Melanie Malach

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

The respondent 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 failed to prove her injuries, including alleged chronic pain and psychological impairments, warranted removal from the MIG.

Consequently, the disputed treatment plans, which exceeded the $3,500 MIG limit, were not payable.

Claims for interest and a section 10 award were also dismissed.

The applicant sought various medical and rehabilitation benefits, out-of-pocket expenses, interest, and an award following a motor vehicle accident.

The Tribunal found the applicant partially entitled to the balance of three treatment plans for chiropractic and massage therapy services, plus interest, as the medical evidence supported ongoing physical complaints and the need for treatment.

However, the Tribunal denied the claims for psychological assessments and services, orthopaedic shoes, and out-of-pocket expenses due to a lack of supporting evidence and failure to establish statutory entitlement.

The claim for an award under s. 10 of Reg. 664 was also dismissed as the applicant made no submissions on the issue.

The applicant sought medical and rehabilitation benefits under the Statutory Accident Benefits Schedule following a motor vehicle accident, specifically claiming expenses for dog walking services and a laptop for an online college course.

The Tribunal found that dog walking services were replacement services for the dog's benefit rather than essential rehabilitation for the applicant, and thus not compensable under s. 16(3)(l).

The Tribunal also denied the claim for the laptop and course due to insufficient details in the treatment plan to assess reasonableness and necessity.

The application was dismissed.

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

The respondent partially denied a treatment plan for an in-home occupational therapy assessment, specifically denying costs for documentation, provider travel time, and the initial report.

The applicant applied to the Licence Appeal Tribunal to dispute the denial and sought an award for unreasonably withheld benefits.

The Tribunal found the applicant was entitled to the balance of the cost for the initial report documentation, as the detailed 29-page report and Form 1 reasonably required the time claimed.

However, the Tribunal denied the costs for completing the OCF-18 and provider travel time, finding insufficient evidence to support those claims.

The Tribunal also dismissed the claim for an award, finding the respondent had reasonable grounds for its partial approval and did not act unreasonably.

The applicant sought statutory accident benefits for chiropractic treatment following a 2016 motor vehicle accident.

The respondent denied the treatment plans, which were authored by the applicant's husband, who is also her treating chiropractor.

The Tribunal addressed procedural issues regarding the applicant's non-compliance with submission page limits and the late filing of a rebuttal report.

On the merits, the Tribunal found that the applicant failed to comply with s. 38(2) of the Schedule for an OCF-6 submitted without a prior treatment plan.

For the remaining treatment plans, the Tribunal concluded that the applicant did not provide sufficient objective medical evidence or contemporaneous clinical notes to prove the treatment was reasonable and necessary, especially given the competing independent medical examinations concluding no further treatment was warranted.

The application was dismissed.

The applicant sought statutory accident benefits after a pick-up truck crashed into his home while he was sleeping, causing him to wake up in a panic to alarms and strobe lights, resulting in psychological impairments.

The insurer denied benefits, arguing the applicant was not an 'insured person' involved in an 'accident' because he merely witnessed the aftermath.

The Tribunal found that the incident met the purpose and causation tests for an accident, as the vehicle was in operation when it struck the home and directly caused the applicant's injuries without any intervening act.

The Tribunal concluded the applicant was involved in the accident and met the definition of an insured person, allowing the application to proceed to a hearing on the substantive issues.

The insured requested a reconsideration of a Licence Appeal Tribunal decision that ordered her to repay Income Replacement Benefits (IRBs) and denied her claims for physiotherapy treatment plans.

The adjudicator granted the reconsideration in part, finding that the original hearing adjudicator committed a material breach of procedural fairness by excluding the insured's reply submissions.

Furthermore, the original decision contained errors of law by incorrectly concluding that non-compliance with section 33 of the Schedule allowed the insurer to claim repayment for past paid IRBs, and by failing to consider the insurer's compliance with section 38 and the insured's expert medical evidence regarding the treatment plans.

The substantive issues were remitted for a new hearing.

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 failed to provide persuasive medical evidence to support removal from the MIG.

Consequently, the disputed treatment plans were denied.

The Tribunal also dismissed the claim for income replacement benefits, finding the applicant failed to provide evidence of accident-related functional impairments preventing him from working.

Claims for interest and an award were also dismissed.

The applicant sought entitlement to various treatment plans for chiropractic services, yoga therapy, assistive devices, and a nutritional assessment following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to meet his evidentiary burden.

Specifically, the applicant failed to provide copies of the disputed treatment plans, making it impossible to determine the exact services, goals, and costs proposed.

The Tribunal also found insufficient medical evidence to support the reasonableness and necessity of the claimed benefits.

Claims for interest and a special award were consequently 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 matter proceeded to a written hearing, but the applicant failed to file any submissions or evidence after her representative withdrew.

The Tribunal found the applicant failed to meet her burden to prove her injuries warranted removal from the MIG or that she was entitled to the disputed treatment plans.

Additionally, the Tribunal ordered the applicant to repay $400.00 in income replacement benefits, as she had returned to work during the period for which the benefits were paid and the respondent had provided proper notice of the overpayment.

The applicant insurer sought repayment of $7,710.19 in Income Replacement Benefits (IRBs) paid to the respondent, alleging wilful misrepresentation of post-accident income.

The respondent argued the application was statute-barred by a two-year limitation period and that any repayment should be deducted from future benefits rather than paid as a lump sum.

The Tribunal found the application was not statute-barred, as the limitation period in section 56 of the Schedule applies to an insurer's refusal to pay, not a claim for repayment.

The Tribunal concluded the respondent wilfully misrepresented his post-accident income and failed to comply with production requests.

The insurer was awarded a lump sum repayment of $7,710.19 plus interest.

The applicant sought statutory accident benefits after being struck in the head by an industrial ceiling fan while standing on the roof of a trailer to perform routine maintenance.

The respondent denied the claim on the basis that the incident was not an 'accident' under s. 3(1) of the Schedule.

The Tribunal applied the two-part purpose and causation test.

While the purpose test was met, the causation test failed because the ceiling fan was an intervening act that broke the chain of causation and was not a normal risk associated with maintaining a trailer.

The application was dismissed.

The applicant sought statutory accident benefits after being struck by a skid steer Caterpillar snowplow while walking in a parking lot.

The respondent denied benefits on the basis that the incident was not an 'accident' under section 3(1) of the Statutory Accident Benefits Schedule.

The Tribunal applied the Adams test and found that the snowplow was not an 'automobile' in ordinary parlance, under any insurance policy, or under any enlarged statutory definition, as it qualified as an exempt 'road-building machine' under the Highway Traffic Act.

The application was dismissed.

The applicant was struck by a motor vehicle while crossing a crosswalk and sought statutory accident benefits 15 months later.

The respondent denied the claim, arguing the applicant failed to notify them within the 7-day limit under s. 32(1) of the Schedule and failed to submit an OCF-1 within the prescribed time.

The Tribunal found that the applicant did not provide a reasonable explanation for the delay under s. 34, noting a lack of documentary evidence to support claims that her counsel attempted to contact the respondent earlier.

The Tribunal held that the respondent was prejudiced by the delay, as the applicant had moved out of the country, preventing medical assessments.

The application was dismissed as statute-barred.

The applicant insurer applied to the Licence Appeal Tribunal to determine if the respondent was barred from claiming statutory accident benefits under s. 61 of the Schedule.

The respondent had applied for both accident benefits and WSIB benefits following a motor vehicle accident in the course of her employment.

The Tribunal found that the respondent failed to commence a tort action and her election to receive accident benefits was primarily for the purpose of claiming those benefits.

Consequently, the respondent did not meet the exception under s. 61(2) and was statute-barred from proceeding with her application for accident benefits.

The applicant sought statutory accident benefits after allegedly being forced off the road while riding an e-bike by an unidentified motorist.

The respondent denied benefits, arguing the applicant failed to prove the involvement of an automobile.

The Licence Appeal Tribunal found the applicant's evidence regarding the incident to be inconsistent and unreliable, noting contradictions between his testimony, medical records, and statements to police.

The Tribunal concluded the applicant failed to meet the purpose test to establish he was involved in an 'accident' under section 3(1) of the Schedule.

The application was dismissed.

The minor applicant was involved in a motor vehicle accident and sought statutory accident benefits for optical, speech and language, and psychological assessments.

The respondent insurer denied the treatment plans.

The adjudicator found that the applicant failed to provide sufficient objective medical evidence to prove on a balance of probabilities that the proposed assessments were reasonable and necessary as a result of the accident.

The adjudicator accepted the respondent's medical evidence that the applicant's impairments were related to pre-existing diagnoses of Autism Spectrum Disorder and Attention Deficit Hyperactivity Disorder, rather than the accident.

The application was dismissed.

The applicant sought statutory accident benefits following an alleged motor vehicle accident where he claimed to be a pedestrian struck by a reversing vehicle.

The respondent denied benefits, arguing there was no evidence the applicant was involved in the accident.

The Tribunal found that the police reports and the statement of the applicant's fiancé, who was also struck, did not mention the applicant's presence or involvement.

Furthermore, the medical evidence did not support his involvement in the accident.

The Tribunal concluded the applicant failed to prove on a balance of probabilities that he was involved in an 'accident' under s. 3(1) of the Schedule, and dismissed the application.

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

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

The Tribunal found the applicant demonstrated a chronic pain condition with functional impairment, satisfying the AMA Guides criteria, and removed him from the MIG.

The Tribunal approved the disputed treatment plans for chiropractic services, psychological services, and various assessments, finding them reasonable and necessary based on the treating practitioners' records and s. 25 assessments.

The claim for a special award under s. 10 of Reg. 664 was dismissed, as the respondent reasonably relied on its expert reports.

The applicant was injured when he was assaulted and dragged by a vehicle while attempting to repossess it.

He did not notify the insurer of his intention to apply for accident benefits until over a year later, after consulting with legal counsel.

The insurer denied the claim based on the failure to notify within the 7-day time limit under s. 32(1) of the Schedule.

The Tribunal found that the applicant provided a reasonable explanation for the delay under s. 34, as the incident was an unconventional accident and the applicant was unaware he had access to accident benefits.

The Tribunal concluded that the hardship to the applicant outweighed the prejudice to the insurer, and the applicant was not barred from proceeding with his claim.