Theresa McGee

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that dismissed her application for medical benefits on the basis that she had reached maximum medical improvement.

The applicant alleged errors of law, errors of fact, and a reasonable apprehension of bias.

The Vice-Chair dismissed the request, finding that the Tribunal applied the correct legal test, its factual findings were supported by the evidence, and there was no reasonable apprehension of bias in its determination that the insurer acted in good faith.

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

The respondent denied several treatment and assessment plans, arguing they were not reasonable and necessary.

The Tribunal found that while the applicant's pre-existing degenerative disc disease and chronic pain syndrome removed her from the Minor Injury Guideline, she had reached maximum medical improvement from her accident-related injuries.

Relying on the respondent's medical examinations, the Tribunal concluded that further facility-based treatment would not yield substantial improvement.

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

The applicant sought statutory accident benefits for psychological services, chiropractic services, and a driver anxiety assessment following a motor vehicle accident.

The insurer denied the benefits.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to establish on a balance of probabilities that the requested treatments and assessment were reasonable and necessary as a result of the accident.

The Tribunal noted the applicant's pre-existing psychological conditions and found insufficient evidence linking her current symptoms to the accident.

Claims for interest and an award under Regulation 664 were also dismissed.

The applicant requested a reconsideration of a preliminary issue decision that barred her application for statutory accident benefits because it was filed beyond the two-year limitation period.

The applicant argued the Tribunal acted outside its jurisdiction and made errors of law by not properly weighing evidence and misconstruing her arguments.

The Tribunal dismissed the request, finding that the applicant was attempting to re-litigate the issues and failed to establish any of the criteria required for granting a reconsideration under Rule 18.2.

The insurer requested a reconsideration of a preliminary issue decision which found that section 56 of the Statutory Accident Benefits Schedule did not bar the applicant's claim for a non-earner benefit.

The Tribunal dismissed the request, finding that under Rule 18 of the Common Rules of Practice and Procedure, it can only reconsider decisions that finally dispose of an appeal.

Because the preliminary issue decision was interlocutory and did not deprive the insurer of a substantive right determinative of the entire application, it was not subject to reconsideration.

The applicant's request for costs was also dismissed.

The applicant sought medical benefits for physiotherapy, an orthopedic assessment, and a psychological assessment following a motor vehicle accident.

The respondent denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the funding limit had been exhausted.

The Tribunal found that the applicant failed to prove her injuries, including headaches, chronic pain, and psychological issues, warranted removal from the MIG.

The Tribunal also found insufficient evidence that pre-existing conditions prevented her from achieving maximal recovery within the MIG limit.

The application was dismissed.

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

The insurer determined her injuries fell within the Minor Injury Guideline (MIG) and denied funding for physiotherapy and occupational therapy beyond the $3,500 limit.

The Tribunal found that the applicant had sustained a head injury, removing her from the MIG.

However, the Tribunal dismissed the claims for the disputed treatment plans, finding the applicant failed to prove they were reasonable and necessary.

The claim for an award under Regulation 664 was also dismissed, as there was insufficient evidence of unreasonable delay or bad faith by the insurer.

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

The insurer denied certain benefits and requested the applicant attend insurer's examinations to determine ongoing entitlement to income replacement benefits.

The applicant refused to attend, arguing the insurer's reasons were boilerplate and insufficient.

The Tribunal found the insurer's reasons satisfied the notice requirements under section 44 of the Schedule, as they provided a principled rationale based fairly on the applicant's file.

Consequently, the applicant was statute-barred from proceeding with her application under section 55(1)2 of the Schedule, and the application was dismissed.

The applicant sought medical and rehabilitation benefits following a motor vehicle accident.

The respondent denied the treatment plans and an expense claim form.

The Tribunal found that one of the treatment plans was statute-barred as the applicant failed to apply within the two-year limitation period under s. 56 of the Schedule.

For the remaining plans, the Tribunal held that the applicant failed to prove the treatments were reasonable and necessary as a result of the accident, noting the lack of evidence connecting the physical therapy to his psychological complaints and the impact of an intervening slip and fall injury.

The application was dismissed.

The applicant sought medical benefits for chiropractic, physiotherapy, and occupational therapy services following a motor vehicle accident.

The respondent denied the benefits, initially arguing the injuries fell within the Minor Injury Guideline (MIG), though it later removed the applicant from the MIG.

The Tribunal found that the applicant failed to establish on a balance of probabilities that the disputed treatment plans were reasonable and necessary.

The evidence showed the applicant had returned to work and regular activities shortly after the accident, and there was insufficient current medical evidence to support the need for the proposed passive therapies and assessments months or years post-accident.

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 and denied treatment plans exceeding the monetary limit.

The insurer requested an Insurer's Examination to determine if the injuries were predominantly minor, which the applicant refused to attend.

The Tribunal found that the insurer's notice met the requirements of section 44(5) of the Schedule and that the applicant failed to provide a valid reason for non-attendance.

Consequently, the applicant was statute-barred from proceeding under section 55(1), and the application was dismissed.

The applicant was injured in a rear-end motor vehicle accident and sought statutory accident benefits.

The respondent insurer determined the injuries were predominantly minor and subject to the $3,500 limit under the Minor Injury Guideline (MIG).

The applicant argued for removal from the MIG based on a pre-existing right shoulder injury and a chronic pain disorder with psychological impacts.

The Tribunal found the applicant failed to provide compelling medical evidence that her pre-existing condition prevented her from achieving maximal recovery, or that she suffered from chronic pain or psychological issues beyond the sequelae of her minor soft tissue injuries.

The Tribunal also found the insurer provided adequate reasons for denying the treatment plans.

The application was dismissed.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits, including non-earner benefits (NEBs) and medical benefits for physiotherapy and a chronic pain assessment.

The respondent insurer denied the benefits.

The Licence Appeal Tribunal found that the applicant suffered a complete inability to carry on a normal life due to severe psychological impairment resulting from the accident, which continuously prevented her from engaging in her pre-accident activities of caring for her children and pursuing her vocational goals.

The Tribunal awarded NEBs of $185.00 per week and interest.

However, the Tribunal dismissed the claims for physiotherapy and a chronic pain assessment, finding insufficient evidence that they were reasonable and necessary, as the applicant's impairment was fundamentally psychological rather than physical.

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

The respondent insurer determined her injuries fell within the Minor Injury Guideline (MIG) and denied further benefits.

The applicant applied to the Licence Appeal Tribunal, arguing she suffered from chronic pain and neurological issues warranting removal from the MIG.

The Tribunal found the applicant failed to establish her injuries were more than minor soft tissue injuries.

As the applicant had exhausted the $3,500 funding limit under the MIG, the claims for further medical benefits and examination costs were dismissed.

The Tribunal also dismissed the claim for an award under Ontario Regulation 664, finding no evidence the insurer unreasonably withheld or delayed payments.

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

The respondent insurer paid benefits up to the $3,500 limit under the Minor Injury Guideline (MIG) and denied further claims.

The applicant applied to the Licence Appeal Tribunal, arguing her pre-existing conditions, chronic pain, and psychological issues warranted removal from the MIG.

The Tribunal found that the applicant sustained predominantly minor, soft tissue injuries and that her pain and psychological complaints were merely clinically associated sequelae.

The Tribunal dismissed the application, concluding the applicant was not entitled to benefits beyond the MIG limit.

The applicant sought statutory accident benefits after slipping and falling on ice while disembarking from his vehicle.

The respondent insurer denied the claim, arguing the incident did not meet the definition of an 'accident' under the Schedule because the applicant had already exited the vehicle.

The Tribunal found that the applicant was still holding the interior door handle when he fell, meaning he was in the process of disembarking, which is an ordinary use of a vehicle.

The Tribunal further held that slipping on ice while exiting a vehicle is a reasonably foreseeable risk and not an intervening act that breaks the chain of causation.

The incident was deemed an accident.

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

The insurer requested the applicant elect between an income replacement benefit and a non-earner benefit.

The applicant filed an application with the Licence Appeal Tribunal before making an election or receiving a denial from the insurer.

The Tribunal held it lacked jurisdiction to adjudicate the claim because, under section 280 of the Insurance Act, there can be no dispute until a claim is denied by the insurer.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the insurer's determination that her injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant sustained predominantly minor soft tissue injuries and rejected her claims of chronic pain and psychological impairments, preferring the insurer's psychiatric assessment over the applicant's expert reports.

However, the Tribunal ordered the insurer to pay $1,090.00 for one physiotherapy treatment plan because the insurer failed to provide notice of its refusal within the 10-day period required by section 38(8) of the Schedule.

The remaining claims for medical benefits and assessments were denied as the $3,500 MIG limit had been reached.

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

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

The Licence Appeal Tribunal found that the applicant suffered accident-related psychological impairments and chronic pain that warranted removal from the MIG.

The Tribunal ordered the respondent to pay for the disputed physiotherapy, psychological treatment, and chronic pain assessment, finding them reasonable and necessary, along with interest on the overdue amounts.

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule.

The respondent insurer denied the benefits.

The Licence Appeal Tribunal found that while the applicant's pre-existing chronic pain and degenerative disc disease removed her from the Minor Injury Guideline, she had reached maximum medical improvement from her accident-related injuries.

Relying on the respondent's medical assessments, the Tribunal concluded that further facility-based treatment was not reasonable and necessary.

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