the AMA Guides criteria for chronic pain.

The application for medical benefits, interest, and an award for unreasonable delay was 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 Tribunal found that the applicant sustained predominantly minor injuries, noting a lack of objective evidence for ongoing physical or psychological impairments beyond the MIG.

The disputed treatment plans for physiotherapy and a psychological assessment were deemed not reasonable or necessary.

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

The applicant requested a reconsideration of a Tribunal decision that awarded attendant care benefits at a rate of $644.63 per month.

The applicant argued the Tribunal made an error of fact by failing to award benefits at a higher rate of $1,919.06 per month based on an updated Form 1.

The Tribunal dismissed the reconsideration request, finding that the claim for the higher rate was not properly before the Tribunal as an issue in dispute.

The applicant had not requested to amend the claim to reflect the increased quantum prior to or during the hearing.

The appellant police officer appealed findings of misconduct (neglect of duty and deceit) and the penalty of dismissal imposed by a Hearing Officer.

The misconduct arose from the appellant's failure to properly investigate a suspected impaired driver and his subsequent false explanations to his supervisor and Professional Standards Bureau.

The Ontario Civilian Police Commission dismissed the appeal, finding that the Hearing Officer did not misapprehend the expert evidence, drew reasonable inferences from the facts, and appropriately weighed the dispositional factors in imposing the penalty of dismissal.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, claiming she sustained a catastrophic impairment due to mental and behavioural disorders.

The Licence Appeal Tribunal found that the applicant sustained a marked impairment (Class 4) in Adaptation, qualifying her for catastrophic impairment status.

The Tribunal awarded attendant care benefits, professional organizing services, and vision therapy, but denied aquatherapy sessions.

The Tribunal also denied the applicant's request for a special award under Regulation 664, finding the insurer's denials were not unreasonable.

The applicant, who was catastrophically impaired following a 2012 motorcycle accident, sought entitlement to 24-hour attendant care benefits ($7,522.85 per month) due to severe psychological impairments, including panic attacks, memory issues, and anger outbursts.

The respondent argued that 24-hour supervision was not an appropriate psychological treatment and recommended cognitive behavioural therapy instead.

The Tribunal found that while therapy might eventually reduce the applicant's fear of being alone, the proposed attendant care was reasonable and necessary in the interim to address significant safety concerns and manage his psychological symptoms.

The applicant was awarded the ongoing attendant care benefits.

The applicant was involved in a motor vehicle accident and sought a determination that she sustained a catastrophic impairment due to a mental or behavioural disorder.

The respondent denied the claim, arguing her impairments were mild to moderate and complicated by other factors.

The Tribunal applied Chapter 14 of the AMA Guides and preferred the evidence of the applicant's experts, finding that the applicant's psychological and cognitive symptoms significantly impeded her useful functioning.

The Tribunal concluded that the applicant sustained a marked (Class 4) impairment in the domains of Concentration, Persistence and Pace, and Adaptation, thereby meeting the threshold for catastrophic impairment.

The applicant sought statutory accident benefits following an incident where he was punched in the face by another driver after a road rage encounter.

The Licence Appeal Tribunal held that the incident was not an 'accident' under s. 3(1) of the Statutory Accident Benefits Schedule.

Applying the Purpose and Causation tests, the Tribunal found that the applicant's vehicle was merely the venue for the assault, and the use or operation of the vehicle was not the direct cause of his impairments.

The assault was an intervening act that broke the chain of causation.

The applicant sought statutory accident benefits following an automobile accident.

The respondent insurer raised a preliminary issue, arguing it was not required to pay income replacement benefits under s. 31(1) of the Schedule because the applicant intentionally failed to disclose a material change in risk.

The Tribunal found that the applicant had moved from Brantford to Toronto and intentionally failed to notify the insurer of this change of address, which would have significantly increased his insurance premiums.

Consequently, the Tribunal held that the respondent was not required to pay the applicant an income replacement benefit.