Tanjoyt Deol

The applicant requested a reconsideration of a preliminary issue decision which found she was not involved in an 'accident' under the Statutory Accident Benefits Schedule.

The applicant argued the Tribunal breached procedural fairness by holding a written hearing and erred in law and fact by distinguishing her case from Dittmann regarding an improperly secured coffee lid.

The Tribunal dismissed the request, finding no breach of procedural fairness as the parties consented to a written hearing, and no error of law or fact as the improperly secured lid constituted an intervening act breaking the chain of causation.

The applicant sought accident benefits following a motor vehicle accident, arguing that chronic pain and psychological impairments warranted removal from the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant failed to establish chronic pain with functional limitations or a psychological impairment, noting a lack of supporting contemporaneous medical evidence and relying on the respondent's section 44 assessment.

As the applicant's injuries were deemed predominantly minor and the $3,500 MIG limit had been exhausted, the claim for a $2,500 orthopedic assessment and interest was dismissed.

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

The respondent insurer denied the benefits, arguing the applicant was an excluded driver under the policy pursuant to s. 31(1)(a)(iii) of the Statutory Accident Benefits Schedule.

The insurer relied on an Excluded Driver Endorsement (OPCF 28A).

The Tribunal found the signed endorsement contained multiple ambiguities, including a missing policy number, unidentified vehicles, and an inconclusive signature date.

The Tribunal concluded the insurer failed to meet its evidentiary onus to establish the applicant was an excluded driver.

The applicant was permitted to proceed with the substantive hearing for benefits.

The applicant sought statutory accident benefits after being pulled from his vehicle and assaulted by a group of assailants who then stole his car.

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

The Tribunal applied the two-part test for an accident and found that while the purpose test was met, the causation test was not.

The assault was an intervening act that broke the chain of causation, and the use or operation of the vehicle was not the direct cause of the applicant's injuries.

The application was dismissed.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision which found her injuries were subject to the Minor Injury Guideline (MIG) limits.

The applicant argued the adjudicator erred in law and fact by misinterpreting the Schedule, misconstruing her injuries, and failing to assign the reconsideration to a different member.

The Tribunal dismissed the request, finding that having the same adjudicator hear the reconsideration does not violate procedural fairness.

Furthermore, the Tribunal held that the applicant was attempting to re-litigate her case and failed to establish any error of law or fact regarding the MIG determination or her chronic pain claims.

The applicant was struck by a snowplough and sought statutory accident benefits.

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

The Tribunal found the applicant was removed from the MIG because she sustained a concussion, which falls outside the definition of a minor injury.

The Tribunal also held the applicant was entitled to a psychological assessment because the respondent's denial letter failed to provide adequate medical reasons, violating s. 38(8) of the Schedule.

However, the applicant's claim for an award for unreasonable delay was dismissed.

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

The insurer denied the benefits, citing non-compliance with a request for an Employer's Confirmation Form.

The applicant filed an application with the Licence Appeal Tribunal more than two years after the denial.

The Tribunal found the insurer's denial was clear, unequivocal, and compliant with the principles in Smith, thereby triggering the two-year limitation period.

The Tribunal declined to extend the limitation period under section 7 of the LAT Act, finding no bona fide intention to appeal within the time limit and a significant, unexplained delay.

The application was dismissed as statute-barred.

The applicant sought resolution of a dispute over the quantum of income replacement benefits (IRB) and the respondent's claim for repayment following her approval for CPP Disability benefits.

The Tribunal found that the applicant's pre-accident Employment Insurance benefits must be included in calculating her gross weekly employment income, resulting in a higher IRB quantum.

The Tribunal also held that the respondent was not entitled to repayment because its overpayment notices were invalid, having been sent before the applicant actually received the retroactive CPP-D payments.

The applicant was awarded interest on overdue payments, but her claim for a special award under s. 10 of O. Reg. 664 was dismissed as the respondent's conduct was not found to be unreasonable or in bad faith.

The applicant sought entitlement to statutory accident benefits for chiropractic, massage, psychotherapy, and catastrophic determination assessments following a 2017 motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to meet her evidentiary burden to prove the treatment and assessment plans were reasonable and necessary.

The Tribunal preferred the respondent's more current section 44 assessment reports over the applicant's outdated section 25 reports and noted the lack of consistent recommendations from treating physicians.

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

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

The applicant applied to the Licence Appeal Tribunal, arguing he should be removed from the MIG due to psychological impairments and chronic pain.

The Tribunal found the applicant's evidence of psychological impairment and chronic pain to be underwhelming and unsupported by contemporaneous medical records.

The Tribunal preferred the evidence of the respondent's section 44 assessors, who concluded the applicant suffered only minor soft tissue injuries with no functional limitations.

The Tribunal held the applicant remained within the MIG, dismissed the claims for the treatment plans and interest, and declined to award costs.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for psychological services and an accountant's report.

The insurer denied the benefits.

The Tribunal found the psychological services were reasonable and necessary to treat the applicant's adjustment disorder and specific phobia, noting the treating psychologist's recommendations and the applicant's progress.

However, the Tribunal denied the cost of the accountant's report because the applicant failed to prove he was applying for an income replacement benefit or that the report was reasonable and necessary.

The applicant was awarded the cost of the psychological services with interest.

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

The respondent denied several treatment plans for physiotherapy, massage, chiropractic services, and a worksite assessment.

The Tribunal found that the respondent's denial notices for the treatment plans were non-compliant with s. 38(8) of the Schedule because they lacked adequate medical reasons.

Applying the Divisional Court's decision in Suarez, the Tribunal held that the treatment plans were payable once incurred.

The Tribunal also found the worksite assessment to be reasonable and necessary based on the applicant's consistent reporting of back pain aggravated by prolonged sitting.

The applicant's claim for a bad faith award under s. 10 of O. Reg. 664 was dismissed, as the respondent's reliance on its assessors' reports was not unreasonable.

The applicant, a truck driver, sought statutory accident benefits after allegedly falling from his truck and suffering a stroke.

The respondent denied benefits, arguing the incident did not meet the definition of an 'accident' under s. 3(1) of the Schedule.

The Tribunal found that the applicant failed to establish on a balance of probabilities that he sustained impairments from the fall, or that the stroke would not have occurred 'but for' the use or operation of the vehicle.

The Tribunal also dismissed the applicant's procedural objections regarding hearsay evidence and late production, as well as his request for estoppel.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically a chronic pain assessment and a standing desk.

The insurer denied the benefits, arguing the applicant's physical injuries fell within the Minor Injury Guideline (MIG) and that the standing desk expense was incurred before a treatment plan was submitted.

The Tribunal found the applicant had been removed from the MIG for psychological impairments, granting access to non-MIG funding for all reasonable and necessary treatments.

Based on medical records documenting ongoing pain, the Tribunal approved the chronic pain assessment.

However, the claim for the standing desk was dismissed under s. 38(2) of the Schedule because the expense was incurred before a treatment plan was submitted and did not meet the statutory exceptions.

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

The Licence Appeal Tribunal found that the applicant failed to meet the burden of proving eligibility for an IRB under section 5(1) of the Statutory Accident Benefits Schedule.

The applicant did not provide corroborating documentation to establish that he was receiving employment insurance at the time of the accident or that he had worked for at least 26 weeks in the 52 weeks prior to the accident.

The application was dismissed, and no interest was payable.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming her injuries warranted removal from the Minor Injury Guideline (MIG) due to chronic pain and psychological impairments.

The Tribunal found the applicant failed to meet her burden of proof, noting the lack of contemporaneous medical records and the limited probative value of her assessor's report, which relied heavily on self-reporting.

The Tribunal concluded the applicant's injuries were predominantly minor and subject to the $3,500 MIG limit, dismissing her claims for a chronic pain assessment, chiropractic services, and interest.

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

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

The applicant argued she should be removed from the MIG due to chronic pain syndrome and a psychological impairment.

The Tribunal found the applicant failed to meet her burden of proof to establish either chronic pain with a functional impairment or a psychological impairment warranting removal from the MIG.

The Tribunal ordered that the applicant remains within the MIG but is entitled to the disputed treatment plans, if already incurred, up to the remaining MIG limit pursuant to s. 40(8) of the Schedule.

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

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

The applicant applied to the Licence Appeal Tribunal, arguing he should be removed from the MIG due to pre-existing conditions, chronic pain, and psychological impairments.

The Tribunal found that the applicant failed to provide compelling medical evidence that his pre-existing conditions or alleged chronic pain and psychological impairments prevented his recovery within the MIG limits.

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

The application was dismissed.

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).

The Tribunal found that the applicant failed to establish that she suffered from chronic pain, neurological/cognitive deficits, or psychological impairments caused by the accident that would warrant removal from the MIG.

As the $3,500 MIG limit had already been exhausted, the Tribunal dismissed the claims for additional psychological and physiotherapy treatment plans, as well as the claim for interest.

The applicant sought statutory accident benefits after witnessing her boyfriend being struck and killed by a motor vehicle.

The respondent denied benefits on the basis that the applicant was not an 'insured person' and was not 'involved in' the accident.

The Licence Appeal Tribunal held that the applicant was not 'involved in' the accident because she was not struck by the vehicle, was not an occupant, and was not physically injured.

As she was not a spouse of the deceased, she did not qualify for nervous shock benefits under the Schedule.

The application was dismissed.