Samia Makhamra

The applicant was injured in a motor vehicle accident and received income replacement benefits (IRBs) until they were terminated by the respondent.

The applicant initially disputed the termination but withdrew the application pursuant to a standstill agreement to allow a catastrophic impairment claim to proceed.

The applicant missed the deadline under the standstill agreement to refile the IRB dispute.

The respondent brought a preliminary issue motion arguing the claim was statute-barred under s. 56 of the Statutory Accident Benefits Schedule.

The Tribunal applied s. 7 of the Licence Appeal Tribunal Act, 1999, finding it had jurisdiction to extend the limitation period, and granted the extension based on the applicant's bona fide intention to appeal, the short delay, lack of prejudice to the respondent, and the merits of the case.

The appellant appealed a Notice of Proposal to refuse a cannabis retail operator licence.

The parties reached a settlement and applied for a consent order under s. 4.1 of the Statutory Powers Procedure Act to dispose of the matter without a hearing.

The Tribunal granted the consent order, directing that the appellant be bound by the terms of the settlement agreement, which imposed a condition on the licence requiring notification of any charges or convictions.

The appellant appealed a Notice of Proposal by the Registrar to refuse his application for registration as a motor vehicle salesperson under the Motor Vehicle Dealers Act, 2002.

The parties reached a settlement and requested a consent order disposing of the proceeding without a hearing.

The Licence Appeal Tribunal ordered that the appellant be bound by the terms of the consent agreement, which imposed conditions on his registration, including restrictions on his role and reporting requirements.

The appellant appealed a Notice of Proposal by the Registrar to refuse his registration as a salesperson under the Real Estate and Business Brokers Act, 2002.

The parties reached a settlement and requested a consent order.

The Tribunal ordered that the Registrar withdraw the Notice of Proposal, the appellant withdraw his application, and the appellant may reapply after April 2, 2022, upon completing specified ethics courses.

The applicant sought reconsideration of a preliminary issue decision that barred him from proceeding with his application for statutory accident benefits due to his failure to attend a section 44 insurer's examination.

The applicant argued the adjudicator erred by permanently precluding him from disputing whether his injuries fell within the Minor Injury Guideline (MIG) and that the Tribunal erred in refusing to clarify the decision.

The adjudicator dismissed the reconsideration request, finding that the original decision properly applied section 55(2) of the Schedule and that the issue of future applications or MIG status was not before the original adjudicator.

The request to reconsider the refusal to clarify was also dismissed as there was no ambiguity in the original decision.

Both parties' requests for costs were denied.

The respondent insurer requested a reconsideration of a decision finding the applicant entitled to income replacement benefits during a period of suspension.

The insurer argued the Tribunal erred in law by misinterpreting 'reasonable explanation' under s. 33(8)(b) of the Schedule, as the applicant's explanation was only offered at the hearing.

The Adjudicator dismissed the request, finding no error of law, as the Schedule does not impose a time limitation for providing a reasonable explanation and the Tribunal had properly weighed the evidence in finding the explanation credible.

The applicant sought statutory accident benefits after slipping and falling on snow while attempting to enter his vehicle.

The respondent denied benefits, arguing the incident was a slip and fall, not an automobile accident.

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

It found the purpose test was met because the applicant was in the process of entering his vehicle, having unlocked it with a FOB and reached for the door handle.

The causation test was also met, as the slip and fall was part of a continuous chain of events with no intervening act, making the use of the vehicle a direct cause of the injuries.

The Tribunal concluded the incident was an 'accident' under the Schedule.

The applicant was injured in a motor vehicle accident and received income replacement benefits (IRBs) until the respondent suspended them for failure to provide requested information and participate in psychological treatment.

The applicant sought retroactive payment of the suspended IRBs.

The Tribunal found that the applicant provided a reasonable explanation for failing to provide the requested documents and that she had participated in treatment reasonably provided by her family physician's practice.

The Tribunal ordered the respondent to pay the retroactive IRBs with interest.

The applicant was injured in a motorcycle accident and sought statutory accident benefits for an occupational therapy functional assessment.

The respondent denied the treatment plan on the basis that it was not reasonable and necessary.

The Licence Appeal Tribunal found that the applicant failed to provide sufficient medical evidence demonstrating a need for the assessment, noting a lack of treatment records since 2016.

The application was dismissed, and the applicant's request for costs was denied.

Aviva sought reconsideration of a Licence Appeal Tribunal decision that found M.R. was entitled to payment for a chronic pain assessment and a neurological assessment under the Statutory Accident Benefits Schedule.

The adjudicator dismissed the request regarding the chronic pain assessment, finding no significant error of law or fact in the original decision's reliance on the medical records and the assessor's recommendations.

However, the adjudicator granted the request regarding the neurological assessment, acknowledging an error in focusing on headaches rather than the cervicalgia noted in the treatment plan.

The original decision was varied to deny entitlement to the neurological assessment.

The applicant, the Motor Vehicle Accident Claims Fund, sought repayment of statutory accident benefits paid to the respondent, alleging wilful misrepresentation.

The respondent did not attend the hearing.

The adjudicator found that the respondent had misrepresented his employment status and that he was not actually struck by a vehicle, as determined in prior arbitration and criminal proceedings.

The Tribunal ordered the respondent to repay $28,600.00 for income replacement benefits and $4,954.05 for prescription medication, plus interest.

The applicant sought statutory accident benefits following a 2010 motor vehicle accident.

The respondent insurer raised preliminary issues regarding the applicant's failure to submit treatment plans prior to incurring expenses and failure to attend a required insurer's examination.

The Tribunal held that the applicant was barred from proceeding with most of the disputed expenses because they were incurred without a treatment plan, except for a foot orthotics expense under $250 which fell within a statutory exception.

The Tribunal also held that the applicant was barred from proceeding with claims for treatment plans because he failed to attend a properly scheduled section 44 insurer's examination.

The applicant requested a reconsideration of a Tribunal decision denying her claims for non-earner benefits, chiropractic services, Botox injections, and psychological services following a 2015 motor vehicle accident.

The applicant argued the Tribunal failed to apply the correct legal tests, ignored medical evidence, and violated procedural fairness when an adjudicator lost hearing notes.

The adjudicator dismissed the reconsideration request, finding that the original Tribunal correctly applied the test for non-earner benefits, reasonably preferred the insurer's expert evidence regarding the disputed treatment plans, and that the loss of notes did not result in procedural unfairness.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for a chronic pain assessment and a neurological assessment, which the respondent insurer denied.

The Licence Appeal Tribunal found that both assessments were reasonable and necessary given the applicant's ongoing complaints of pain and headaches, preferring the recommendations of the applicant's assessors over the insurer's medical examiner.

The Tribunal ordered the respondent to pay for the assessments and interest on overdue benefits, but declined to order an award under O. Reg. 664, finding the insurer had properly considered the claims.

The applicant sought medical benefits for chronic pain treatment following a motor vehicle accident, which the respondent insurer denied based on its own medical examinations.

The Tribunal preferred the evidence of the applicant's chronic pain specialist over the insurer's examiners, finding that the applicant suffered from ongoing physical and psychological pain.

The Tribunal ordered the respondent to pay the disputed medical benefit and interest, but declined to order a special award, finding the insurer's denial was not unreasonable.

The applicant sought various medical and rehabilitation benefits following a motor vehicle accident, which the respondent insurer denied.

The Licence Appeal Tribunal found that the treatment plans for lidocaine injections, an EEG assessment, physiotherapy, a dietician assessment, assistive devices, and psychological services were reasonable and necessary to treat the applicant's chronic pain and psychological impairments.

The Tribunal denied the functional abilities evaluation due to the applicant's pain-focused behaviour rendering it inaccurate, and dismissed the claim for a Regulation 664 award.

The respondent insurer brought a preliminary issue motion to stay the applicant's claim for post-104 week attendant care benefits pending the outcome of a FSCO appeal regarding pre-104 week benefits, and to exclude the FSCO arbitration transcripts.

The Tribunal dismissed the motion, finding that the issues before the Tribunal and FSCO were distinct, related to different time periods, and were based on different assessment forms.

The Tribunal also allowed the FSCO transcripts into evidence as prima facie relevant.

The applicant's request for costs was dismissed as there was no evidence of bad faith by the respondent.

The applicant requested an adjournment of a three-day in-person hearing because the respondent insurer's psychology expert witness was unavailable.

The respondent did not consent to the adjournment.

The Tribunal granted the adjournment, noting that the applicant has the right to cross-examine the expert witness.

The applicant requested an adjournment of a scheduled three-day in-person hearing because two witnesses, including an expert, were unavailable and to allow time to request an addendum report.

The respondent opposed the request, arguing the delay was avoidable.

The Tribunal granted the adjournment, noting that denying it would cause the greatest prejudice to the applicant and preferring to adjudicate claims on a complete evidentiary basis.

The respondent's claim for costs thrown away was referred to the hearing adjudicator.

The respondent insurer brought a motion for an order requiring a third-party employer to produce the applicant's complete employment file, including travel expenses.

The applicant consented to the motion.

The Tribunal considered its authority under section 12(1)(b) of the Statutory Powers Procedure Act to compel third-party production prior to a hearing.

Relying on appellate guidance that requiring production only at the hearing would cause delays, the Tribunal granted the motion and ordered the production of the employment file.