Tami Cogan

The self-represented applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's determination that his injuries fell within the Minor Injury Guideline (MIG).

The applicant argued that he sustained psychological impairments and chronic pain that warranted removal from the MIG.

The Tribunal preferred the evidence of the respondent's clinical psychologist, who found no psychological condition removing the applicant from the MIG, over the applicant's evidence, which included a virtual assessment and procedurally excluded late-filed reports.

The Tribunal concluded the applicant's injuries were predominantly minor, dismissed the claims for treatment plans outside the MIG limit, and denied claims for interest and a special award.

The respondent was injured in an automobile accident in Quebec and elected to receive benefits under the Quebec legislative framework pursuant to s. 59(2) of the Statutory Accident Benefits Schedule.

A dispute arose over whether the procedural rules for adjusting the claim, specifically the requirement to attend an Examination Under Oath, were governed by the Schedule or the Quebec Automobile Insurance Act.

The Tribunal held that while the substantive law of Quebec applies to the benefits, the procedural law of the Schedule governs the adjustment of the claim.

The Tribunal also granted the respondent's motion to anonymize the decision to protect her medical privacy.

The applicant sought a determination of catastrophic impairment and entitlement to attendant care benefits and hearing aids following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant was statute-barred from claiming attendant care benefits because she failed to dispute the insurer's denial within the two-year limitation period, and the justice of the case did not warrant an extension.

On the issue of catastrophic impairment, the Tribunal applied the AMA Guides to assess the applicant's physical and psychological impairments, ultimately finding a combined Whole Person Impairment (WPI) of 56%, which exceeds the 55% threshold under Criterion 7.

The Tribunal denied the claim for hearing aids because the applicant incurred the expense without first submitting a treatment plan, contrary to section 38(2) of the Schedule.

The claim for a special award was also dismissed as the insurer did not unreasonably withhold or delay benefits.

The applicant, who sustained a catastrophic impairment (traumatic brain injury) in a 2012 motor vehicle accident, sought $97,398.08 for home modifications.

The Licence Appeal Tribunal found the applicant was partially entitled to the modifications, specifically bilateral handrails on stairs and releveling of front steps, to address his ongoing intermittent dizziness and fall risk.

Requests for a curb-less shower, deck, and private therapy room were denied as not reasonable or necessary.

The Tribunal awarded interest on overdue benefits but dismissed the applicant's claims for a special award under s. 10 of Reg. 664 and costs under Rule 19.

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

The respondent denied benefits because the applicant failed to submit the OCF-1 application within the 30-day time limit prescribed by the Schedule.

The applicant argued that his health condition prevented him from submitting the form on time.

The Tribunal found that the applicant did not provide a reasonable explanation for the delay, noting a lack of corroborating medical evidence and the applicant's prior experience with the claims process.

The application was dismissed as statute-barred.

The applicant sought a determination of catastrophic impairment (CAT) under Criterion 8 (mental and behavioural disorders) and entitlement to post-104-week income replacement benefits (IRBs) following a motor vehicle accident.

The Tribunal found that the applicant's psychological and physical impairments were primarily caused by a pre-existing slip and fall incident, not the motor vehicle accident.

The Tribunal noted significant credibility issues, including surveillance footage and evidence of the applicant's ongoing involvement in complex real estate and construction projects, which contradicted his reported functional limitations.

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 insurer denied a treatment plan and required the applicant to attend orthopaedic and psychological insurer's examinations under s. 44 of the Schedule.

The applicant failed to attend both examinations.

The insurer argued the applicant was barred from proceeding under s. 55(1)2.

The Tribunal found the applicant did not provide a reasonable explanation for her non-attendance and that the notices of examination complied with s. 44(5).

The Tribunal held the applicant was statute-barred from proceeding and dismissed the application.

The applicant, who sustained a catastrophic impairment in a motor vehicle accident, sought attendant care benefits (ACBs) up to $6,000 per month.

The respondent insurer partially denied the invoices, applying a 'ratio method' and Guideline rates because the applicant failed to provide a detailed breakdown of the time spent on each level of care.

The Tribunal found that the respondent's use of the ratio method was reasonable and approved by the Divisional Court in Malitskiy.

The Tribunal also held that insurers are not required to pay above the Guideline rates.

The application for ACBs, interest, and a special award was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits (IRBs) and occupational therapy treatment plans for a concussion.

The respondent insurer denied the benefits, maintaining that the applicant's injuries fell within the Minor Injury Guideline (MIG) and relying on insurer's examinations.

The Tribunal found the applicant was entitled to IRBs for a limited period before they were validly suspended for non-compliance with a section 33 request.

The Tribunal also approved the occupational therapy plans in part, finding the respondent's reliance on assessors who ignored the concussion diagnosis to be unreasonable.

The Tribunal awarded a maximum 50% special award under section 10 of Regulation 664, condemning the respondent's excessive and inflexible conduct in keeping the applicant in the MIG despite clear medical evidence of a concussion.

The applicant sought statutory accident benefits following a motor vehicle accident, including non-earner benefits and physiotherapy treatment plans.

The Licence Appeal Tribunal found that the applicant failed to prove a complete inability to carry on a normal life under the Heath test, as there was insufficient evidence to compare her pre- and post-accident functional limitations.

Furthermore, the Tribunal determined that the applicant's partial labral tear constituted a minor injury under the Schedule, keeping her within the $3,500 Minor Injury Guideline limit.

Consequently, the claims for non-earner benefits and treatment plans exceeding the limit were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including attendant care benefits and payment for various treatment plans.

The Licence Appeal Tribunal found the applicant was entitled to attendant care benefits of $1,879.82 per month, rejecting both the applicant's claim for $6,000 and the insurer's approval of $715.88.

The Tribunal denied the treatment plan for physio/vestibular services because it was not submitted through the HCAI system.

The Tribunal also denied the disputed amounts for occupational therapy and social work services, finding the insurer's approved hourly rate for the social worker was appropriate and that mileage expenses for treatment providers to travel to the applicant's home were not authorized transportation expenses under the Schedule.

The applicant sought statutory accident benefits following a motor vehicle accident in August 2022, claiming entitlement to a non-earner benefit and two physiotherapy treatment plans.

The respondent denied the benefits, arguing the applicant's impairments stemmed from a prior 2019 accident and that he did not suffer a complete inability to carry on a normal life.

The Tribunal found the applicant's evidence highly inconsistent regarding his pre- and post-accident functioning and employment status.

Relying on the consistent evidence of the respondent's assessors and the applicant's own treating records, the Tribunal concluded the applicant failed to prove his entitlement to the non-earner benefit or the treatment plans.

The application was dismissed, and the respondent's request for costs due to late service of documents was also denied.

The applicant sought a determination of catastrophic impairment and various medical, rehabilitation, and attendant care benefits following a 2016 motor vehicle accident.

The Licence Appeal Tribunal found that the applicant did not meet the threshold for catastrophic impairment under either Criterion 7 (55% whole person impairment) or Criterion 8 (marked impairment due to mental or behavioural disorder).

The Tribunal preferred the evidence of the respondent's assessors, finding the applicant's impairments were primarily physical and did not significantly impede her useful functioning.

Claims for attendant care, occupational therapy, and physiotherapy were dismissed as not reasonable and necessary, while a small claim for prescription medication was allowed with interest.

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

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

The adjudicator found the applicant suffered from psychological conditions, including PTSD and Major Depressive Disorder, which removed her from the MIG.

The adjudicator approved a psychological services treatment plan and partially approved a physical therapy treatment plan, finding them reasonable and necessary.

Claims for a special award under s. 10 of Reg. 664 and costs were dismissed.

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

The respondent denied benefits, arguing the applicant was in the course of employment and therefore required to pursue WSIB benefits under s. 61(1) of the Schedule.

The applicant claimed he was an independent contractor and that he elected to pursue a tort action under s. 30 of the WSIA, triggering the exception in s. 61(2).

The Tribunal drew an adverse inference against the applicant for failing to produce employment and WSIB records.

The Tribunal found the applicant had access to WSIB benefits and failed to prove a bona fide intention to pursue a tort claim, as a tort action was barred under s. 28(1) of the WSIA because both vehicles were Schedule 1 employers.

The application was dismissed as statute-barred.

The applicant sought post-104-week income replacement benefits (IRB) following a 2018 motor vehicle accident.

The applicant was involved in a second accident in 2019.

The Tribunal found that the applicant's primary reason for his inability to work was a concussion and related symptoms, which were caused by the 2019 accident, not the 2018 accident.

The applicant failed to prove on a balance of probabilities that the injuries from the 2018 accident caused a complete inability to engage in any employment for which he is reasonably suited by education, training, or experience.

The application for IRB and interest was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including non-earner benefits and funding for psychological and neurological assessments.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove a complete inability to carry on a normal life under the Heath test.

The Tribunal also found the proposed assessments were not reasonable and necessary, noting a lack of corroborating medical evidence and the fact that a neurological assessment had already been completed through OHIP.

Claims for interest and a special award were consequently dismissed.

The applicant sought statutory accident benefits for cannabis oil and yoga expenses following a 2015 motor vehicle accident.

The Tribunal found the cannabis oil expense of $414.94 to be reasonable and necessary, noting the respondent had previously paid for it and the applicant provided ongoing prescription documentation.

The yoga expense of $327.70 was denied as the recommendation was five years old and lacked updated supporting evidence.

The Tribunal also ordered the respondent to pay interest on the overdue cannabis oil payment and granted a 25% special award under s. 10 of O. Reg. 664, finding the respondent's refusal to reassess the cannabis expense was stubborn and inflexible.

The applicant was injured in a motor vehicle accident and received income replacement benefits (IRBs) for the first 104 weeks.

She sought post-104-week IRBs, arguing she suffered a complete inability to engage in suitable employment due to cognitive and physical impairments.

The Tribunal found that the applicant had successfully worked as a restorative aide for approximately 10 months post-accident, working full-time and overtime hours.

Relying on this work history and the preferred expert medical and vocational evidence, the Tribunal concluded the applicant did not suffer a complete inability to engage in suitable employment.

The claims for IRBs, interest, and a special award were dismissed.

The applicant sought a determination of catastrophic impairment and entitlement to various treatment plans following a 2019 motor vehicle accident.

The Licence Appeal Tribunal found that the applicant sustained a catastrophic impairment under Criterion 8 (mental and behavioural disorders), noting marked impairments in social functioning, concentration, persistence and pace, and adaptation.

However, the Tribunal denied all claimed treatment plans because the applicant failed to direct the panel to medical evidence supporting their reasonableness and necessity.

The respondent's claim for repayment of previously funded services was also dismissed for lack of evidence.