Rebecca Hines

The applicant sought accident benefits following a 2017 motor vehicle accident, claiming catastrophic impairment due to mental and behavioural disorders, non-earner benefits, and various treatment plans.

The Tribunal found that the applicant had significant pre-existing conditions from a 2009 workplace injury and failed to prove on a balance of probabilities that the motor vehicle accident was a necessary cause of his psychological impairments.

Consequently, the catastrophic impairment claim and non-earner benefits were denied.

However, the Tribunal approved treatment plans for a chronic pain program, an attendant care assessment, and a driving reintegration assessment, finding them reasonable and necessary to address exacerbations of physical pain and new driving anxiety caused by the accident.

The applicant requested a reconsideration of a previous Licence Appeal Tribunal decision that denied his claims for a catastrophic impairment designation, income replacement benefits (IRBs), and an award.

The applicant argued that the adjudicator breached procedural fairness and erred in law by failing to consider his income tax records, which were included in his voluminous document brief but not specifically pointed out during the hearing.

The adjudicator dismissed the reconsideration request, finding that the applicant failed to meet his onus to identify and rely on the evidence during the hearing, despite multiple reminders.

The adjudicator concluded that it would be an error of law for the Tribunal to make the applicant's case for him, and the reconsideration process is not an opportunity to present arguments or evidence that should have been raised at the hearing.

The applicant, catastrophically impaired following a bus-train collision, sought statutory accident benefits for home modifications, the purchase of a new home, and housekeeping services.

The Tribunal deemed the $166,437.70 home modification expense incurred under s. 3(8) of the Schedule due to the insurer's unreasonable delay and flawed reliance on its assessors, awarding a 25% special award.

The request for $839,104.50 to purchase a new home was dismissed as it exceeded the value of necessary home modifications under s. 16(4)(c).

Housekeeping benefits of $100 per week were granted from February 2019 onwards.

The insurer was found entitled to repayment of an $8,747.42 overpayment of income replacement benefits resulting from a failure to recalculate the benefit when the applicant turned 65.

The applicant sought costs of $12,500 against the respondent insurer, alleging unreasonable, frivolous, vexatious, and bad faith conduct during a dispute over non-earner benefits.

The adjudicator found that the respondent deliberately failed to comply with a production order regarding independent examination records, which delayed the hearing and interfered with the Tribunal's process.

The adjudicator awarded the applicant $500 in costs, finding the requested amount disproportionate to the issues and the respondent's conduct.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including a non-earner benefit, treatment plans for physiotherapy and assistive devices, interest, and a special award.

The Licence Appeal Tribunal found that the applicant was not entitled to the non-earner benefit because he did not suffer a complete inability to carry on a normal life, noting he returned to school and engaged in more activities post-accident than pre-accident.

However, the Tribunal approved the three treatment plans for physiotherapy and the balance of the plan for assistive devices, finding them reasonable and necessary to treat his ongoing left elbow impairment.

Interest was awarded on the approved plans.

The claim for a special award was dismissed as the insurer's reliance on its medical assessors was not unreasonable.

The applicant, a pedestrian struck by a vehicle, sought a non-earner benefit and interest under the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal dismissed the application, finding the applicant's testimony regarding her pre- and post-accident employment, medical history, and daily activities to be highly inconsistent and unreliable.

The Tribunal concluded the applicant failed to prove on a balance of probabilities that she suffered a complete inability to carry on a normal life as a result of the accident.

The applicant was involved in a motor vehicle accident and sought a determination of catastrophic impairment based on a mental and behavioural disorder.

The respondent denied the claim, arguing the applicant's impairments were pre-existing and did not meet the threshold.

The Tribunal found that the accident was a necessary cause of the applicant's psychological impairment, applying the 'but for' test.

Preferring the evidence of the applicant's psychological expert over the respondent's assessors, the Tribunal concluded the applicant sustained a marked impairment in all four spheres of functioning.

The application for a catastrophic impairment determination was granted, but the claim for an award for unreasonable delay was dismissed.

The applicant, a minor who sustained a catastrophic brain injury in a motor vehicle accident, sought statutory accident benefits to fund private school tuition for her twin brother.

The applicant argued that her brother's presence at the school was a necessary rehabilitative tool that significantly improved her communication and social engagement after traditional treatments failed.

The adjudicator found the treatment plans to be reasonable and necessary, rejecting the respondent's insurer examination report which speculated about potential harm to the brother.

However, the adjudicator dismissed the claim for payment because the applicant incurred the expenses before submitting the treatment plans, violating section 38(2) of the Schedule.

Claims for interest and a special award were also dismissed.

The applicant was injured in a motor vehicle accident and sought a non-earner benefit from the respondent insurer.

The respondent denied the benefit, arguing the applicant did not suffer a complete inability to carry on a normal life.

The Tribunal compared the applicant's pre- and post-accident activities, noting his inability to perform meaningful hobbies, home maintenance, and family activities due to a right wrist fracture and ongoing pain.

Preferring the evidence of the treating orthopaedic surgeon over the insurer's assessor, the Tribunal found the applicant met the test for a non-earner benefit and ordered the respondent to pay the benefit with interest.

The applicant sought a non-earner benefit (NEB) following a motor vehicle accident in which she sustained a concussion and a fractured sacrum.

The Tribunal applied the Heath test to compare her pre- and post-accident activities.

Finding the applicant credible and her limitations corroborated by her family doctor, the Tribunal concluded she suffered a complete inability to carry on a normal life for the first ten months post-accident.

The insurer's medical examinations, conducted at the 23-month mark, were deemed unhelpful for assessing the earlier period.

The applicant was awarded the NEB from March 14, 2018, to December 31, 2018, along with interest on overdue payments, but denied benefits for the remainder of the claimed period due to a lack of medical evidence supporting ongoing impairment.

The applicant sought statutory accident benefits following a motor vehicle accident, including treatment plans for physiotherapy, a chronic pain assessment, assistive devices, and psychological services.

The Tribunal dismissed the claims for physiotherapy, chronic pain assessment, and psychological services, finding the applicant's evidence inconsistent and relying on surveillance showing her performing activities she claimed she could not do.

The Tribunal granted the treatment plan for assistive devices, as both parties' occupational therapists recommended them.

Claims for a special award and costs were dismissed.

The applicant sought various statutory accident benefits and a catastrophic impairment (CAT) designation following a 2016 motor vehicle accident.

The Licence Appeal Tribunal found that while the accident contributed to the applicant's psychological impairment, the applicant's self-reports were not credible due to significant inconsistencies regarding his pre-accident health and functional status.

The Tribunal concluded the applicant did not suffer a marked impairment in three spheres of functioning and therefore did not meet the CAT threshold.

All claims for income replacement benefits, attendant care, and medical benefits were dismissed as the applicant failed to prove they were reasonable, necessary, or incurred.

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

The respondent denied a treatment plan for a neurological assessment on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.

The applicant argued that chronic back pain, disc bulges, and carpal tunnel syndrome warranted removal from the MIG.

The Tribunal found the applicant's evidence regarding the onset of back pain to be inconsistent and failed to establish a causal link to the accident.

The Tribunal concluded the injuries were predominantly minor, and because the MIG limit was exhausted, the disputed treatment plan and interest were denied.

The applicant sought an award after the Tribunal previously determined that the respondent unreasonably withheld and delayed payment of a $2,200 psychological assessment treatment plan.

The Tribunal considered factors including the length of delay, blameworthiness, vulnerability of the minor applicant, and the need for deterrence.

Finding that the respondent failed to comply with procedural obligations without rationale for nearly two years, but noting the applicant suffered no prejudice and the benefit was eventually approved, the Tribunal awarded a lump sum of $550 (25% of the benefit amount) plus interest.

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

The respondent denied certain treatment plans and a non-earner benefit, arguing the applicant's impairments fell within the Minor Injury Guideline (MIG).

The adjudicator found that the applicant failed to prove she suffered from chronic pain or a psychological impairment that would remove her from the MIG, preferring the respondent's expert evidence due to the applicant's inconsistent self-reports.

As the $3,500 MIG limit was exhausted, the disputed treatment plans were not payable.

The adjudicator also dismissed the claim for a non-earner benefit, finding the applicant did not suffer a complete inability to carry on a normal life.

The applicant requested a reconsideration of a decision finding that the Licence Appeal Tribunal does not have jurisdiction to determine bad faith claims for punitive damages.

The applicant argued that the adjudicator erred in law by finding that the legislature removed punitive damages as an available remedy absent clear language, and by failing to appreciate that the Insurance Act and the Statutory Accident Benefits Schedule do not displace the common law remedy.

The adjudicator dismissed the request, finding that the applicant was merely relitigating arguments that failed at the hearing and had not demonstrated any significant error of law or fact that would result in a different decision.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically disputing the denial of a treatment plan for physical therapy and claiming a special award for unreasonable delay.

The adjudicator found the physical therapy treatment plan partially reasonable and necessary, excluding chiropractic treatment not supported by the treating physicians.

The adjudicator rejected the respondent's orthopaedic insurer examination, finding it inconsistent with the medical evidence.

While no special award was granted for the physical therapy denial, the adjudicator awarded a penalty against the insurer for its arbitrary denial and two-year delay in approving a psychological assessment.

The applicant sought ongoing Income Replacement Benefits (IRBs) and a psychological assessment following a motor vehicle accident.

The insurer terminated IRBs after 104 weeks, arguing the applicant no longer met the test for entitlement.

The Tribunal found that while the applicant suffered from accident-related physical and psychological impairments, he failed to prove a substantial or complete inability to work as a real estate agent.

The applicant's credibility was significantly undermined by a forensic accounting report revealing he misrepresented his pre- and post-accident income to all assessors, and that he actually earned more in the year following the accident.

Consequently, the claim for ongoing IRBs was dismissed.

However, the Tribunal granted the $2,000 psychological assessment, finding it reasonable and necessary to address the applicant's ongoing psychological impairment.

The applicant requested a reconsideration of a previous decision denying an award for the respondent's delayed payment of income replacement benefits.

The applicant argued the adjudicator erred in finding the delay was an administrative error and not imprudent conduct.

The adjudicator dismissed the request, finding no significant error of fact or law that would have led to a different result, and noted the applicant was attempting to relitigate arguments that failed at the original hearing.

The applicant was injured in a motor vehicle accident while working as a personal support worker.

The respondent insurer argued the applicant was precluded from claiming statutory accident benefits because she opted out of WSIB benefits solely to claim accident benefits.

The Tribunal found the applicant had a bona fide intent to pursue a tort action and was not precluded under s. 61(2) of the Schedule.

However, the Tribunal concluded the applicant's impairments fell within the Minor Injury Guideline (MIG), rejecting her claims of chronic pain, mild traumatic brain injury, and psychological impairment due to a lack of objective medical evidence.

As the $3,500 MIG limit was exhausted and the insurer's denial notices were compliant with s. 38(8), the applicant was not entitled to the disputed treatment plans or assessments.