Theresa McGee

The applicant sought attendant care benefits following a motor vehicle accident.

The Tribunal held that section 42(5) of the Statutory Accident Benefits Schedule barred the applicant from claiming attendant care expenses incurred before she submitted a Form 1, as she failed to establish exceptional circumstances that made compliance impossible or impracticable.

For the period after the Form 1 was submitted, the Tribunal found the applicant proved she incurred 33 hours of attendant care expenses provided by a friend acting as a professional service provider.

The Tribunal ordered the respondent to pay $462.00 for these incurred expenses, plus interest, but declined to deem any other expenses incurred.

The applicant sought statutory accident benefits following a rear-end motor vehicle collision.

The respondent denied funding for a physiotherapy treatment plan on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 funding limit had been exhausted.

The applicant argued he should be removed from the MIG due to chronic pain and psychological impairments, relying on expert reports from a physiatrist and a psychiatrist.

The Tribunal found the expert reports unpersuasive as they failed to distinguish pre-existing conditions, relied on an unproven concussion diagnosis, and contradicted the objective medical records of the treating family physician.

The Tribunal concluded the applicant sustained only minor soft tissue injuries and dismissed the application.

The appellants appealed a Notice of Proposal issued by the Registrar to apply conditions to their registrations as a motor vehicle dealer and 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 appellants be bound by the terms of the consent agreement, which included conditions regarding registration class, books and records, disclosure, transaction fees, consumer buy-backs, and completion of a certification course.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that found his accident-related injuries fell within the Minor Injury Guideline (MIG).

The applicant argued the Tribunal erred in its application of the pre-existing condition test, its assessment of his degenerative changes, its weighing of a chronic pain assessment, and by failing to mention certain clinical records.

The Vice-Chair dismissed the reconsideration request, finding no errors of law, fact, or procedural fairness.

The Tribunal correctly concluded that the applicant failed to provide compelling medical evidence that his pre-existing conditions would prevent maximal recovery within the MIG limit, and properly weighed the medical evidence before it.

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

The respondent denied medical benefits beyond the $3,500 limit, determining the injuries fell within the Minor Injury Guideline.

The applicant argued she suffered from chronic pain and psychological impairments exceeding the minor injury definition.

The Tribunal found the applicant failed to meet her evidentiary onus, as the medical evidence did not establish chronic pain or psychological impairments.

The application for treatment plans and an award for unreasonably withheld benefits was dismissed.

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

The respondent insurer raised a preliminary issue, arguing the applicant was barred from proceeding under s. 55 of the Schedule for failing to attend insurer's examinations.

The Tribunal found the applicant made himself reasonably available and was not barred.

On the substantive issues, the Tribunal found the accident directly caused the applicant's physical and psychological impairments.

The Tribunal granted entitlement to the disputed physiotherapy, chiropractic treatment, and an occupational therapy in-home assessment, finding them reasonable and necessary.

The claim for psychological treatment was dismissed due to lack of evidence that the applicant utilized previously approved treatment.

The Tribunal declined to order an award under Regulation 664, finding the insurer's conduct did not rise to the requisite level of unreasonableness.

The applicant sought statutory accident benefits following a rear-end motor vehicle accident.

The respondent insurer denied treatment plans for physiotherapy, a chronic pain assessment, and a psychological assessment on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 funding limit had been exhausted.

The Licence Appeal Tribunal found that the applicant failed to prove her injuries warranted treatment outside the MIG, noting that the medical evidence from her family doctor did not support the diagnoses of concussion, psychological impairment, or chronic pain syndrome advanced by her assessing experts.

The application was dismissed, along with claims for a special award and costs.

The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit and medical benefits for physiotherapy and psychological services.

The respondent denied the claims, arguing the applicant's injuries fell within the Minor Injury Guideline.

The Licence Appeal Tribunal found the applicant was not entitled to a non-earner benefit as he failed to establish a complete inability to carry on a normal life.

However, the Tribunal determined the applicant's psychological impairments, including a diagnosis of post-traumatic stress disorder, exceeded the Minor Injury Guideline.

The Tribunal awarded funding for the disputed physiotherapy and psychological counselling services, but denied the request for a psychological assessment as duplicative.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied her attendant care benefits on the basis that she failed to prove her care provider sustained an economic loss.

The applicant argued that the Tribunal erred in its calculation of the care provider's pre-accident earnings by excluding a specific pay period that included holiday pay.

The Vice-Chair dismissed the request, finding that the Tribunal had properly excluded the pay period because it represented abnormally high earnings and distorted the average, and that the applicant was attempting to relitigate the matter without establishing any error of fact or law.

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

The respondent denied medical benefits beyond the $3,500 Minor Injury Guideline cap.

The Tribunal found that the applicant's physical and psychological injuries were predominantly minor and treatable within the Guideline.

As the funding limit was exhausted, the claims for additional medical benefits and assessments were dismissed.

Furthermore, the Tribunal ordered the applicant to repay $372.21 for an overpayment of income replacement benefits.

The applicant sought statutory accident benefits following a 2017 motor vehicle accident, disputing the respondent's denial of an ongoing income replacement benefit (IRB), a chronic pain assessment, and psychological services.

The Licence Appeal Tribunal dismissed the claim for ongoing IRB, finding the applicant failed to prove a substantial inability to perform the essential tasks of his employment, relying on a psychological reassessment indicating his driving anxiety had improved.

The Tribunal also denied the disputed psychological services due to a lack of evidence challenging the respondent's partial approval.

However, the Tribunal granted the $2,000 chronic pain assessment, finding it reasonable and necessary given the applicant's consistent pain reporting and objective evidence of meralgia paresthetica.

The applicant sought medical and rehabilitation benefits under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The respondent insurer denied treatment plans for psychological services, physiotherapy, and vision therapy based on the opinions of its assessors.

The Licence Appeal Tribunal found that the applicant met her burden of proving the treatments were reasonable and necessary, preferring the evidence of her treating practitioners over the respondent's assessors.

The Tribunal ordered the respondent to pay $16,870.79 for the disputed treatment plans plus interest, but declined to make a special award under Regulation 664.

The applicant sought medical benefits for chiropractic services and a chronic pain assessment following a motor vehicle accident.

The respondent insurer denied the claims.

The Tribunal found that the applicant sustained uncomplicated soft tissue injuries and that ongoing physical therapy beyond May 2019 was not reasonable and necessary, relying on the opinions of the respondent's medical assessors.

The Tribunal awarded the first two treatment plans for chiropractic care totaling $5,006.42 plus interest, but denied the remaining plans and the chronic pain assessment as duplicative and unnecessary.

The applicant was involved in a motor vehicle accident and initially returned to work, resulting in the respondent denying his claim for an income replacement benefit.

Nearly five years later, the applicant stopped working and submitted a new disability certificate, which the respondent denied as statute-barred under the two-year limitation period in section 56 of the Statutory Accident Benefits Schedule.

The Tribunal held that the principle of discoverability applied, as the applicant could not have discovered his claim while working.

In the alternative, the Tribunal exercised its discretion under section 7 of the Licence Appeal Tribunal Act, 1999 to extend the limitation period, finding the applicant's delay reasonable and the prejudice to the respondent minimal.

The preliminary issue was dismissed, allowing the claim to proceed to a full hearing.

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

The respondent denied medical benefits beyond the $3,500 Minor Injury Guideline limit.

The applicant argued his injuries, including chronic pain, exceeded the minor injury definition and that pre-existing conditions warranted removal from the guideline.

The Tribunal found the applicant's injuries were predominantly minor soft tissue injuries and rejected the evidence of his chiropractor regarding chronic pain.

The Tribunal also found the respondent's denial notices complied with the statutory timelines.

The application was dismissed.

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

The insurer determined the injuries fell within the Minor Injury Guideline (MIG) and denied further treatment plans.

The Tribunal found the applicant's injuries were predominantly minor and subject to the MIG.

However, the insurer failed to provide a timely denial notice for a physical therapy treatment plan under s. 38(8) of the Schedule.

As a result, the insurer was ordered to pay $168.00 for expenses incurred during the 'shall pay' period under s. 38(11).

The remaining claims for chiropractic treatment and a psychological assessment were dismissed as they were validly denied and the MIG limit was exhausted.

The applicant sought medical and rehabilitation benefits for physiotherapy and psychological treatment following a 2015 motor vehicle accident.

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

The Tribunal found that the applicant had significant pre-existing physical and psychological conditions, and the medical evidence did not establish that the proposed treatments were reasonable and necessary as a result of the accident.

The Tribunal also dismissed the applicant's claim for an award under Regulation 664, finding no evidence that the respondent's conduct was excessive or imprudent.

The application was dismissed in its entirety.

The applicant sought reconsideration of a Licence Appeal Tribunal decision which found that the respondent was not liable to pay for a $2,600 treatment plan despite issuing a late denial notice under s. 38(8) of the Statutory Accident Benefits Schedule.

The applicant argued that the Tribunal erred in law by conducting a reasonableness and necessity analysis, relying on the Divisional Court's decision in Kyrylenko.

The Vice-Chair dismissed the reconsideration request, distinguishing Kyrylenko and finding that because the late denial notice was issued on the 11th day, the mandatory 'shall pay' period under s. 38(11) ended the same day it began.

Therefore, no expenses were incurred during the penalty period, and the Tribunal correctly required the applicant to prove the treatment was reasonable and necessary under s. 15.

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

The respondent denied medical benefits beyond the $3,500 Minor Injury Guideline limit.

The applicant argued for removal from the guideline based on psychological impairment and chronic pain.

The Tribunal found the applicant's injuries were predominantly minor soft tissue injuries and their clinically associated sequelae.

The Tribunal preferred the evidence of the applicant's family physician and the respondent's psychological assessor over the applicant's expert reports, which were either based solely on self-reporting or outside the assessor's scope of practice.

The application was dismissed.

The applicant sought medical benefits for injuries sustained in a motor vehicle accident.

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

The applicant argued he suffered from chronic pain and had pre-existing conditions that justified removal from the MIG.

The Tribunal found the medical evidence established only minor, soft tissue injuries.

The Tribunal rejected the applicant's chronic pain assessment as it was conducted virtually and unsupported by objective evidence.

The applicant also failed to provide compelling evidence that his pre-existing conditions would prevent his recovery within the MIG.

The application was dismissed.