Melanie Malach

The applicant requested a reconsideration of a Licence Appeal Tribunal decision which found that the Tribunal lacked jurisdiction under s. 280 of the Insurance Act over her claim for the $45,054.65 balance of her medical and rehabilitation policy limit.

The applicant argued that the Tribunal breached procedural fairness, made errors of law and fact, and that new evidence in the form of an adjuster's file warranted reconsideration.

The adjudicator dismissed the request, finding no breach of procedural fairness as the preliminary issue was correctly identified from the Case Conference Report and Order.

The adjudicator also found no error of law or fact, noting there were no specific treatment plans in dispute at the time of the hearing, and concluded that the new evidence would not have affected the outcome.

The applicant requested reconsideration of a Tribunal decision that found her application for medical and rehabilitation benefits was barred by the two-year limitation period.

The applicant argued the adjudicator erred in fact and law by finding she had sufficient information to dispute the denials, claiming she did not receive the denials due to an outdated address.

The Tribunal dismissed the request, finding the adjudicator correctly applied the law regarding clear and unequivocal denials and properly addressed the evidence that the denials were faxed to her legal representative.

The applicant failed to establish grounds for reconsideration under Rule 18.2(b).

The applicant was injured when the TTC bus she was riding made a sudden stop, causing her to strike the interior of the bus.

The bus did not collide with any external object.

The applicant sought statutory accident benefits, arguing that she herself constituted 'any other object' with which the bus collided under s. 268(1.1) of the Insurance Act.

The Tribunal rejected this argument, finding that the ordinary meaning of the provision requires the public transit vehicle to collide with an object external to it.

As the bus did not collide with an external object, the applicant is barred from claiming accident benefits.

The respondent insurance company requested a reconsideration of a Tribunal decision which found that the applicant was principally dependent for care on his sister at the time of the accident.

The respondent argued that the adjudicator erred in law and fact by failing to compare the applicant's abilities with the care provided by his sister, and by finding that a physical or mental vulnerability is not generally required for a finding of dependency.

The Tribunal dismissed the request, finding that the adjudicator had properly applied the legal test from Co-Operators v. TD, considered the applicant's physical, emotional, and social needs, and that the respondent was merely attempting to re-litigate its case.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing he should be removed from the Minor Injury Guideline (MIG) due to a pre-existing shoulder condition, chronic pain, and a psychological impairment.

The Tribunal found insufficient evidence that a pre-existing condition would preclude maximal medical recovery within the MIG.

Applying the AMA Guides criteria, the Tribunal concluded the applicant did not suffer from a chronic pain condition, as medical reports indicated he had returned to full-time work and pre-accident activities without functional impairment.

The Tribunal also accepted the respondent's psychological assessment, finding no accident-related psychological diagnosis.

As the applicant's injuries were predominantly minor, he remained subject to the $3,500 MIG limit, and his claims for further assessments, interest, and an award were dismissed.

The applicant requested a reconsideration of a previous Tribunal decision that barred her from proceeding to a hearing on several treatment plans due to her failure to attend an insurer's examination.

The applicant argued that the Tribunal made errors of law and fact, and that new evidence—specifically her subsequent removal from the Minor Injury Guideline—should alter the outcome.

The Tribunal dismissed the reconsideration request, finding no errors of law or fact in its previous determinations regarding the validity of the notices of examination and denial letters at the time they were issued.

The Tribunal also found that the new evidence did not meet the criteria for reconsideration.

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 prove she suffered from chronic pain or a psychological condition that would warrant removal from the MIG.

The Tribunal also dismissed the claim for an income replacement benefit, finding insufficient medical evidence to demonstrate a substantial inability to perform the essential tasks of her pre-accident employment.

The application was dismissed in its entirety.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's determination that his injuries fell within the Minor Injury Guideline (MIG).

The applicant argued for removal from the MIG based on a psychological assessment diagnosing an adjustment disorder and specific phobia.

The adjudicator gave limited weight to the psychological report as it relied solely on self-reporting without contemporaneous medical evidence or validity testing.

The adjudicator also dismissed the claim for income replacement benefits, finding no medical evidence supporting a substantial inability to work.

As the applicant remained within the MIG and the limits were exhausted, the disputed treatment plans were denied.

The adjudicator further found the respondent's denial notices compliant with the Schedule and dismissed claims for interest and an award.

The applicant, a pedestrian involved in a motor vehicle accident, sought statutory accident benefits but did not notify the insurer until nearly two years after the accident.

The insurer denied the claim on the basis that the applicant failed to comply with the time limits under section 32 of the Statutory Accident Benefits Schedule.

The Tribunal found that the applicant's explanation for the delay—that she did not have the third party's insurance information and was busy with work and family—was not reasonable.

The Tribunal concluded that the insurer was prejudiced by the delay and dismissed the application as statute-barred.

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 did not meet the test for income replacement benefits (IRBs).

The Tribunal found that the applicant failed to prove she suffered a concussion or a psychological condition that would warrant removal from the MIG.

Consequently, the disputed treatment plan for physiotherapy was denied.

The Tribunal also found insufficient medical evidence to establish that the applicant suffered a substantial inability to perform the essential tasks of her pre-accident employment, dismissing her claim for IRBs and interest.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that found she was not removed from the Minor Injury Guideline and denied her claims for treatment plans and clinical notes and records.

The applicant argued the Tribunal breached procedural fairness and made errors of law and fact by failing to properly weigh medical evidence regarding her psychological impairments.

The adjudicator dismissed the request, finding that the applicant was attempting to re-litigate the case and re-weigh the evidence, which are not valid grounds for reconsideration under Rule 18.2.

The applicant sought statutory accident benefits following a motor vehicle accident and was denied by the respondent.

The respondent raised a preliminary issue, arguing the applicant was statute-barred from proceeding to a hearing for failing to attend a scheduled insurer's examination.

The Tribunal found that the applicant had provided a reasonable explanation for her non-attendance, having notified the respondent of a scheduling conflict prior to the examination and requested a rescheduled date, to which the respondent did not reply.

The applicant was permitted to proceed to a substantive hearing.

The applicant's request for costs was denied due to a lack of supporting submissions or evidence.

The applicant, a pedestrian making a delivery for Uber Eats, was struck by an e-scooter and sought statutory accident benefits.

The respondent denied the claim on the basis that an e-scooter is not an 'automobile' and therefore the incident was not an 'accident' under s. 3(1) of the Schedule.

The Tribunal applied the Adams test and found that the applicant failed to provide sufficient evidence regarding the e-scooter's features to prove it was an automobile in ordinary parlance.

The application was dismissed.

The applicant sought statutory accident benefits after an incident where he was struck in the face with a walking stick by a pedestrian while seated in his vehicle.

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

The Tribunal applied the purpose and causation test, finding that while the incident arose out of the ordinary use of a vehicle, the assault was an intervening act that broke the chain of causation.

The application was dismissed.

The applicant sought accident benefits following a motor vehicle accident.

The respondent denied a treatment plan on August 26, 2022, and requested an insurer's examination.

Following the examination, the respondent issued a further denial on December 1, 2022.

The applicant filed an application with the Tribunal on November 15, 2024.

The respondent argued the application was statute-barred as it was filed more than two years after the initial August 26, 2022 denial.

The applicant argued the initial denial was invalid and the limitation period should run from the December 1, 2022 denial.

The Tribunal found the August 26, 2022 denial was clear, unequivocal, and met the requirements set out in Smith v. Co-operators.

The request for an insurer's examination did not override the valid denial.

The Tribunal declined to extend the limitation period under s. 7 of the LAT Act as the applicant provided no submissions on the issue.

The application was dismissed as statute-barred.

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

The Tribunal found the applicant did not prove on a balance of probabilities that she suffered from a psychological condition or a pre-existing medical condition that would warrant removal from the MIG.

The Tribunal also found the respondent's denial notices were compliant with s. 38(8) of the Schedule, except for one which was late but still provided sufficient reasons.

The application was dismissed, and no interest or award was granted.

The applicant sought payment for a forensic audit report after entering into a full and final settlement of her statutory accident benefits claim.

The respondent argued the application was barred because the applicant had not rescinded the settlement agreement or returned the settlement funds pursuant to section 9.1 of Regulation 664.

The Tribunal found that the settlement agreement was valid and binding, and the applicant was barred from proceeding with her application.

The respondent's request for costs was dismissed.

The applicant, a truck driver, was injured in a motor vehicle accident while driving his employer's truck.

He applied for statutory accident benefits but was denied by the insurer on the basis that he was in the course of his employment and therefore entitled to Workplace Safety and Insurance Board (WSIB) benefits.

The Tribunal held that the applicant was working at the time of the accident and was entitled to WSIB benefits.

Furthermore, the Tribunal found that the applicant's election to pursue a tort claim was made primarily for the purpose of claiming accident benefits, as he did not have a bona fide intention to commence a tort action at the time of his application.

Consequently, the applicant was statute-barred under s. 61 of the Schedule from proceeding with his application for accident benefits.

The applicant was injured while a passenger on a TTC bus and sought statutory accident benefits.

The respondent denied the claim on the basis that the applicant failed to notify it of his intention to apply for benefits within seven days of the accident, as required by section 32(1) of the Schedule.

The Tribunal found that the applicant did not provide notice within the prescribed timeline and failed to establish a reasonable explanation for the delay under section 34.

Consequently, the applicant was statute-barred from proceeding with his application.

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule, which the respondent insurer denied.

The Licence Appeal Tribunal found the applicant was entitled to treatment plans for physiotherapy, a functional abilities evaluation, an occupational therapy assessment, and an optometrist assessment, as the medical evidence supported ongoing physical and functional limitations.

The Tribunal denied the claim for provider travel time related to social rehabilitation counselling due to lack of evidence.

The applicant was awarded interest on the overdue benefits, but the claim for a special award under s. 10 of Regulation 664 was dismissed as the insurer's conduct was not found to be unreasonable.