Lisa Holland

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

The respondent insurer denied benefits, arguing the application was delayed without a reasonable explanation.

The Tribunal found that the applicant, being seven years old at the time of the accident and reliant on her parents, had a reasonable explanation for the delay.

The Tribunal noted the applicant's minority status, her parents' language barriers, and the lack of significant prejudice to the insurer.

The applicant was permitted to proceed with her claim.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to a non-earner benefit and a physiotherapy treatment plan outside the Minor Injury Guideline (MIG).

The respondent denied the benefits.

The Tribunal found that the applicant failed to prove her soft tissue injuries warranted removal from the MIG, noting she had returned to her pre-accident activities in a reduced capacity.

The Tribunal also dismissed the claim for a non-earner benefit, finding no complete inability to carry on a normal life.

The application was dismissed.

The applicant was struck by an unidentified driver as a pedestrian and failed to notify the respondent of his intention to claim accident benefits within the prescribed time.

The respondent argued the claim was statute-barred.

The Tribunal found that the applicant, an unsophisticated person with no knowledge of automobile insurance, provided a reasonable explanation for the delay.

The Tribunal concluded that the hardship to the applicant outweighed any prejudice to the respondent, allowing the applicant to proceed to a substantive issues hearing.

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

The respondent denied claims for a non-earner benefit, physiotherapy, and translation services.

The Tribunal found that the applicant was statute-barred from proceeding with the claims for the non-earner benefit, the first physiotherapy plan, and the translation services because he failed to dispute the clear and unequivocal denials within the two-year limitation period under s. 56 of the Schedule.

The Tribunal also found that the applicant failed to prove the second physiotherapy plan was reasonable and necessary, and that the respondent's denial of that plan complied with s. 38(8).

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to income replacement benefits (IRB) and treatment plans outside the Minor Injury Guideline (MIG) due to chronic pain.

The Licence Appeal Tribunal found that the applicant failed to prove his injuries fell outside the MIG, as the medical evidence did not support a diagnosis of accident-related chronic pain with functional impairment.

The Tribunal also dismissed the claim for IRB, finding the applicant had returned to work and failed to establish a substantial inability to perform the essential tasks of his pre-accident employment.

The application was dismissed.

The applicant sought entitlement to statutory accident benefits for chiropractic services, a chronic pain assessment, and driving therapy following a motor vehicle accident.

The Tribunal found that the applicant failed to prove the treatments and assessments were reasonable and necessary, noting inconsistencies in the applicant's self-reporting regarding his return to work and driving.

The application was dismissed and no interest was payable.

The applicant was involved in a motor vehicle accident and submitted an application for accident benefits (OCF-1) 56 days later, outside the prescribed statutory timeline.

The respondent insurer argued the applicant was statute-barred from proceeding with the claim.

The Tribunal found that the applicant had a reasonable explanation for the delay, noting the applicant was involved in a second accident shortly after the first, the insurer failed to acknowledge receipt of the initial faxed OCF-1, and the insurer suffered limited prejudice while the applicant would suffer significant hardship if barred.

The Tribunal ruled the applicant is not statute-barred and may proceed to a substantive hearing.

The applicant was involved in a motor vehicle accident and notified the insurer within seven days.

The insurer sent the application for accident benefits (OCF-1) via email, but the applicant did not submit the completed form until over a year later.

The insurer raised a preliminary issue that the applicant was statute-barred from proceeding with his claim due to the delay.

The Tribunal found that the insurer failed to prove the applicant consented to receive documents electronically or understood the application process, especially given a language barrier.

The Tribunal concluded the applicant had a reasonable explanation for the delay and allowed the application to proceed.

The applicant sought a non-earner benefit and a treatment plan for chiropractic services following a motor vehicle accident.

The Tribunal found the applicant was statute-barred from proceeding with the claim for a non-earner benefit because he failed to attend reasonably necessary insurer examinations without a reasonable explanation, and the insurer's notice of examination was compliant with s. 44 of the Schedule.

The Tribunal also dismissed the claim for the treatment plan, finding the applicant failed to prove it was reasonable and necessary, and that the insurer had provided a valid denial notice under s. 38(8).

Claims for interest and an award were 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) and that she failed to attend scheduled Insurer Examinations (IEs).

The Tribunal found the applicant did not prove her injuries warranted removal from the MIG.

Furthermore, the applicant failed to establish entitlement to an Income Replacement Benefit (IRB) and was barred from proceeding with the IRB claim due to her unexcused failure to attend properly scheduled IEs.

The application was dismissed.

The applicant insurer sought repayment of $4,336.81 in income replacement benefits (IRBs) paid to the respondent, alleging he returned to work without notifying them.

The respondent argued the repayment notices were deficient under s. 52 of the Schedule.

The Tribunal found the applicant's initial notices for $1,697.09 were valid and timely, but a subsequent notice for the higher amount was issued beyond the 12-month limitation period without proof of wilful misrepresentation or fraud.

The Tribunal ordered the respondent to repay $1,697.09 plus interest, and denied the respondent's request for costs.

The applicant sought accident benefits for psychological injuries allegedly sustained as a result of her spouse's involvement in a motor vehicle accident four years prior.

The respondent denied the claim, arguing the applicant was not an 'insured person' under section 3(1) of the Statutory Accident Benefits Schedule and had failed to apply within the prescribed timelines.

The Tribunal found that the applicant failed to provide evidence linking her psychological impairments to the accident, as her medical records did not mention the accident and instead noted unrelated anxiety.

Consequently, the Tribunal concluded the applicant was not an 'insured person' and dismissed the claim, finding it unnecessary to address the limitation period issue.

The applicant sought various statutory accident benefits following a 2019 motor vehicle accident, including a determination of catastrophic impairment, income replacement benefits, attendant care benefits, and several treatment plans.

The respondent denied the benefits and argued the applicant was statute-barred from proceeding due to non-attendance at insurer's examinations.

The Tribunal found the applicant was not statute-barred because the notices of examination were non-compliant and she had a reasonable explanation for non-attendance.

However, the Tribunal dismissed the application on the merits.

The applicant failed to prove she sustained a catastrophic impairment under Criterion 7 or 8, largely due to significant pre-existing physical and psychological conditions.

Consequently, she was not entitled to medical or attendant care benefits beyond the 260-week limit, nor did she prove entitlement to post-104-week income replacement benefits or the disputed treatment plans.

The applicant sought a $10,000 death benefit following the death of his daughter in a motor vehicle accident.

The central issue was whether the daughter was principally dependent on the applicant for financial support at the time of the accident.

The Tribunal found that the daughter had recently graduated, was working full-time, and was able to meet her basic financial needs using her own income.

Applying the Miller factors and considering forensic accounting evidence based on LICO and MBM methods, the Tribunal concluded the daughter was not principally dependent on the applicant.

The application for death benefits, interest, and an award was dismissed.

The applicant, a special needs student, was assaulted by another student while riding a school bus and subsequently suffered a stroke.

She applied for statutory accident benefits.

The respondent denied the claim, arguing the incident was not an 'accident' under the Schedule.

The Tribunal found that while the purpose test was met, the causation test was not.

The assault was an intervening act that broke the chain of causation, and the use or operation of the school bus was not the direct cause of the applicant's injuries.

The application was dismissed.

The applicant sought payment for two chiropractic treatment plans following a motor vehicle accident.

The respondent denied the plans, and the applicant argued the denials were procedurally defective under s. 38(8) of the Schedule.

The Tribunal found that the respondent's denial notices were compliant, as they provided specific medical reasons and relied on an Insurer's Examination report.

Because the applicant made no submissions on the substantive reasonableness and necessity of the treatment plans, the Tribunal dismissed the application and denied claims for interest and a special award.

The applicant sought statutory accident benefits following a 2022 motor vehicle accident, claiming catastrophic impairment under Criterion 8, income replacement benefits, attendant care benefits, and various treatment plans.

The Licence Appeal Tribunal dismissed the majority of the claims, finding the applicant's self-reports of pre-accident functioning were inaccurate, as he was receiving long-term disability and Canada Pension Plan disability benefits prior to the accident.

Surveillance evidence and testimony contradicted the applicant's claims of severe social and functional isolation.

The Tribunal found the applicant did not sustain a catastrophic impairment, was not entitled to an IRB, and was only entitled to a minor portion of one treatment plan due to a late denial by the insurer.

The applicant, who sustained a catastrophic impairment in a motor vehicle accident, sought payment for outstanding balances on six treatment plans for psychological services and $400 for housekeeping benefits.

The Licence Appeal Tribunal dismissed the application.

The Tribunal found the applicant failed to justify billing a psychotherapist's services at the higher hourly rate of a psychologist.

The claim for housekeeping benefits was denied because the applicant provided no evidence that the expenses were actually incurred or reasonable and necessary.

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

The respondent denied treatment plans for psychological and physiotherapy services on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant failed to prove on a balance of probabilities that he suffered from accident-related chronic pain or psychological impairments warranting removal from the MIG.

As the MIG limits were exhausted, the disputed treatment plans were not payable.

The Tribunal also found that the respondent's denial notices complied with s. 38(8) of the Schedule.

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

The respondent argued the applicant was barred from proceeding on certain issues due to non-attendance at insurer's examinations.

The Tribunal found the applicant had a reasonable explanation for non-attendance due to the respondent's failure to provide previous examination reports.

On the merits, the Tribunal dismissed the claim for income replacement benefits, finding the applicant returned to her pre-accident part-time work level.

The Tribunal found the applicant entitled to attendant care benefits of $612.75 per month, but they were not payable as they had not been incurred.

Several treatment plans for assessments and assistive devices were partially approved, while claims for psychological treatment, an award, and costs were dismissed.