Kimberly Parish

The applicant sought a rehabilitation benefit of $11,865 for private hockey skills training following a motor vehicle accident.

The respondent denied the claim because the expense was incurred before a treatment plan was submitted, contrary to s. 38(2) of the Statutory Accident Benefits Schedule.

The Tribunal agreed, finding that the applicant's failure to submit a treatment plan prior to incurring the expense relieved the respondent of liability.

The Tribunal also held that it lacked jurisdiction to grant relief from forfeiture under s. 98 of the Courts of Justice Act, and that even if it had jurisdiction, relief would not be warranted.

The claim for an award for unreasonable delay was also dismissed.

The applicant was injured in a motor vehicle accident and received income replacement benefits (IRBs) from the respondent.

The respondent terminated the IRBs on September 2, 2016, following insurer examinations.

The applicant applied to the Licence Appeal Tribunal on May 1, 2019, nearly eight months after the two-year limitation period expired.

The Tribunal found the termination letter was a clear and unequivocal denial.

The Tribunal declined to extend the limitation period under s. 7 of the LAT Act, finding no bona fide intention to appeal within the time limit, an unreasonable length of delay, and significant prejudice to the respondent, despite acknowledging some merit to the appeal.

The application was dismissed as statute-barred.

The applicant sought payment for the cost of an accounting report obtained to calculate his Income Replacement Benefit (IRB) following a motor vehicle accident.

The insurer denied the expense.

The Tribunal found that the accounting report was not reasonable and necessary because it was commissioned prematurely before any dispute over the IRB quantum existed, and the applicant's IRB calculation was straightforward, based on only two income sources.

The claim for the cost of the report and interest was dismissed.

The applicant was a pedestrian struck by a vehicle and sought statutory accident benefits.

The respondent insurer limited the applicant's medical and rehabilitation benefits to the $3,500 cap under the Minor Injury Guideline (MIG).

The applicant applied to the Licence Appeal Tribunal, arguing that chronic pain and psychological impairment warranted removal from the MIG.

The adjudicator found that the applicant failed to prove on a balance of probabilities that he suffered from chronic pain or a psychological impairment, preferring the objective findings of the insurer's examination assessors over the subjective reports of the applicant's experts.

As the injuries fell within the MIG and the maximum benefits had already been approved, the disputed treatment plans were denied.

The claims for an award and costs were also dismissed, as the insurer did not act unreasonably.

The applicant was injured in a motor vehicle accident in November 2016 and sought statutory accident benefits from the respondent insurer.

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

The Licence Appeal Tribunal found that the applicant suffered from chronic pain syndrome and a specific driving-related phobia caused by the 2016 accident, removing her from the MIG.

The Tribunal granted the applicant's claims for a physiotherapy treatment plan and a psychological assessment, finding them reasonable and necessary, but denied a claim for occupational therapy services.

The applicant was also awarded interest on overdue benefits.

The applicant sought an award under s. 10 of Ontario Regulation 664, arguing the respondent unreasonably withheld or delayed payment for medical cannabis expenses.

The respondent had requested additional information, including a proper medical note and specific prescription details, before funding the expenses.

The Tribunal found the respondent's request for information was reasonable and that it did not unreasonably delay or withhold payment, as it paid the expenses within 30 days of receiving the complete medical documentation.

The applicant's claims for an award and costs were dismissed.

The applicant sought a determination of catastrophic impairment and entitlement to attendant care benefits and cost of examinations following a 2007 motor vehicle accident.

The Licence Appeal Tribunal found that the applicant sustained a catastrophic impairment under Criterion 8, specifically a Class 4 Marked impairment in the domain of Activities of Daily Living due to chronic pain and psychological impairments.

The Tribunal awarded attendant care benefits at $507.03 per month retroactively to October 2009, along with interest.

The applicant was also awarded the costs of specific occupational therapy and attendant care assessments.

Claims for a triage assessment, a Regulation 664 award, and costs were dismissed.

The applicant sought statutory accident benefits following an alleged motor vehicle collision.

The respondent denied benefits, arguing the collision was a staged accident and the applicant wilfully misrepresented material facts.

The Licence Appeal Tribunal found numerous inconsistencies in the applicant's testimony and accepted the respondent's uncontradicted forensic engineering evidence, which indicated the collision was staged.

The Tribunal concluded the applicant was not involved in an accident under s. 3(1) of the Schedule and had wilfully misrepresented material facts.

The respondent was entitled to terminate benefits under s. 53 and was awarded a repayment of $8,189.25 under s. 52(1)(a).

The applicant sought income replacement benefits following a 2011 motor vehicle accident.

The insurer terminated the benefits in May 2014, providing a clear and unequivocal denial along with information on the dispute process.

The applicant failed to file an application with the Tribunal until November 2018, well beyond the two-year limitation period under section 56 of the Schedule.

The Tribunal found the applicant was statute-barred from proceeding and declined to grant an extension of time under section 7 of the Licence Appeal Tribunal Act, noting the significant delay and prejudice to the insurer.

The applicant requested a reconsideration of a Tribunal decision that denied her claim for income replacement benefits, the cost of an accounting report, an award, and costs following a motor vehicle accident.

The applicant argued the Tribunal made significant errors of fact and law by failing to appreciate her psychological impairments and by not assigning appropriate weight to her evidence.

The adjudicator dismissed the request, finding that the Tribunal had carefully weighed the totality of the evidence, including the psychological impairments, and provided sound reasons for its conclusions.

The adjudicator held that the reconsideration process is not an opportunity to re-weigh evidence or give an unsuccessful party a second chance to have their case heard.

The respondent insurer requested a reconsideration of a Tribunal decision that ordered it to pay a registered psychotherapist providing cognitive behaviour therapy at the same hourly rate as a psychologist ($149.61).

The insurer argued the Tribunal acted outside its jurisdiction and made errors of law and fact.

The adjudicator dismissed the reconsideration request, finding no jurisdictional error or significant error of law or fact, as psychotherapists are not listed in the Professional Services Guideline and the Tribunal properly exercised its discretion based on the provider's specialized training and the services rendered.

The applicant's request for costs was also dismissed.

The applicant sought reconsideration of a preliminary issue decision that found his claim for income replacement benefits was statute-barred under s. 56 of the Schedule.

The applicant argued the Tribunal erred in its application of s. 56 and s. 7 of the LAT Act regarding an extension of time.

The Tribunal found no significant error of law or fact that would have changed the outcome, noting the 15-month delay was still significant.

The request for reconsideration was dismissed, as was the respondent's request for costs.

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs) and the cost of a multi-disciplinary assessment from her insurer.

The insurer terminated IRBs after 104 weeks and denied the assessment costs.

The Licence Appeal Tribunal found that the applicant suffered a substantial inability to perform the essential tasks of her pre-accident employment as a restaurant crew member due to unresolved left shoulder tendonitis, entitling her to IRBs up to the 104-week mark.

However, the Tribunal concluded she did not meet the post-104 week test of a complete inability to engage in any suitable employment, relying on surveillance evidence and vocational assessments showing she could perform alternative jobs.

The Tribunal also awarded partial costs for the multi-disciplinary assessment, finding the occupational therapy, orthopedic, and vocational components reasonable and necessary, while denying the psychological and neurological components.

The respondent insurer requested a reconsideration of a Tribunal decision that awarded the applicant a medical benefit of $4,086.68.

The insurer argued the adjudicator made an error of fact by attributing an income replacement benefit assessment report to the insurer rather than the applicant.

The adjudicator acknowledged the factual error but dismissed the reconsideration request, finding that the error would not have led to a different result because the treatment plan was found reasonable and necessary based on other evidence, including the applicant's consistent reporting and steady improvements.

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs) and various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule.

The adjudicator found that the applicant failed to prove she suffered a substantial inability to perform the essential tasks of her employment, noting she returned to work post-accident and was terminated for performance issues.

The adjudicator preferred the respondent's insurer's examination reports, which concluded the applicant had no functional impairments preventing her from working.

The claims for IRBs, treatment plans, and assessments were dismissed.

The respondent insurer brought a motion to stay the applicant's LAT application pending her attendance at an occupational therapy catastrophic impairment insurer's examination (OT CAT IE).

The applicant argued she was not required to attend because the insurer's notices denying catastrophic impairment and requesting the IE did not comply with the medical reasons and timeline requirements of section 45(3)(b) of the Schedule.

The Tribunal found that while the insurer's notices were indeed defective and non-compliant, the requested OT CAT IE was still reasonable and necessary to complete a deferred neuropsychological assessment.

The Tribunal granted a four-month stay of the application to allow the insurer to issue a compliant notice and for the applicant to attend the examination.

The applicant was injured in a motor vehicle accident and sought approval for a multi-disciplinary catastrophic impairment assessment totaling $22,416.69.

The respondent partially approved the treatment plan for $7,006.00.

The applicant applied to the Licence Appeal Tribunal for the unapproved balance of $15,410.69.

The adjudicator found that most of the disputed assessments were either duplicitous, ancillary to the psychological assessment, or exceeded the $2,000 statutory cap per assessment under s. 25(5)(a) of the Schedule.

The applicant was awarded $2,000 for the CAT Rating/Executive Summary and $200 for the OCF-19 completion fee, plus interest, with the remainder of the claim dismissed.

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

The Licence Appeal Tribunal found that the applicant suffered from chronic pain, removing her from the MIG.

The Tribunal awarded medical benefits for two treatment plans and a chronic pain assessment, but denied a third treatment plan and a psychological assessment as duplicative.

The Tribunal also found the applicant suffered a substantial inability to perform the essential tasks of her pre-accident employment as a cleaner, entitling her to income replacement benefits.

A claim for a special award under Regulation 664 was dismissed.

The applicant, a pedestrian struck by a vehicle, sought statutory accident benefits for medical and rehabilitation treatments.

The respondent denied the claims, arguing the injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit was exhausted.

The Tribunal found that the applicant's physical injuries were minor and that she failed to prove a pre-existing condition or a psychological impairment that would warrant removal from the MIG.

The Tribunal preferred the respondent's comprehensive psychological assessment over the applicant's pre-screen.

As the injuries fell within the MIG and the limit was exhausted, the claims for further treatment and interest were dismissed.

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

The adjudicator found that the applicant failed to establish that the ongoing low back pain was caused by the accident, noting a delay in reporting musculoskeletal complaints and affording little weight to the applicant's physiatrist.

Relying on the insurer's orthopedic examination, the adjudicator concluded the treatment plans were not reasonable and necessary.

The claims for the treatment plans, an award, and interest were dismissed.