Theresa McGee

The applicant was injured in a motor vehicle accident when struck as a pedestrian and sought attendant care benefits from the respondent insurer.

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

The Tribunal found that the applicant failed to prove on a balance of probabilities that her non-professional care provider (her spouse) sustained an economic loss as a result of providing attendant care.

The evidence showed no marked difference between the care provider's pre- and post-accident hours of work and earnings.

The application for attendant care benefits, interest, and an award under Regulation 664 was dismissed.

The respondent insurer requested reconsideration of a preliminary issue decision which found that it had requested Insurer's Examinations more often than reasonably necessary, meaning the applicant was not barred from proceeding with his income replacement benefit claim under s. 55 of the Schedule.

The Tribunal denied the reconsideration request, finding that the preliminary issue decision did not finally dispose of the appeal and therefore fell outside the scope of Rule 18.1.

Furthermore, the Tribunal found no procedural unfairness or error of law, as the insurer's requests for examinations were duplicative and unreasonable, and the applicant had no duty to explain his non-attendance at improperly requested examinations.

The applicant sought medical benefits following a motor vehicle accident.

The respondent insurer denied the claims 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 that pre-existing conditions, psychological injuries, and chronic pain warranted removal from the MIG.

The Licence Appeal Tribunal found that the applicant failed to provide compelling medical evidence of a pre-existing condition that would prevent maximal recovery within the MIG.

The Tribunal also determined that the applicant's psychological symptoms and pain complaints were clinically associated sequelae of his minor soft tissue injuries.

Although the respondent failed to provide timely notice of denial for one treatment plan, barring it from relying on the MIG for that specific plan, the Tribunal found the treatment was not reasonable and necessary.

The application was dismissed.

The applicant requested reconsideration of a preliminary issue decision that barred him from proceeding with claims for a non-earner benefit, attendant care assessment, and treatment plans due to his failure to attend Insurer's Examinations.

The Tribunal dismissed the request, finding it did not comply with Rule 18 as the preliminary decision did not finally dispose of the application.

In the alternative, the Tribunal found no error of law or fact in the original decision's finding that the insurer provided sufficient medical reasons for the examinations.

The applicant sought attendant care benefits and transportation costs for a psychological assessment following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to provide any proof that the attendant care expenses were actually incurred as required by section 3(7)(e) of the Schedule.

The claim for transportation costs was also dismissed as the applicant provided no evidence that the expense was reasonable and necessary.

Claims for interest and an award for unreasonable delay were consequently dismissed.

The applicant requested reconsideration of a preliminary issue decision that dismissed her application under s. 55 of the Statutory Accident Benefits Schedule for failing to attend insurer's examinations.

She argued the Tribunal misinterpreted case law regarding the notice requirements under s. 44(5) and sought costs based on new evidence of late production.

The Tribunal dismissed the request, finding no error of fact or law in the original decision's application of the notice requirements, and concluding that the new evidence did not establish unreasonable conduct warranting a costs award.

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 to a hearing for an income replacement benefit because he failed to attend three insurer's examinations.

The Tribunal found that the requested examinations were duplicative and unreasonable, as the applicant had attended examinations with the exact same assessors just two months prior, and there was no rational connection between a suspected change in employment status and a new round of physical examinations.

The Tribunal held that the requests did not comply with s. 44 of the Schedule, and therefore the s. 55 procedural bar did not apply.

The applicant requested reconsideration of a Licence Appeal Tribunal decision that denied funding for an income replacement benefit multidisciplinary report.

The applicant argued the Tribunal erred in law by finding that procedural fairness does not apply to an insurer's administrative processes and by restrictively interpreting the Statutory Accident Benefits Schedule.

The Tribunal dismissed the request, finding no error of law, as procedural fairness is a public law doctrine inapplicable to insurers, and the Schedule clearly limits funding for such reports.

The applicant sought statutory accident benefits, including an income replacement benefit and medical/rehabilitation benefits, following a 2015 motor vehicle accident.

The Licence Appeal Tribunal found the applicant failed to prove a substantial inability to perform the essential tasks of his employment, noting he returned to work for over a year post-accident and his work stoppage coincided with the sale of his employer's business.

The Tribunal also denied the claimed medical benefits, finding the applicant's shoulder and knee issues were degenerative or unrelated to the accident, and the psychological assessment lacked evidentiary weight.

The application was dismissed in its entirety.

The applicant's daughter was catastrophically injured in a motor vehicle accident.

More than three years later, the applicant applied for accident benefits on her own behalf, claiming she was unaware of her eligibility.

The insurer raised a preliminary issue that the claim was barred under s. 55(1)1 of the Statutory Accident Benefits Schedule due to the delay.

The Tribunal found that the applicant's ignorance of the law and her other explanations did not constitute a reasonable explanation under s. 34 of the Schedule.

The delay prejudiced the insurer's ability to gather contemporaneous evidence.

The application was dismissed.

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

The insurer denied several claims and requested the applicant attend Insurer's Examinations under section 44 of the Statutory Accident Benefits Schedule.

The applicant refused to attend, arguing the requests were made in bad faith and lacked sufficient medical reasons.

The Tribunal found that the insurer's notices complied with the Schedule and provided clear, comprehensible rationales.

Because the applicant failed to attend the properly requested examinations, section 55 of the Schedule barred her from commencing a proceeding before the Tribunal.

The application was dismissed without costs.

The applicant sought $10,200.00 for a multidisciplinary report to rebut the respondent's termination of his income replacement benefit.

The applicant argued that procedural fairness and section 25 of the Statutory Accident Benefits Schedule entitled him to an insurer-funded rebuttal report.

The Tribunal held that the Schedule does not provide for the funding of rebuttal reports for income replacement benefit determinations, noting that section 25(1)5 specifically applies to catastrophic impairment applications.

The Tribunal dismissed the application, finding the respondent was not liable for the cost of the assessment.

The applicant sought payment for the costs of an accounting report obtained to calculate her income replacement benefit following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the accounting report was not reasonable and necessary because the calculation of the applicant's income was straightforward and did not require professional expertise.

The Tribunal also dismissed the applicant's request for a costs award, as there was no evidence of unreasonable, frivolous, vexatious, or bad faith conduct by the respondent.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied her entitlement to an income replacement benefit and the cost of a psychological assessment following a motor vehicle accident.

The applicant argued the Tribunal omitted consideration of her knee condition and erred in weighing the medical evidence.

The Vice-Chair found no errors of fact or law in the original decision, noting the applicant failed to prove her layoff was accident-related rather than due to corporate restructuring, and that her psychological symptoms had resolved.

The request for reconsideration was dismissed.

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

The insurer denied medical benefits beyond the $3,500 Minor Injury Guideline (MIG) limit and denied an income replacement benefit.

The Licence Appeal Tribunal found that the applicant's injuries were predominantly minor soft tissue injuries and that she failed to establish a chronic pain condition that would remove her from the MIG.

As the MIG limit was exhausted, the disputed medical benefits were denied.

The Tribunal also dismissed the claim for an income replacement benefit, finding that the applicant's inability to work was due to her pre-planned return to full-time studies and the pandemic, rather than an accident-related impairment.

The applicant sought $10,200 for a multidisciplinary report to rebut the respondent's termination of his income replacement benefit.

The applicant argued that procedural fairness and section 25 of the Schedule entitled him to funding for the report.

The Tribunal held that the Schedule does not provide for funding of rebuttal reports for income replacement benefit determinations, noting that section 25(1)5 applies specifically to catastrophic impairment applications.

The application was dismissed.

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

The insurer denied medical benefits beyond the $3,500 Minor Injury Guideline limit and denied a non-earner benefit.

The Licence Appeal Tribunal found that the applicant failed to prove her injuries extended beyond predominantly minor soft tissue injuries, rejecting her claims of chronic pain and psychological impairment due to insufficient objective medical evidence.

The Tribunal also dismissed the claim for a non-earner benefit, finding no evidence that the applicant suffered a complete inability to carry on a normal life.

All claims, including a request for an award for unreasonable delay, were dismissed.

The applicant sought a non-earner benefit following a motor vehicle accident.

The insurer raised a preliminary issue, arguing the applicant was barred from proceeding because he failed to submit an OCF-10 form electing between an income replacement benefit and a non-earner benefit.

The Tribunal found that the applicant's initial application created ambiguity regarding his entitlement, triggering the insurer's duty under s. 35 of the Schedule to require an election.

Because the applicant failed to submit the OCF-10, his application was incomplete, and the Tribunal lacked jurisdiction to adjudicate the non-earner benefit claim.

The applicant, an incarcerated veteran with severe pre-existing spinal stenosis, sought statutory accident benefits following two prisoner transfers in unpadded, unrestrained vehicles.

The respondent insurer denied the claims, arguing the events were not 'incidents' and the dominant feature of the impairment was the applicant's pre-existing condition, not the use or operation of an automobile.

The Tribunal found that the events were 'incidents' under a purposive interpretation of the Schedule, noting the applicant was shackled and unable to brace himself.

Applying the Greenhalgh test, the Tribunal concluded the use and operation of the vehicles were the dominant feature and a direct cause of the exacerbation of the applicant's pain.

The preliminary issue was resolved in the applicant's favour, allowing the substantive claims to proceed.

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

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

The applicant argued he sustained a psychological impairment and chronic pain exceeding the MIG.

The Tribunal found the applicant failed to discharge his evidentiary onus, noting a lack of objective medical evidence and giving little weight to the psychological reports which relied solely on self-reporting.

The Tribunal concluded the injuries were predominantly minor and dismissed the application.