Lindsay Lake

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including treatment plans for massage therapy, physiotherapy, psychological services, and an in-home attendant care assessment.

The respondent denied the treatment plans.

The Licence Appeal Tribunal found that the applicant failed to prove on a balance of probabilities that the disputed treatment plans were reasonable and necessary, noting a lack of objective medical evidence supporting the requests.

The Tribunal awarded interest on two previously approved and incurred expenses but declined to deem other approved but unincurred expenses as incurred under s. 3(8) of the Schedule, finding the respondent did not unreasonably withhold payment.

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

The applicant was injured in a motor vehicle accident and sought non-earner benefits.

The respondent denied the claim, leading to a preliminary issue hearing to determine whether the insurance policy was entered into or renewed before June 1, 2016, which would dictate the applicable version of the Statutory Accident Benefits Schedule.

The Tribunal found that the insurance contract was a new contract entered into on April 28, 2016, before the June 1, 2016 amendments.

Consequently, the pre-June 1, 2016 Schedule applied to the applicant's claim for non-earner benefits.

The respondent insurer requested a reconsideration of a Tribunal decision that found the applicant entitled to three chiropractic treatment plans due to the insurer's failure to comply with s. 38(8) of the Schedule.

The insurer argued the adjudicator violated procedural fairness and made errors of law by imposing requirements beyond binding case law.

The adjudicator dismissed the request, finding no violation of procedural fairness as the insurer had a full opportunity to present its case.

Furthermore, the adjudicator held that the denial letters were boilerplate and failed to provide specific details about the applicant's condition, thus failing to meet the requirements of s. 38(8) and binding jurisprudence.

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

The respondent raised a preliminary issue that the applicant was statute-barred from proceeding with her claim because she failed to submit a Disability Certificate (OCF-3) within 104 weeks of the accident.

The Tribunal found that the applicant did not submit the OCF-3 until well after the 104-week period expired.

Applying sections 12(3)(c), 36(2), and 36(3) of the Statutory Accident Benefits Schedule, the Tribunal held that the language is compulsory and provides no exceptions.

The applicant's claim for non-earner benefits was dismissed as statute-barred.

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

The insurer denied claims for physiotherapy and assessments, 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 impairment, and a pre-existing condition.

The Tribunal found the applicant failed to prove on a balance of probabilities that his chronic pain adversely affected his well-being, applying the AMA Guides criteria.

The Tribunal also gave little weight to the applicant's psychological evidence and found no documented pre-existing condition preventing maximal recovery.

As the MIG limits were exhausted, the application was dismissed.

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

The respondent denied various treatment plans and assessments 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 chronic pain, psychological impairment, and pre-existing conditions.

The Tribunal found that the applicant failed to meet her burden of proving her injuries warranted removal from the MIG, placing little weight on her expert's report due to a lack of contemporaneous medical support.

As the respondent had already approved the $3,500 maximum under the MIG, the disputed treatment plans were not considered, and the application was dismissed.

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

The respondent denied various treatment plans and income replacement benefits, asserting the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found the applicant failed to prove on a balance of probabilities that he sustained a psychological impairment or chronic pain warranting removal from the MIG.

The Tribunal preferred the respondent's expert evidence, which was consistent with the family physician's records showing no psychological complaints and a return to full-time work.

The claim for income replacement benefits was dismissed because the applicant failed to submit a completed Disability Certificate prior to the period claimed.

The application was dismissed in its entirety.

The applicant sought statutory accident benefits following a 2018 motor vehicle accident.

The respondent brought a preliminary issue motion seeking production of the applicant's complete accident benefits and long-term disability files from a prior 2007 motor vehicle accident.

The Tribunal ordered the applicant to produce the complete files, redacted for privilege and reserves, finding them highly relevant to the applicant's pre-accident functioning and entitlement to non-earner benefits, given the severity of the 2007 injuries and the applicant's failure to return to work since that time.

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

The respondent terminated the benefits and later raised a preliminary issue that the applicant's claim was statute-barred under s. 56 of the Statutory Accident Benefits Schedule.

The Tribunal found that the application was filed outside the two-year limitation period.

The Tribunal also held that it lacked jurisdiction to extend the limitation period under s. 7 of the Licence Appeal Tribunal Act, 1999, as the Schedule is a regulation, not an Act.

The application was dismissed.

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

The respondent raised a preliminary issue that the claim was statute-barred under s. 56 of the Statutory Accident Benefits Schedule, as the application was filed more than two years after the benefits were denied.

The applicant argued that the respondent was estopped from relying on the limitation period due to a prior agreement with former counsel.

The adjudicator held that the Tribunal lacks jurisdiction to apply equitable remedies such as estoppel or to extend the limitation period under s. 7 of the Licence Appeal Tribunal Act.

Consequently, the applicant's claim for non-earner benefits was found to be statute-barred.

The applicant, a cyclist injured in a motor vehicle accident, sought funding for a physical treatment plan and a chronic pain assessment under the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove the treatment plans were reasonable and necessary.

The Tribunal noted the physical treatment plan lacked support from treating practitioners at the time it was submitted, and the applicant did not meet the criteria for chronic pain syndrome under the AMA Guides to warrant a chronic pain assessment.

The applicant sought statutory accident benefits for physiotherapy services following a motor vehicle accident.

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

The adjudicator found that the applicant failed to prove on a balance of probabilities that his injuries warranted removal from the MIG due to a pre-existing condition, chronic pain, or psychological impairment.

As the $3,500 MIG limit had already been exhausted, the treatment plans were not payable.

The application was dismissed.

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

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

The applicant argued she sustained a psychological impairment and bilateral psoas bursitis warranting removal from the MIG.

The Tribunal preferred the insurer's psychological assessment, finding the applicant's evidence inconsistent and insufficient to establish a psychological impairment.

The Tribunal also found the physical diagnoses were not accident-related.

The application was dismissed as the MIG limits were exhausted.

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

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

The Tribunal found that while the applicant's physical injuries were predominantly minor, he had sustained a psychological impairment (adjustment disorder with depressed mood) that removed him from the MIG.

Consequently, the Tribunal approved the treatment plans for a psychological assessment and psychological treatment, along with interest.

The claims for physical therapy were dismissed as not reasonable and necessary.

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

The insurer raised a preliminary issue, arguing the application was statute-barred under s. 56 of the Statutory Accident Benefits Schedule because it was filed more than two years after the insurer allegedly sent a notice terminating the benefits.

The Tribunal found that the insurer failed to prove on a balance of probabilities that it delivered the termination notice to the applicant or her representatives by mail or fax in accordance with s. 64 of the Schedule.

The notice was only properly delivered via email years later.

Therefore, the limitation period had not expired, and the applicant's claim was permitted to proceed.

The applicant sought statutory accident benefits for the prescription medication Saxenda, arguing that her type 1 diabetes was triggered by emotional stress following a motor vehicle accident.

The adjudicator found that the applicant failed to prove on a balance of probabilities that the accident caused her diabetes, as her own medical expert could not determine the exact initiation of the condition.

In the alternative, the adjudicator held that the applicant failed to prove the medication was reasonable and necessary, noting it was an off-label treatment for weight loss and no evidence of her body mass index was provided.

The application was dismissed.

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

The adjudicator held a written hearing to determine entitlement to attendant care benefits, physiotherapy, occupational therapy, and psychological services.

The adjudicator denied the claim for attendant care benefits, finding that the applicant failed to prove the expenses were incurred under s. 3(7)(e) of the Schedule, as there was no evidence of economic loss by the family member providing care.

The adjudicator partially allowed the claims for physiotherapy, finding that provider travel time was reasonable and necessary given the applicant's mobility limitations, but denied funding for planning services and mileage.

The claims for occupational therapy and psychological services were dismissed for lack of evidence demonstrating reasonableness and necessity.

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

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

The Tribunal found that the applicant's injuries were not predominantly minor due to chronic pain, removing her from the MIG.

However, the Tribunal dismissed the claims for the disputed treatment plans, finding that the applicant failed to prove on a balance of probabilities that the chiropractic treatments and psychological assessment were reasonable and necessary.

The applicant sought statutory accident benefits following two motor vehicle accidents.

The respondent insurer raised a preliminary issue, arguing that the applicant's claims for income replacement benefits and two treatment plans were statute-barred under s. 56 of the Schedule because the application was filed more than two years after the benefits were denied.

The applicant requested an extension of time under s. 7 of the LAT Act.

The Tribunal found that the claims were filed outside the two-year limitation period and held that it lacked jurisdiction under s. 7 of the LAT Act to extend a limitation period set out in a regulation like the Schedule.

The claims were dismissed as statute-barred.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming entitlement to dental services and psychological services.

The Licence Appeal Tribunal dismissed the application.

The Tribunal found the applicant failed to prove on a balance of probabilities that his dental issues were caused by the accident, preferring the respondent's dental assessment over the applicant's dental surgeon's letter.

The Tribunal also denied the unapproved portion of a treatment plan for psychological services, finding the respondent's approved hourly rate of $100 for a psychotherapist was reasonable and the applicant failed to justify a higher rate or the necessity of additional administrative fees.

Claims for an award and interest were consequently dismissed.