Stephanie Kepman

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied her claims for various treatment plans and a psychological assessment under the Statutory Accident Benefits Schedule.

The applicant argued the Tribunal made significant errors of law and fact regarding the evidentiary burden for proving treatments were reasonable and necessary, and in finding the psychological assessment was duplicative.

The adjudicator dismissed the request, finding no errors of law or fact in the original decision, which correctly applied the binding precedent that the applicant bears the evidentiary onus.

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

The insurer denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and that he made a material misrepresentation regarding his address.

The Tribunal found that the applicant failed to provide sufficient medical evidence to prove his injuries warranted removal from the MIG.

Furthermore, the Tribunal concluded that the applicant made a material misrepresentation by failing to notify the insurer that he lived in Mississauga rather than Hamilton, which resulted in a lower insurance premium.

Consequently, the applicant was not entitled to an income replacement benefit, medical benefits beyond the MIG limit, interest, or an award.

The applicant requested a reconsideration of a preliminary decision which found him precluded from receiving accident benefits under s. 31(1)(a) of the Schedule because his motorcycle was uninsured.

The applicant argued the Tribunal erred in its findings regarding vehicle ownership, his reasonable belief of insurance coverage under s. 2.2.3 of the OAP-1, and the interpretation of condition 5 of s. 2.2.3.

The adjudicator dismissed the request, finding no significant errors of law or fact that would have led to a different outcome, and noting that the Tribunal is not required to act as an advocate for arguments not raised by the parties at the original hearing.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming funding for psychological services and a catastrophic impairment assessment.

The respondent denied the claims on the basis that they were not reasonable and necessary.

The Tribunal found that the respondent provided sufficient medical reasons for its denials and complied with the notice requirements under the Schedule.

The Tribunal concluded that the applicant failed to meet his evidentiary burden to prove the treatments and assessments were reasonable and necessary, particularly given the lack of response to prior psychological treatment and the absence of evidence supporting a neurological impairment.

The application was dismissed.

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

The respondent denied several treatment plans and withheld payment for approved services, arguing the service provider failed to provide requested information.

The Tribunal found it had jurisdiction to hear the dispute over withheld payments and ordered the respondent to pay the approved amounts, less $400 for unexplained supplementary goods.

The Tribunal dismissed the applicant's claims for further physiotherapy, a social work assessment, and disability certificates, finding them not reasonable and necessary.

Claims for an award and interest were also dismissed.

The applicant sought reconsideration of a Licence Appeal Tribunal decision denying her claims for an income replacement benefit, medical benefits, interest, and costs.

She argued the Tribunal acted outside its jurisdiction, violated procedural fairness, and made errors of law and fact.

The adjudicator excluded the applicant's references to privileged settlement communications and declined to conduct further investigation.

The adjudicator found that the Tribunal did not violate procedural fairness and that the applicant was improperly attempting to reargue her substantive case.

The request for reconsideration was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits (IRBs) and funding for various medical assessments and treatments.

The Licence Appeal Tribunal found that the applicant was not entitled to pre-104 or post-104 week IRBs, as she failed to prove a substantial inability to perform her pre-accident employment tasks or a complete inability to engage in any suitable employment, largely due to credibility issues and lack of effort during assessments.

The Tribunal also denied funding for chiropractic services and a functional abilities assessment.

However, the Tribunal granted funding for a physiatry assessment and a psychological examination to further explore the applicant's chronic pain and psychological symptoms, along with interest on these overdue amounts.

The applicant requested a reconsideration of a Tribunal decision that barred her from proceeding with her application due to alleged non-attendance at insurer's examinations.

The applicant argued that the Tribunal failed to consider her preliminary issue reply submissions due to an administrative error.

The Tribunal agreed that the failure to consider the submissions caused an unjust outcome and granted the reconsideration, ordering a new hearing on both the preliminary and substantive issues.

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

The respondent insurer denied certain benefits and requested the applicant attend insurer examinations under s. 44 of the Schedule.

The applicant failed to attend, arguing the notices of examination were invalid because they did not specifically mention her suspected concussion.

The Tribunal found the notices were valid and compliant with s. 44(5), as the insurer relied on the information available at the time.

The Tribunal declined to exercise its discretion under s. 55(2) to allow the application to proceed, noting the applicant provided no reasonable explanation for her non-attendance and the passage of four years prejudiced the insurer's ability to assess her injuries.

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

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

The respondent argued the applicant was barred from proceeding because she failed to submit a complete disability certificate (OCF-3) as required by section 36 of the Statutory Accident Benefits Schedule, and disputed receiving a second OCF-3 by fax.

The Tribunal found that the first OCF-3 was complete for the purposes of the Schedule, noting the respondent failed to notify the applicant of any deficiencies as required by section 32(6).

The Tribunal also found, based on a split onus and fax confirmation evidence, that the second OCF-3 was successfully faxed to the respondent.

The applicant was permitted to proceed with her claim.

The applicant sought a non-earner benefit, interest, and an award under Regulation 664 following a motor vehicle accident.

The Licence Appeal Tribunal applied the Heath test to determine if the applicant suffered a complete inability to carry on a normal life.

The Tribunal found that the applicant failed to provide a sufficient comparison of her pre- and post-accident activities to meet the rigid test.

As the applicant did not establish entitlement to the non-earner benefit, the claims for interest and a Regulation 664 award were also dismissed.

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

The core dispute was whether the applicant's injuries fell outside the Minor Injury Guideline (MIG) due to a concussion, pre-existing conditions, psychological injuries, or chronic pain.

The Tribunal found the applicant's evidence insufficient to establish any of these exceptions, noting that diagnoses were either outside the practitioners' scope, based solely on self-reporting, or lacked objective psychometric testing.

The Tribunal also dismissed the claim for a non-earner benefit, finding the applicant failed to provide a detailed comparison of pre- and post-accident activities as required by the Heath test.

The application was dismissed in its entirety.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming entitlement to three physiotherapy treatment plans and a psychological assessment.

The Licence Appeal Tribunal found that while the applicant suffered from chronic pain syndrome, she failed to provide specific medical evidence demonstrating that the disputed physiotherapy plans were reasonable and necessary.

The Tribunal also denied the psychological assessment, finding it duplicative of a prior assessment conducted by the respondent's assessor.

Claims for interest, a special award, and costs were consequently dismissed.

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

The respondent denied benefits on the basis that the applicant was operating an uninsured vehicle at the time of the accident.

The Tribunal found that the applicant, a mechanic, failed to prove he purchased the motorcycle within 14 days of the accident to qualify for newly acquired vehicle coverage under his existing policy.

The Tribunal concluded the applicant knew or ought to have known the motorcycle was uninsured, precluding him from receiving benefits under section 31(1)(a)(i) of the Schedule.

The applicant sought statutory accident benefits following a 2007 motor vehicle accident.

The Tribunal dismissed the application in its entirety.

The claim for an income replacement benefit was barred because the applicant failed to provide the respondent with requested financial information regarding her self-employment income for over a decade, without a reasonable explanation.

The claims for various medical and rehabilitation benefits, including physiotherapy and vocational training, were dismissed because the applicant failed to submit the required treatment plans (OCF-18s) to the respondent via the Health Claims for Auto Insurance (HCAI) system, as required by the Statutory Accident Benefits Schedule and the FSCO Guidelines.

Both parties' requests for costs were denied.

The applicant was involved in two separate motor vehicle accidents and sought statutory accident benefits, which the respondent insurer denied on the basis that the injuries fell within the Minor Injury Guideline (MIG).

The applicant argued that his physical and psychological injuries, as well as pre-existing conditions, warranted removal from the MIG.

The Tribunal found that the applicant failed to provide persuasive medical evidence, such as diagnoses from qualified practitioners, to prove his injuries extended beyond the MIG definition.

The Tribunal preferred the evidence of the respondent's physiatrists, who concluded the injuries were soft tissue in nature and treatable within the MIG.

As the applicant had exhausted the MIG limits for both accidents, the claims for outstanding treatment plans and interest were dismissed.

The insurer applied to the Licence Appeal Tribunal for repayment of medical benefits, insurer examination expenses, and adjusting expenses paid to the respondent, alleging the respondent staged the accident and wilfully misrepresented his claim.

The respondent did not participate in the hearing.

The Tribunal found that the respondent wilfully misrepresented the accident based on an engineering report and admissions.

The Tribunal ordered the respondent to repay $3,291.23 in medical benefits with interest.

However, the Tribunal dismissed the insurer's claims for repayment of insurer examination expenses and adjusting expenses, finding no basis in the Statutory Accident Benefits Schedule to recover such costs.

The Tribunal also denied the insurer's requests for a special award and costs.

The applicant sought an income replacement benefit (IRB) of $79.00 per week beyond the 104-week mark following a motor vehicle accident.

The respondent insurer denied the benefit, arguing the applicant did not suffer a complete inability to engage in suitable employment.

The Tribunal reviewed medical and vocational evidence, finding the respondent's insurer examinations persuasive, particularly as they directly addressed the post-104 week test.

The applicant's medical evidence, while supporting her complaints of pain and psychological issues, failed to address whether she suffered a complete inability to work.

The Tribunal dismissed the application for IRBs, interest, and costs, noting the applicant failed to meet her evidentiary burden.

The applicant sought an income replacement benefit (IRB) following a motor vehicle accident.

The respondent conceded entitlement but disputed the quantum, arguing the applicant failed to provide sufficient financial disclosure regarding his self-employment income.

The Tribunal found that the applicant failed to comply with section 33 of the Schedule by not providing requested bank statements and schedules to clarify inconsistencies in his reported income.

Consequently, the Tribunal accepted the respondent's calculation, setting the IRB quantum at $0.00 for the period of August 1 to December 31, 2019, and barred the applicant from proceeding with his claim for the period of January 1 to 18, 2020, until he complied with the disclosure requests.

Claims for interest and costs were dismissed.

The applicant sought an income replacement benefit following a motor vehicle accident.

The respondent argued the applicant was barred from proceeding under section 55(1) of the Statutory Accident Benefits Schedule because he failed to submit a completed disability certificate (OCF-3) for the subject accident.

The Tribunal found that the applicant's initial OCF-3 was unclear as it contained information relating to a previous accident, and the applicant subsequently withdrew it without submitting a new one for the subject accident.

As the applicant failed to submit a completed OCF-3, he was barred from proceeding with his application for an income replacement benefit.