Samia Makhamra

The applicant sought statutory accident benefits following a motor vehicle accident, including an income replacement benefit and several treatment plans for physical and psychological rehabilitation and assessments.

The Licence Appeal Tribunal dismissed the application, finding that the applicant did not suffer a substantial inability to perform the essential tasks of his pre-accident employment.

The Tribunal preferred the evidence of the respondent's insurer's examination assessors, who concluded the applicant sustained minor soft tissue injuries and a temporary adjustment disorder, over the applicant's evidence.

All disputed treatment plans were deemed not reasonable and necessary.

The applicant sought a non-earner benefit (NEB) following a motor vehicle accident, which the respondent insurer denied.

The applicant argued the denial notice was deficient and that she met the disability test based on psychological assessments.

The Tribunal found the denial notice compliant as it clearly referenced the independent medical assessors' conclusions.

Relying on the insurer's psychological assessment, the Tribunal concluded the applicant did not suffer a complete inability to carry on a normal life, as she continued to perform personal care, household chores, and caregiving duties.

The application for the NEB, an award, and interest was dismissed.

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

The respondent denied the benefits, and the applicant applied to the Licence Appeal Tribunal.

The respondent raised a preliminary issue that the application was statute-barred because the applicant failed to dispute the denials within the two-year limitation period under s. 56 of the Schedule.

The applicant requested an extension of time under s. 7 of the Licence Appeal Tribunal Act.

Applying the Manuel test, the adjudicator found that the applicant did not demonstrate a bona fide intention to appeal within the time limit, provided no explanation for the significant delay, and failed to show that the respondent would not be prejudiced.

The adjudicator declined to exercise discretion to extend the limitation period, barring the applicant from proceeding to a hearing.

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

The respondent denied various treatment plans 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 for removal from the MIG due to psychological impairment and chronic pain.

The Tribunal preferred the evidence of the insurer's assessors, finding no psychiatric diagnosis or chronic pain attributable to the accident.

The Tribunal concluded the injuries were predominantly minor, the MIG limit applied, and dismissed the claims for further treatment, interest, and an award for unreasonable delay.

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

The respondent denied benefits because the applicant failed to submit the OCF-1 application within 30 days of receiving the forms.

The applicant argued she delayed submitting the form because she initially did not believe her injuries required medical treatment.

The Tribunal found this explanation unreasonable, noting medical records showed she sought treatment the day after the accident and continued to experience worsening symptoms.

As the applicant failed to provide a reasonable explanation for the delay, her application was statute-barred under s. 55(1) of the Schedule and dismissed.

The applicant sought a non-earner benefit, an award, and interest following a motor vehicle accident.

The adjudicator drew an adverse inference against the applicant for failing to produce ordered medical and employment records without explanation.

Relying on the respondent's medical assessments, the adjudicator found that the applicant did not suffer a complete inability to carry on a normal life, as he remained independent with self-care, household tasks, and his studies.

The application was dismissed, and claims for an award and interest were denied as no benefits were owed.

The applicant sought accident benefits following a 2019 motor vehicle accident.

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

The respondent also raised a preliminary issue seeking to bar the application due to the applicant's failure to attend an insurer's examination (IE).

The Tribunal dismissed the preliminary issue, finding the respondent's notices of examination deficient for failing to provide sufficient medical reasons.

On the substantive issues, the Tribunal found the applicant's injuries were predominantly minor and subject to the MIG limit, relying on the uncontested IE report of an orthopaedic surgeon.

Consequently, the disputed treatment and assessment plans were deemed not reasonable and necessary, and no interest was payable.

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

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

The Tribunal found that the applicant suffered from chronic pain with functional impairment, removing him from the MIG.

The Tribunal approved treatment plans for physiotherapy, a psychological assessment, and a chronic pain assessment, but denied a treatment plan for psychological services.

The claim for a non-earner benefit was barred because the applicant failed to submit an Election of Benefits form (OCF-10).

A claim for an award under s. 10 of O. Reg. 664 was dismissed.

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

The respondent denied several treatment plans for chiropractic 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 her injuries, including alleged chronic pain and psychological impairments, warranted removal from the MIG.

The Tribunal accepted the respondent's medical assessment, which was corroborated by the applicant's family physician's records, over the applicant's chiropractor's recommendations.

As the MIG limits were exhausted, the disputed treatment plans were denied.

Claims for an award and interest were also dismissed.

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

The respondent denied treatment plans for a psychological assessment, chronic pain assessment, and physiotherapy, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found the applicant's injuries were predominantly minor, relying on the respondent's s. 44 assessors and noting a lack of compelling medical evidence of chronic pain or psychological impairment.

Although the respondent breached the 10-day response requirement under s. 38(8) for the physiotherapy treatment plan, no amounts were payable as the treatment was not incurred during the delay.

The application was dismissed, and claims for an award and interest were denied.

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

The respondent denied income replacement benefits and several treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline.

The Tribunal found the applicant was not entitled to income replacement benefits or the disputed treatment plans, as he failed to provide sufficient evidence or submissions to challenge the respondent's section 44 assessments.

Although the respondent failed to respond to one treatment plan within the required 10 business days, no amounts were owing as the treatment had not been incurred.

The claims for an award and interest were dismissed.

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 Tribunal found that the applicant's injuries were predominantly minor, noting the family physician's records of soft tissue injuries and lack of pre-existing or psychological impairments.

The Tribunal also found that the respondent's denial letters complied with the notice requirements under s. 38 of the Schedule.

Furthermore, a psychological treatment plan submitted more than five years after the accident was statute-barred under s. 20(1)(a).

The application was dismissed.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits, which were denied by the respondent insurer.

The applicant applied to the Licence Appeal Tribunal to dispute the denial of a non-earner benefit, various treatment plans, and the determination that his injuries fell within the Minor Injury Guideline (MIG).

The adjudicator found that the applicant's injuries were predominantly minor, as there was no compelling evidence of a pre-existing condition or that the injuries fell outside the MIG.

The adjudicator also dismissed the claim for a non-earner benefit, noting the applicant returned to work as an Uber driver shortly after the accident and failed to demonstrate a complete inability to carry on a normal life.

Consequently, the disputed treatment plans were denied as they exceeded the exhausted MIG limits, and no interest was awarded.

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

The respondent denied the benefits.

The Licence Appeal Tribunal found that the applicant did not suffer a substantial inability to perform the essential tasks of his employment, relying on section 44 assessments.

The Tribunal also found that the applicant did not require attendant care services or the disputed medical benefits and assessments, as they were not supported by the medical evidence.

The application was dismissed in its entirety.

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 the $3,500 limit had been exhausted.

The Tribunal found that the applicant failed to provide compelling medical evidence of chronic pain or psychological impairment to warrant removal from the MIG.

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

Claims for further treatment plans, an award for unreasonable delay, and interest were consequently dismissed.

The respondent insurer brought a motion on preliminary issues seeking to permanently bar the applicant from proceeding with claims for two treatment plans because the applicant failed to attend scheduled independent examinations (IEs).

The respondent also argued the Tribunal lacked jurisdiction to determine the applicability of the Minor Injury Guideline (MIG) as a standalone issue.

The Tribunal found that while the applicant missed the IEs, a complete bar was disproportionate given the applicant's explanation of a family emergency abroad and her agreement to attend the rescheduled IEs.

The Tribunal dismissed the request to bar the claims and instead stayed the application for 60 days pending the applicant's attendance at the IEs.

The request regarding the MIG issue was also dismissed, to be determined by the hearing adjudicator if necessary.

The respondent insurer brought a motion to bar the applicant from proceeding with a claim for a non-earner benefit because the applicant failed to submit an OCF-10 form electing benefits.

The Licence Appeal Tribunal found that the applicant's OCF-3 indicated potential entitlement to both an income replacement benefit and a non-earner benefit, triggering the mandatory election requirement under section 35(1) of the Schedule.

Because the applicant failed to submit the requested OCF-10, the application was incomplete and the insurer was relieved from paying the benefit under section 33(6).

The applicant was barred from proceeding with the non-earner benefit claim, but the respondent's request for costs was dismissed.

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

The respondent denied the benefits, placing the applicant in the Minor Injury Guideline, and requested an insurer's examination under section 44 of the Statutory Accident Benefits Schedule.

The applicant refused to attend, arguing the notice lacked proper medical reasons.

The respondent brought a motion to bar the applicant from proceeding.

The Tribunal found the respondent's notices met the statutory requirements and stayed the hearing until the applicant attends the requested examination.

The applicant sought statutory accident benefits for psychological injuries sustained after he parked his vehicle in someone else's spot, resulting in his vehicle being vandalized and him being verbally assaulted.

The respondent denied benefits on the basis that the incident was not an 'accident' under the Schedule.

The Tribunal found that while parking is an ordinary use of a vehicle, the causation test was not met.

The vandalism and verbal assault were intervening acts that occurred after the use of the vehicle had ended.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs) from the respondent insurer.

The insurer denied the IRBs and brought a preliminary motion arguing that the applicant's subsequent application to the Tribunal was statute-barred for missing the two-year limitation period under section 56 of the Statutory Accident Benefits Schedule.

The Tribunal found that the limitation period expired on a Saturday, meaning it was deemed to expire on the next business day.

Because the applicant filed her application on that next business day, the application was within the limitation period and she was permitted to proceed with her claim.