Theresa McGee

The applicant sought various statutory accident benefits following a 2007 motor vehicle accident.

The insurer denied the benefits between 2008 and 2010.

The applicant applied to the Licence Appeal Tribunal in 2019 and 2020, well beyond the two-year limitation period.

The Tribunal found that the insurer's denials were clear, unequivocal, and compliant with the legal requirements to trigger the limitation period.

The Tribunal also held that it lacked jurisdiction under section 7 of the Licence Appeal Tribunal Act to extend the limitation period for a regulation like the Schedule.

The applicant was therefore barred from proceeding with her claims.

The applicant, an uninsured pedestrian injured in a hit-and-run, sought accident benefits from the Motor Vehicle Accident Claims Fund (MVACF).

MVACF denied a $1,950 in-home occupational therapy assessment and requested an insurer's examination (IE) by an occupational therapist, who deferred on causation.

MVACF then requested a second IE, which the applicant refused to attend.

The Tribunal found the proposed assessment was reasonable and necessary to address accident-related exacerbations of pre-existing injuries.

The Tribunal held the applicant was not barred from proceeding because MVACF's request for a second IE was not reasonably necessary, as the first IE improperly asked an occupational therapist to opine on medical causation.

The Tribunal also ordered a 40% special award against MVACF under O. Reg. 664, finding its conduct in adjusting the claim and maintaining the denial was unyielding and unreasonable given the applicant's vulnerability.

The applicant was involved in a motor vehicle accident and sought non-earner benefits.

The respondent raised a preliminary issue, arguing that the applicant was barred from proceeding with her claim under section 56 of the Statutory Accident Benefits Schedule because she failed to establish eligibility within the prescribed time limit.

The Tribunal found that the respondent had never issued a clear and unequivocal denial of a specific claim for the benefit, as no claim existed at the time of the purported denials.

Therefore, the limitation period under section 56 was not triggered, and the applicant was not barred from proceeding with her application.

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

The insurer denied the treatment plans and sought to rely on Insurer's Examination reports.

The Tribunal found that the insurer failed to provide adequate 'medical and any other reasons' for the examinations as required by s. 44(5) of the Schedule, and excluded the reports as a remedy.

Applying the 'but for' test for causation, the Tribunal found that the subject accident was a necessary cause of the applicant's impairments, despite pre-existing injuries and a subsequent accident.

The Tribunal ordered the insurer to pay the disputed treatment plans with interest.

The applicant, a 69-year-old retiree, was involved in a motor vehicle accident and sought a non-earner benefit from the respondent insurer.

The respondent denied the benefit, arguing the applicant did not suffer a complete inability to carry on a normal life and had a pre-existing shoulder injury.

The Tribunal found that the applicant failed to establish that his impairment continuously prevented him from engaging in substantially all of his pre-accident activities.

Medical evidence and the applicant's own self-reporting indicated he had returned to most of his activities of daily living.

The application for a non-earner benefit was dismissed, and the respondent's request for costs was also dismissed.

The applicant was injured in a rear-end motor vehicle collision and sought medical and rehabilitation benefits beyond the $3,500 limit of the Minor Injury Guideline (MIG).

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

The Tribunal found that the applicant's physical injuries were soft tissue in nature and that his pain complaints did not meet the criteria for chronic pain syndrome under the AMA Guides.

Furthermore, the Tribunal concluded that the applicant's psychological complaints were clinically associated sequelae of his minor physical injuries.

As the applicant failed to prove his injuries were not predominantly minor, and the MIG funding limit was already exhausted, the claims for a psychological assessment, chiropractic treatment, and interest were dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for a psychological assessment, physical therapy, and psychological treatment.

The respondent insurer denied portions of the treatment plans.

The Tribunal found that the applicant failed to prove the disputed costs for the psychological assessment and treatment were reasonable and necessary, as the insurer's examiners had found the proposed costs excessive or partially unnecessary.

However, the Tribunal awarded the cost of the physical therapy based on the recommendation of the applicant's family doctor, which the insurer failed to rebut with medical evidence.