Rachel Levitsky

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

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

The applicant argued that the respondent's denial notices were deficient under s. 38(8) of the Schedule, rendering the s. 44 assessment reports void and triggering mandatory payment under s. 38(11).

The Tribunal found that while some initial notices were deficient, the applicant was not entitled to the treatment plans because they were not incurred prior to the deficient notice being cured.

The Tribunal rejected the argument that attending an assessment after a deficient notice waives the right to benefits.

The application was dismissed as the applicant failed to prove his injuries warranted removal from the MIG.

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

The respondent denied benefits and argued the applicant was precluded from proceeding because she had entered into a settlement agreement.

The Tribunal found the applicant validly rescinded the settlement within the two-day cooling-off period under the Legislation Act.

On the substantive issues, the Tribunal held the applicant sustained a psychological impairment (vehicular anxiety) warranting removal from the Minor Injury Guideline.

However, the Tribunal denied the treatment plan for an in-home functional assessment due to a lack of contemporaneous medical evidence supporting its necessity.

Claims for an award and interest were also dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including non-earner benefits (NEBs) and several treatment plans for physiotherapy, orthotics, and a chronic pain assessment.

The Licence Appeal Tribunal found that the applicant did not suffer a complete inability to carry on a normal life, as her impairments were not continuous and she was able to work part-time.

The Tribunal denied the physiotherapy and orthotics treatment plans due to a lack of compelling evidence of their reasonableness and necessity.

However, the Tribunal granted the $2,200 treatment plan for a chronic pain assessment, finding that the applicant's pain was worsened by the accident and warranted further investigation.

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

The respondent denied portions of a treatment plan for catastrophic impairment assessments and suspended income replacement benefits due to the applicant's non-attendance at an assessment.

The Tribunal found the mental/behavioural assessment was reasonable and necessary, awarding its cost and associated HST, but denied the cost of a comprehensive file review as a duplication of services.

The Tribunal also found the applicant provided a reasonable explanation for missing the assessment due to illness, making the suspended income replacement benefits overdue and subject to interest.

An award of $370 was granted against the respondent for unreasonably withholding the benefits despite the explanation.

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

The Tribunal found that the applicant's injuries were predominantly minor and subject to the Minor Injury Guideline (MIG), rejecting expert evidence of psychological impairment and chronic pain syndrome.

However, the Tribunal ordered the respondent to pay for five disputed physiotherapy and psychological treatment plans because the respondent's denial letters contained boilerplate language that failed to provide sufficient medical reasons as required by s. 38(8) of the Schedule.

A claim for a chronic pain assessment was dismissed as the denial notice for that plan was compliant.

The Tribunal declined to order an award under s. 10 of Reg. 664.

The applicant sought statutory accident benefits after slipping and falling on ice while closing his car door.

The respondent denied the claim, arguing the incident did not meet the definition of an 'accident' under the Schedule.

The Tribunal found that the incident was an accident, as the applicant was actively using his vehicle and the ice was not an intervening event.

The Tribunal also determined that the applicant's fractured elbow removed him from the Minor Injury Guideline.

However, the Tribunal dismissed the claims for an income replacement benefit and specific treatment plans because the applicant failed to provide sufficient medical evidence or copies of the treatment plans to prove entitlement.

The applicant, a minor, sought a $10,000 death benefit from the respondent insurer following the death of her father in a motor vehicle accident.

The applicant's mother held a policy with the respondent.

The Tribunal found that the deceased father was not an "insured person" under the mother's policy, as they were not spouses and he was not a dependent.

The application for a death benefit was dismissed.

The applicant sought non-earner benefits following a September 2022 motor vehicle accident.

The respondent denied the claim, arguing the applicant's impairments stemmed from pre-existing depression and a prior accident in June 2022.

The Tribunal applied the 'but for' causation test and the Heath framework, finding the applicant failed to prove her impairments were caused by the September accident.

The Tribunal preferred the respondent's section 44 assessors, who properly compared the applicant's functioning before and after both accidents, over the applicant's section 25 assessors, who failed to review pre-accident records or account for the prior accident.

The application was dismissed.

The applicant sought a $10,000 death benefit under the Statutory Accident Benefits Schedule following the death of her father in a motor vehicle accident.

The respondent denied the benefit on the basis that the deceased was not an insured person under his father's policy.

The Tribunal found that the applicant failed to prove the deceased was principally dependent on his father or stepmother for financial support or care.

As the deceased was not a dependent, he was not an insured person under the policy, and the applicant was not entitled to the death benefit.

The applicant sought a $10,000 death benefit from the respondent insurer following the death of her father in a motor vehicle accident.

The respondent denied the claim on the basis that the deceased was not an "insured person" under the policy issued to the applicant's mother.

The Tribunal found that the deceased was not a named insured, a specified driver, a spouse of the named insured, or a dependent of the named insured.

As the applicant failed to prove the deceased was an insured person under the respondent's policy, the application for a death benefit was dismissed.

The applicant sought statutory accident benefits after falling when the driver of her hired vehicle stepped backwards into her while loading the trunk.

The respondent insurer denied benefits, arguing the incident did not meet the definition of an 'accident' under section 3(1) of the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal found that the applicant satisfied both the purpose and causation tests, as loading a vehicle is an ordinary use of an automobile and the driver's push was a normal incident of the risk created by such use.

The Tribunal concluded the applicant was involved in an accident and is entitled to proceed with her claim.

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

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

The Tribunal found the applicant sustained a psychological impairment, removing him from the MIG.

However, the applicant failed to prove entitlement to a non-earner benefit, as he returned to most pre-accident activities.

Most treatment plans were denied as not reasonable and necessary, or because the respondent cured initially deficient notices before the plans were incurred.

One psychological assessment was deemed payable under s. 38(11) because it was incurred before the respondent provided proper medical reasons for denial.

The claim for an award for unreasonable delay was dismissed.

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

The Tribunal found that the applicant's injuries were predominantly minor and subject to the Minor Injury Guideline (MIG), as there was insufficient evidence of chronic pain or psychological impairment.

However, the Tribunal ordered the respondent to pay a $3,782.56 treatment plan for chiropractic services because the respondent's denial notice failed to comply with s. 38(8) of the Schedule by not adequately explaining the MIG.

Claims for a $110 invoice and a section 10 award were dismissed.

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

The respondent insurer raised a preliminary issue, arguing the applicant was barred from proceeding because he failed to submit his application for benefits (OCF-1) within 30 days of receiving the forms, contrary to s. 32(5) of the Schedule.

The Tribunal found that the respondent failed to prove it sent the forms to the correct address prior to June 22, 2022.

The Tribunal accepted the applicant's evidence that he submitted the OCF-1 by regular mail on July 29, 2022, which was within the 30-day window of the deemed receipt date.

Consequently, the applicant was not in breach of the Schedule and was permitted to proceed with his claim.

The applicant sought statutory accident benefits following a motor vehicle accident, including an income replacement benefit (IRB), chiropractic services, and psychological services.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove a substantial inability to perform the essential tasks of his employment or a complete inability to engage in any employment.

The Tribunal also found the proposed treatment plans were not reasonable and necessary, relying on the respondent's s. 44 assessment reports which the applicant did not dispute.

Claims for an award and interest were consequently dismissed.

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

The respondent denied the claims for non-earner benefits and various treatment plans.

The applicant applied to the Tribunal more than two years after receiving the denial notices.

The Tribunal found that the denial notices were clear and unequivocal, satisfying the requirements to trigger the limitation period under s. 56 of the Schedule.

Consequently, the applicant was statute-barred from proceeding with her claims.

Furthermore, the Tribunal determined that the applicant's injuries fell within the Minor Injury Guideline, as she failed to provide compelling evidence of a psychological impairment or pre-existing condition that would warrant removal from the guideline.

The claims for an award and interest were also dismissed.

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

At the time of the accident, the applicant was participating in a Work Transition Plan through the WSIB and working at an architecture firm, but his WSIB payments were not contingent on providing services to the firm.

The Tribunal found that the applicant was not 'employed' under section 5(1)(1) of the Statutory Accident Benefits Schedule because he did not receive remuneration in exchange for the services he provided.

Consequently, the applicant was not entitled to income replacement benefits.

The applicant sought payment for a catastrophic impairment assessment and an income replacement calculation report following a motor vehicle accident.

The Licence Appeal Tribunal found that the insurer's denial notices complied with s. 38(8) of the Schedule.

The Tribunal dismissed the claims, concluding the applicant failed to prove the separate catastrophic assessments were reasonable and necessary, and that the income replacement calculation was not sufficiently complex to warrant a professional accounting report.

The applicant was struck by a Caterpillar wheel loader equipped with a snow plow while walking on a public roadway.

He applied for statutory accident benefits, which the respondent insurer denied on the basis that the wheel loader was not an 'automobile' and thus the incident was not an 'accident' under s. 3(1) of the Statutory Accident Benefits Schedule.

The Tribunal applied the Adams test and found that the wheel loader was an automobile in ordinary parlance, given its purpose, function, and features such as a steering wheel, braking system, and capability of driving on public roads.

The Tribunal concluded the applicant was involved in an accident, but declined to order a special award against the respondent.

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

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

The Tribunal found that the applicant sustained a psychological impairment, specifically driving anxiety and nightmares, removing him from the MIG.

The Tribunal approved a psychological assessment and partially approved a physiotherapy treatment plan for a TENS unit and heating pad, but denied facility-based treatment.

The Tribunal also found the respondent's initial denial notice non-compliant with s. 38(8) of the Schedule, but held that s. 38(11) only required payment for items incurred during the non-compliance period.

The claim for an award for unreasonable delay was dismissed, but interest on overdue benefits was granted.